Permit C ITY OF TIGARD PLUMBING PERMIT
Avitvel DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2003 -00211
t � J II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/21/03
SITE ADDRESS: 16240 SW WOODCREST AVE PARCEL: 2S1146A -07700
SUBDIVISION: COPPER CREEK STAGE 2 ZONING: R -4.5
BLOCK: LOT: 017 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 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: 8 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocate water and waste lines for clothes washer.
FEES
Owner:
Description Date Amount
JANINE WALDO
16240 SW WOODCREST AVE [PLUMB] Permit Fee 5/21/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 5/21/03 $5.80
Total $78.30
Phone : 503 984 - 5564
Contractor:
RONALD HUDSON PLUMBING, INC.
942 SW 15TH
TROUTDALE, OR 97060 REQUIRED INSPECTIONS
Phone : 503 998 - 5871 Rough -in Insp
Final Inspection
Reg #: LIC 103571
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: ,C)0 2,t. cat, Permittee Signatur £
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
liu!iujnz r fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
Received Plumbing
DateBy:6 ' T,�j Permit No.: ruroo03 fVa l /
CI of Ti and Planning Approval Sewer
`J g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 /a �o�(� i Date/By: Case No.:
\ Post - Review Land Use
Internet: www.ci.tigard.or.us x �, ei I Contact Juris: ® See Page 2 for
^
24 -hour Inspection Request: 503 -639 -4175 Name/Method: T I 1 Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description • I Qty. I Fee(ea.) ) Total
® Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings
- CATEGORY OF C CONSTRUCTION (Includes 100 ft for each utility connection)
1 & 2-Family dwelling Commercial/Industrial SFR (1) bath 249.20
Q y g ❑ C l/Id 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: /4/ 90 S v ,re vdc resT A cee-- 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/Directions to job site: Manufactured home utilities 110.00
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
Absorption valve 16.60
M o u e 001/6 4 ...al L L i4 ro 7- -, Backflow preventer Page 2
r eat x, Ay& fAr„ 4 // Backwater valve 16.60
U !n.L /arm fd.- Clothes washer / 16.60
Dishwasher
,-/-(---;1-e_. ,-/-(---;1-e_. ? d ti S< 2 e l Dri � inking g 16.60
fountain 16.60
❑ PROPERTY OWNER ❑ TENAN Ejectors/sump 16.60
Name: Sor.A „ At LA A. /dO Expansion tank 16.60
Address % yo 5,,,.:' e.✓®oda repT r¢ v.e.. Fixture/sewer cap 16.60
City/State/Zip: ,�/pd ®/1 q17, a y Floor drain/floor sink/hub 16.60
9 Garbage disposal 16.60
Phone pz)g 8 4- Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City /State /Zip:
Primer 16.60
Roof Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Water closet 16.60
Business Name: Dona I! 0.,eldon Pi ,A, Al Zit. Water heater 16.60
Address: q y 2 j 0 a* rod' Other:
Other:
City /State /Zip: 7;. ei 1 -d4 to IA Tao 0 Other:
Phone @o) (39 ®- fl 7 / Fax ) N9-947/ Plumbing Permit Fees*
CCB Lic. #: / Plumb. Lic. #: 3 -3 oq pj5 S$7 $
Minimum Permit Fee $72.50 2.50 $
Authorized / a -I`f '2 -0`1 R Backflow Minimum Fee $36.25 .5i)
Signature: / - � r � Date: �= 2, -� Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ 5. to
(Please print name) TOTAL PERMIT FEE $ 7 g 30
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 - 1 100' 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 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
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
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\PlmPernitAppPg2.doc 01/03
11/16/2004
Case Activity Listing 2:30:31PM
TIDEMARK Case #: PLM2003 -00211
COMPUTER SYSTEMS, INC.
r date
it
✓° i �4' '�,+. r'?� -" +,� , °� „� ,� 4w, � �ra. `` ' � t�p O " _ Y r - . C
CtIVI " I eSC17 t10I1 *- s ' ., lateq .t `<,�+ ,^�'w /a •r � "'�c�sw`.:,�"v f l ate" °',: ;-:IYOI. ^? iStY s :.� O �., , �^� ,<�'�*�: 0 . 4 1
PLMA003 Application received 5/21/2003 None DONE BB 5/21/2003
BLD
PLMA005 Create Permit 5/21/2003 None DONE BB 5/21/2003
BLD
PLMA715 Rough -in Insp 5/29/2003 None PASS MRS 5/29/2003
MRS
PLMA799 Final Inspection 7/15/2003 None PASS RB 7/15/2003
RB
PLMA050 (F) Issue permit 5/21/2003 None DONE BB 5/21/2003
BLD
PLMA800 Case Finaled 7/15/2003 None DONE RB 7/15/2003
RB
Page 1 of 1 CaseActivity..rpt
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5'
{ 1*- 75 MST =
INSPECT:OW DIVISION . Business Line: (5 • , ! -4171
Y BUP
Received Date Requested r )--
0 D � �� PM BUP
Location / 6 �- 5 vl J 470 � S Suit e , / / MEC
Contact Person Ph ( ) 6 cf - k(v PLT 1 62
��yy
Contractor ( - 4 ' `k Ph ( ) SWR - QOo / /
BUILDING Tenant/Owner ia--e'7 C.'L.P l/l, GfLO ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: / � 0 / f. SIT
Post & Beam ` � w
Shear Anchors - -- 6-"L.0 1 k K d h ---‹
Ext Sheath/Shear
Int Sheath/Shear ir, � I ' • e VC-6---- - _ Q1 J - s'5 �-'
Framing � 1.�� �1 \
Insulation - ' c._h 9—r/ C�✓%-
Drywall Nailing
Firewall Fire Sprinkler . i/ • (! • 57 - - I Al / SS 4
Fire Alarm I vY C s CJ- l_.- c .
Susp'd Ceiling
Roof
Other: • � / Y /, , /
Final / / ( / Q 3 / SR) c r C/Y7 p (N d L-e_
PUMBI RT FAIL 1 � _ n c'Sae ( - k 9 _ 4 2 3
Post Beam `' ` /)
Under Slab
Rough -In I Z ro lie- a iISI -S s G. Water Sery 1,= g /-��
Sanitary Sewer "y (sue 3 1 E �/ / _ 547 3 I.
Rain Drains / 7" C�
Catch Basin / Manhole
Storm Drain / f
Shower Pan 7/ / &f/ 6 3 U 9 '/ q LI 6.11 &l y �.
Other: 111 "�
TII k -$s .e (�7).6 - 6 6E2 .
PART FAIL NICAL
Post & Beam �r i � — L'7L�
Rough -In - I
Gas Line //�� -�
Smoke Dampers 0 S . 3 U -7// c(�1 / v� s'
Final
PASS PART FAIL
ELECTRICAL / o
Service �`' ° �
Rough -In ;'� r
UG/Slab f '
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7/K/
�� I nspector 14 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL