Permit Y" 1T' OF TIGARD PLUMBING PERMIT
4 DEVELOPMENT SERVICES PERMIT #: P -00369
Ai' 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 8/17/20017/200 4
SITE ADDRESS: 11790 SW WILDWOOD ST PARCEL: 2S1106D -00500
SUBDIVISION: SHADOW HILLS ZONING: R -2
BLOCK: LOT: 003 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: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacing fixtures: 1 lay, 1 tub /shower, 1 water closet.
FEES
Owner:
Description Date Amount
. STEVENS, MERLE
11790 SW WILDWOOD ST [PLUMB] Permit Fee 8/17/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 8/17/2004 $5.80
Total $78.30
Phone : 503 624 - 7946
Contractor:
EAGLE PLUMBING
13801 S FORSYTHE RD
OREGON CITY, OR 97008 REQUIRED INSPECTIONS
Phone : 503 - 650 - 8703 Rough -in Insp
Final Inspection
Reg #: LIC 47914
PLM 3 -154PB
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.
Issued By: Permittee SignatureA
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures c
Plumt in g Perinit'Ap I�CD FOR OFFICE USE ONLY
Q
City of Tigard Received �0 8 Permit No d 0 �0
2004
13125 SW Hall Blvd., Tigard, OR 97223 AUG 17 Plan n Review
��� ^ ^ ^ ^������,
Phone: 503.639.4171 Fax: 503.598.1960 � //( -r ;� Date/By Date/By. Other Permit No
24- Hour Inspection Line: 503.639.417 'CITY OF TIGARD ' ° � � I Date Ready/By. i °'u H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: r/ 1 Supplemental Information
BUII DING DI VISION
- - F , " , TYPE OF _WORK "-.,;, 7,q, :, • ,.FEE *: . SCHEDULE -"-
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. Ea I Total
Z Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY_ OF' CONSTRUCTION_ ' ;' `''_' . .':'Z'"- - ':'': - '; 1 SFR(1)bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/latchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq ft.) Page 2
-_ `.' JOB SITE INFORMATION AND LOCATION, ` _ •- Site utilities
Job site address: ` 1 ,... ) I t_0„). /s V , Catch basin or area drain 16.60
City/State/ZIP: 'IN ci 1 •• ( Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
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.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION :OF WORK `-
Backflow preventer Page 2
Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
® PROPERTT" OWNLR' -. ': ANT , Drinking fountain 16.60
. ' ` Ejectors /sump 16.60
Name: ( P .L� S
d Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain floor sink/hub 16.60
Phone:.(5 3) (42.k( 7�'('1 Fax: ( ) Garbage disposal 16.60
❑ APFLICANT ,❑ CONTACT PERSON Hose bib 16 60
Ice maker 16 60
Business name: Interceptor /grease trap 16 60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16 60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: Fax:: Sink/basin/lavatory ( 16.60 I (o 1.10 ( ) ( ) Tub /shower /shower pan 9 16.60 16 4 ' ,
E -mail:
Urinal 16 60
. - ■ ' CONT . -- ` +2; y �. ; 1 O
- _x )Jr = Water closet i 16.60 I
.
Business name: eptc,LC ipLOIN∎diAJ S Water heater 16 60
Address: 1,3 ro i C f,S I Other.
J Subtotal
City/State/ZIP: T CI ( 620 °17
Minimum permit fee: $72.50 4 $O
Phone: ( 503) ( ., 7.5 Fax: (n3) �� -F _ Residential backflow minimum permit fee. $36.25 19
CCB Lic.: / 7 C I .� j Plumbing Lic. no.: >„ 5L) Plan review (25% of permit fee)
Authorized signature: ll t7 State surcharge (8% of permit fee) 3 7 9
� TOTAL PERMIT FEE j 3 ?—�
Print name: flu_ c e th5,5 Date: 3)) 7 l v This permit application expires if a permit is not obtained within
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Buildin Industry Se er ce
Service Board.
m
•
1 \ Building �Peuts 'PLMF- PerrnitApp dot 12/03 440- 4616T(10/02/COMIWEB) 7 lJ 3D
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
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 ro
Fixture Type: Replace
New ' Moved - E xisting - 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
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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
- Bradley Quantity Total
Commercial a► Isometric or riser diagram is required if fixture quantity
- Service total is >9.
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:
t \BmidingWermitsWLM- PermnApp doc 3/03