Permit CITY TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2003 -00516
, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
SITE ADDRESS: 10420 SW VIEW TERR PARCEL: 2S111BC -03700
SUBDIVISION: DOUGLAS HEIGHTS ZONING: R -3.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: ALT 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: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Hook up ice maker, and relocate 2 sinks.
FEES
Owner:
Description Date Amount
FAIRLEY, RONALD S + KAREN S
10420 SW VIEW TERRACE [PLUMB] Permit Fee 9/30/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Tax 9/30/03 $5.80
Total $78.30
Phone : 503 639 - 6344
Contractor:
MARSH PLUMBING & MECHANICAL
14790 MISTY DRIVE
CLOVERDALE, OR 97112 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 41390
SUP 3630JP
PLM 29 -55PB
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: (,,,, � ��{��t�G Permittee Signature: j: c vi. '&11
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Euiltling Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
Received Plumbing ( 7 e t2 /
City �e Date/By ' ,, 03 � Permit No
`-r g RE CEIVED Planning Appr• al Sewer
CI of Ti and Date/By. Permit No :
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 () 7103 Post-Review Review Permit ��g -C(-I/3
503- 639 -4171 Fax: 59 1 6 o- Date/By: Case No
Internet: www.ci.tigard.or.us 1 4 �(�1 •
�� F AR * ^^ - Contact Juris.. 0 See Page 2 for
24 -hour Inspection Request: g '(! ,f - D I NG DIVISION Name/Method ric Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description i Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: . New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft for each utility connection)
III 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (I) bath 249.20
SFR (2) bath 350.00
EAccessory 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: /0 143 Uec`00 - e_,. Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line /trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: r love l4 L() .1e, Manufactured home utilities 110 00
/ b3 4v VC∎ u.) r JC -v-- . Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Pa•e 2
DESCRIPTION OF WORK Fixture or Item
j ' R 1 " _ n Absorption valve 16.60
[ t (Grit}Q Backflow preventer Page 2
A ntg∎te_ COl,-% 5: %OA -x ? Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER 1 0 TENANT Dunking fountain 16.60
Ejectors/sump 16.60
Name: � _ipil, f , ,-A R{' 6tr Expansion tank 16.60
Address: /6420 ) 0 \PCiv3A-�- 2IL -e.- Fixture /sewer cap 16.60
City /State /Zip: ce „ (-- 172z1-■ Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: „Q)3 z(li Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker I 16.60
Name: `1?,vc \k C��\ Interceptor /grease trap 16.60
Address: / D,�6" t4 . ?c Medical gas - value: $ Page 2
City /State /Zip: k.c11Sto6C7, 4 7 orb Primer 16.60
�� Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory .2_ 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Unnal 16.60
Business Name: 56 � e May P(�u41,1%4 Water heater 16 60
� , Water heater r 16.60
Address: 4 O ` saf 1 ' Nt/e.- Other:
City /State /Zip: . \ t , ‘ ), e .c e t oc a. e a /3C', q-) 11-z_ Other
Phone: Fax: Plumbing Permit Fees*
Subtotal $
CCB Lic. #: /41310p4 Plumb. Lic.#: Minimum Permit Fee $72.50 $
Authorizes - Residential Backflow Minimum Fee $36.25 77.- cU
Signature ,,c.1 , , _ , D ate. 03 Plan Review (25% of Permit Fee) $
-I. X11 WA ati 7.� State Surcharge (8% of Permit Fee) $ 5 „0
(Please pnnt na e) TOTAL PERMIT FEE $ 7 2)d
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
q lL57,•tlo
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 - 1' 100' 55 00 0 to 2,000 $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
additional $100 00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total 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
and including $50,000.00
specially requested inspections - per hour 72.50 $50,001 00 and up $742 00 for the first $50,000 00 and $ 1 20 for
Subtotal: 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
Drinking 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 uner p
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 DWISIO'N Business Line: (503) 639 -4171
BUP
Received 1 2-/l 41.1 ate Requested / Z c l l o AM PM BUP
Location / 0 � 7J 1` 2 L L) Suite MEC
Contact � a� ` 79.3 -b Z3i • -()d .5
on act Person G� P h ( ) � _
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof •
Other: .-7/1"
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab .
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O
Fi •.=
O S PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
=
ea pers
S PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for rein pection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA l
Approach/Sidewalk Date ` 1 `� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL