Permit CITY T I GA R D PLUMBING PERMIT
I�
DEVELOPMENT SERVICES PERMIT
#: P /03 00275
, - II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/18/03
SITE ADCRESS: 10265 SW VIEW TERR PARCEL: 2S1116C -01700
SUBDIVISION: GREENBRIER ZONING: R -3.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: WATER LINE: 20 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Remove and replace 1 shower and valve, install new valve on tub, and repipe approx. 20 LF of existing galv.
FEES
Owner:
Description Date Amount
STACK, RICHARD W JUDITH C [PLUMB] Permit Fee 6/18/03 $72.50
TIGARD, OR 97224 5 SW VIEW TERR [TAX] 8% State Tax 6/18/03 $5.80
Total $78.30
Phone :
Contractor:
3 MOUNTAINS PLUMBING
PO BOX 386
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone : 503 - 925 - 1342 Water Line Insp
Rough -in Insp
Reg #: LIC 141187 Final Inspection
PLM 34 -368PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
//
Issued By: ��� Permittee Signature: / ' /
l /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Bunning : H fixtures
F�lu lermit Aation FOR OFFICE USE ONLY
Received // Plumbing
\ Date . /� O3 0 Permit No �( //j ?�U $ -00,1 7�
Planning Approval Sewer
City of Tigard �� 61 Date/By: Permit No.:
13125 SW Hall Blvd. d c /: Plan Review Other
Tigard, Oregon 97223 \ \dl: �i DatelBy: Permit No.:
Phone: 503- 639 -4171 Fax: 504.-,M � \ ` Post-Review Land Use
� � 0 \J Dant a:Nl� ; I Date/By: Case No.:
Internet: www.ci.tigard.or.us Ca �',� �noc, - a e!i i I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 5 503 , 1639 -4175 Name/Method: _ Tl 6 Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description • • 1 Qty. I Fee(ea.) I Total
EI Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 Ct for each utility connection)
dwelling Commercial/Industrial SFR (1) bath 249.20
1 & 2-Family g ❑ SFR (2) bath 350.00
Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: / 626,C . UP,,,,J -1'c,,,`a.._.- Site Utilities
Suite #: I Bld /Apt. #: Catch basin/area drain 16.60
Project Name: IMAs � e...... n � (t�, , � Footing l/leach line/trench drain 16.60
� Footin drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
veiuote.A.A._ _ k \.O 3 tee Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK Fixture or Item
r / Absorption valve 16.60
i 12, rd� fe /Z etf //�-e_ ( si.dt e^-- F U� Backflow preventer Page 2
//v5.- 0/i/ 74 / Backwater valve 16.60
/Zip - a//)e- 7 D G� D l / /5, p. Clothes washer
9 /" Dishwasher 16.60
16.60
Drinking fountain 16.60
illa PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: , ,i,,„ 54L "I _ Expansion tank 16.60
Address: \ 0 Z ep S ... _) U. e e....J ' - c, ".�.2., Fixture /sewer cap 16.60
City /State /Zip: -- % 7 2 Z Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone Fax: Hose bib 16.60
f] APPLICANT ❑ CONTACT PERSON Ice maker • 16.60
Name: 0-s 1 0 C C C 0s 4-.m J C- • -.-,_ Interceptor /grease trap 16.60
Address: \ \v 04 s c--o 3'71"' Aell e-- Medical gas - value: $ Page 2
City /State /Zip: -P p 1C /72-r9 Roof 16.60
Roof drain (commercial) 16.60
Phone: (- 03)z4s - I Fax: .- 16.60
E -mail: Oc,SS (Tub /shower ewerpan p Z 16.60
CONTRACTOR � t ri naF 16.60
S Pk 6� „� Water closet 16.60
Business Name:
3 �O°"" "" Water heater 16.60
Address: Other:
City /State /Zip: Other: /2T , h e rn - - c✓cec-
Phone: Fax: Plumbing Permit Fees*
CCB Lic. #: P umb ic. #: Pe Subtotal $
�� - Minimum Permit Fee $72.50 $
Authorized / / Residential Backflow Minimum Fee $36.25 70) , <G
Signature: / - Date: (-C -/ �'d 3 Plan Review (25% of Permit Fee) $
M/ GG? J / l C. / {c5 /i State Surcharge (8% of Permit Fee) $ 5. WO
(Please print name) TOTAL PERMIT FEE $ '7 , 3)
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms \PlmPermitApp.doc 01 /03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l" 100' 55.00 0 to 7,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000 00 $148.50 for the first $10,000.00 and $1 54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001 00 to $50,000.00 $379.50 for the first $25,000.00 and $1 45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00
Subtotal: $50,001 00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
• -Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Dnnking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
. Received '/' 1 14 Date Requested, V AM PM BUP
Location /CS* S �5 1/I - / PW /AA A Suite MEC
Contact Person / 1 h Ph ( - g/ &9' 4l5 7 PLM - 0 6 3' 7 S
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Ins ectip Notes: SIT
Post & Beam l4'( '"' L� ! v 7 S �d 3
Sr Anchors
��
Ext Sheath/Shear ear 9 Arnfrt/ i l"'of , ( 1
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ..frj"
Roof
Other: •
Final
PASS PART FAIL
IN
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan •
Other:
•
PART FAIL
Y ECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL •
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Air
Approach/Sidewalk Dat �� v Inspecto i � ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL