Permit CITY OF TIGARD PLUMBING PERMIT
° 'r � I�` DEVELOPMENT SERVICES PLUMBING
PLM2003 -00306
F!�+L : °'� �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/27/03
SITE ADDRESS: 12820 SW WALNUT ST PARCEL: 2S104AD -03501
• SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 280 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft •
Remarks: Install sewer and 280 ft of line
FEES
Owner:
Description Date Amount
CHRISTOPHER JAM
12820 SW WALNUT ST [PLUMB] Permit Fee 6/27/03 $135.98
TIGARD, OR 97223 [TAX] 8% State Tax 6/27/03 $11.82
Total $147.80
Phone :
Contractor:
P
! 3
-m om 24, p- 0 It '11 a`31 REQUIRED INSPECTIONS
Phone : Sewer Inspection
Reg #: LIC 148204
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 Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
, i
Issued By: Permittee Signature: • ,i
Call ( 3) 639 -4175 by 7:00 P.M. for an inspection needed the next busin — s day
Budding r fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
�U Received Plumbing
P l( 3 w�a 06 .69
Date/By: � a d Permit Nos
Cl of Ti and Planning Approval Sewer
ty g Date/By: Permit No.0 20 63 -0030(0
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 //y M '� l' Post-Review Land Use
O t �' Date/By: Case No.:
Internet: www.ci.tigard.or.us ` --. y er l Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 " Name/Method: 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)
1 & 2-Family dwelling SFR (1) bath 249.20
❑ y g ❑ Commercial/Industrial 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 INFORMA ION and LOCATION Fire spnnkler - sq. ft.: Page 2
Job site address:J Sid, 14J4)1 4- $- Li Site Utilities
Suite #: I 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/D job site: / / Manufactured home utilities 110.00
x / h 0_6) s t W a `vl ` lot 16.60
0 g)
p Y 5/ S i wail/tut
a (/l 5 Rain drain connector 16.60
Sanitary sewer (no. linear ft.) o Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WO Fixture or Item
, ,t l ( Absorption valve 16.60
Mew / „SOWI • St° i.o Pig !h5 / CIr i d� 7O Backflow preventer Page 2
(it, &. e r- Mar n , A'- p X 74 L , / Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I 0 TENANT Ejectors/sump 16.60
Name: (./l 9/4-n___I Expansion tank 16.60
Address: / / 56 560 /- --iz2JV Fixture /sewer cap 16.60
City /State /Zi p: 8 q? g Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: S 0 96, 7 I Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONT TO Urinal 16.60
S C X
Business Name: i I ' Replacement- closet 16.60
r �e 1 hP f7 GCPrYI t? Water heater 16.60
Address: /355 . /H /I/a �i Other:
City /State /Zip: ` or'f" .e O,! 9 / ! Other:
Phonei523 /5/5- ,578 Fax,SD,7fo?3'"77JCV Plumbing Permit Fees*
CCB Lic. #: ////, . / Plumb. Lic. #: S$bto $
Authorized Minimum Permit Fee $72.55 al 0 $
� � � R es id ent i al Backflow Minimum Fee $36.25
i ature: V ,. =�� Date:6Q a 7-47 Plan Review (25% of Permit Fee) $
1 1Li rfi I Wl il
State Surcharge (8% of Permit Fee) $
' • lease print name) TOTAL PERMIT FEE $
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.
r:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 3 3 $
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a . 80
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 2300 $1 15.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' /00 ' 55.00 SS Q 7,201 and greater $309.00
Sewer - each additional 100' / ') 46.40 ya, gL
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 (ca) 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: / � / � �D $50,001.00 and up $742 00 for the first $50,000.00 and $1.20 for
7 each additional $100.00 or fraction thereof.
II.g
/ 3s' (
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
-Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
-4 „
Car Wash Dram *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refng. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 •
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1 1 I AM PM BUP
Location I - 8 oZ O At Suite MEC
Contact Person /<u/1 Ph ( ) S1$' PLM - d p 30
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC .-
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 4--Q-12 .!/
Shear Anchors •
• Ext Sheath/Shear ft 1/ 112. 4 Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Sus 'd Ceiling
g i /_ / FA '�/
Other:
Final
PASS PART FAIL /
PLUMBING / / /,
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: •
S PART FAIL
HANICAL
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
Approach/Sidewalk Date f , Inspector Z Ext
Other:
Final DO OT REMOVE Inspection record from the Job site.
PASS PART FAIL