Permit .
CITY TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00071
..,j I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/17/04
SITE ADDRESS: 12700 SW WATKINS AVE PARCEL: 2S102BC -01701
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 027 JURISDICTION: TIG
CLASS OF WORK: REP 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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 65 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 65' water service.
FEES
Owner:
Description Date Amount
HEIDGERKEN
12700 SW WATKINS [PLUMB] Permit Fee 2/17/04 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 2/17/04 $5.80
Total $78.30
Phone :
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone : 503 624 4880 Water Line Insp
Final Inspection
Reg #: LIC 81837
PLM 26 -445PB
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
I sued By: 4 j �1 / Permittee Signature:
— Call (503) 639 75 by 7:00 P.M. for an inspection neede the next business day
' Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By. d _ / Permit No. 140 6,007
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 il , Other Permit No
24- Hour Inspection Line: 503.639.4175 6` j Date/By. Date Ready /By �IOf ®See Page 2 for
Internet. www.ci.tigard.or.us Notified/Method (/6 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description [ Qty. I Ea. I Total
,EKAddition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 249.20
1- and 2- family dwelling ❑ Commercial /industnal SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire spnnkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 2,7 0 0 5 ( �6c-- 1 0 -S Catch basin or area drain 16 60
City/State/ZIP: 5 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
J
Suite/bldg. /apt.no.: I Project name: --la1 av _ ke(/‘
_
I Manufactured home utilities 110.00
Cross street/directions to job site: n FE (A) 'I,\ v
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.. 65 ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 1 6.60
DESCRIPTION OF WORK Backflow preventer Page 2
(o , ,� � (Na- S�y Y Backwater valve 16.60
`�� Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/ State/ZIP: Floor drain /floor sink/hub 16 60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
•APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: -ru V\e - y e U IM l7 I v∎s ) 1� c_ Interceptor /grease trap 16.60
Contact name: Gun v y , �>� �J Medical gas (value. $ ) Page 2
Address: (� , Q 6� Z 3�1$ S Primer 16.60
City/ State/ZIP: T D 2 1? Zg ( - 3S S Roof drain (commercial) 16.60
Phone: (5 o 3) &z 4 8 'O Fax: : ( d3) ( - 2..-( - 7 3 Sink /basin/ lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
C NTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other
City/ State/ZIP: Subtotal
Minimum permit fee. $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25p i
CCB Lic.: O / g. , 7 Plumbing Lic. no.: 24, -(.7 l_s— t, G Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6 V)
Authorized signature: TOTAL PERMIT FEE 7 'n
�
Print name: /y�� Date: This permit application expires if a permit is not obtained within
- ' ✓U �� — / 180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
i\ Building \Petmits'PLMF- PermitAppdoe 12/03 440- 4616T(10 /02/COM/WEB)
r ,
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' 8" 46.40 67 `t0
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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or 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
Replace
Fixture Type: New Moved Existing Capped Comments regarding fixture work:
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
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service -
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i \Buildmg\Pemuts\PLM -Pc nutApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - - 41 MST
Received' / al e Date Reques ed ‘ C r‘ / PM BUP
Location 7 Suite MEC
Contact Person %-12/4 darraCr s-�Ph (5 ) 3 50 - �O 00 7 4` �XO 7/
Contractor U Ph ( ) SWR
BUILDING Tena i Owne' ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: C � ! S� SIT
Post & Beam
Shear Anchors / / / - ld 4441
Ext Sheath/Shear f
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Othe
Final
FAIL
PLUMBIN /
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
S F•
PART FAIL
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
Approach/Sidewalk Da te J/d Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL