Permit ^ R CITY OF TIGARD PLUMBING PERMIT
rr l'� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00384
;.� �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/24/2004
SITE ADDRESS: 13241 SW WOODSHIRE LN PARCEL: 2S104DC -08500
SUBDIVISION: MORNINGSTAR ZONING: R -4.5
BLOCK: LOT: 022 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
WHEELER, JOHN R + TRACT [PLUMB] Permit Fee 8/24/2004 $36.25
13241 TIGARD, OR R 9 97223 SW IRE DR [TAX] 8% State Surcharl 8/24/2004 $2.90
GA7223
Total $39.15
Phone :
Contractor:
ALL NATURAL LANDSCAPE LLC
PO BOX 2815
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone : 503 RP /Backflow Preventer
Final Inspection
Reg #: PLM 7883
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 -001 -. 10. You may obtain copies of these rules or direct questions to OUNC by «I Ming (503)
246 :699.
Issu d By: i)\ ,� � /,/ � �! i Permittee Signature: 1 / ,,L
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures ,
Plumbing Permit Application FOR OFFICE USE ONLY
Received (� 1441.4 9 K, /r
City Of Tigard Date/By.
� Permit No. Cl g
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review l r
Phone: 503.639.4171 Fax: 503.598.1960 // + Date/By: Other Permit No
_14 2 Hour Inspection Line. 503.639.4175 e l I I Ju r
Internet. www.ci.tigard.or.us W Notified/Method See Page 2
!�p- Supplemental Information
, s TYPE , OR WORK ,'...'-,';-°.-- : , .--.1..... e A,`z. i • . < =` .-EEE *= SCHEDULES_ '
❑ New construction ❑ Demolition For special information use checklist
Description I Qty" I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft for each utility connection)
-,- ;' CATEGORY. OF CONSTRUCTION' , . ;; .... = - ., = - ' '- `- f , --: 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/kitchen 45 00
❑ Master builder ❑ Other:
Fire spnnkler ( sq ft.) Page 2
;JOB :SITE `INFORMATION :AND; 'OCATION
_. . _ _ .. ., "" :, _ . - Site utilities
Job site address: ---;2� 73W • a j `,rQ n � �; Catch basin or area drain 16 60
• A... A... �
City / State/ZIP: p �� Drywell, leach line, or trench drain 16 60
Footing drain (no linear ft • ) Page 2
Suite/bldg. /apt. no.: I Project name: (O H f L Lsc
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.:
s f , '':"
Absorption valve 16 60
' , , ,- - DESGItIPTION - OF ,W ` ; `l i ' : ' : = ::` '# 6 . / Z
: ' - . - -. Backflow preventer / Page 2 C
�`v k \ -' de___AavJ �� Backwater valve 16 60
Clothes washer 16.60
Dishwasher 16 60
�
� , �� - ❑ TENANT - -K- r > —, - Drinking fountain 16 60
OWNER ' _
Electors /surrtp 16 60
Name: A • .4- j .. 1 A ' ' Expansion tank 16.60
Address: ∎1 �� O "1 Fixture/sewer cap 16.60 •
City/State/Z� I t � ' -Z Floor drain/floor sink/hub 16 60
Phone: (S3) mo • 5 b Z Fax: ( ) Garbage disposal 16.60
-,• Hose bib 16.60
:'1<: Sti. APPL= ICANT� . ` '' ■" CONTACT; ,PERSON - _
Ice maker 16 60
Business name:
Interceptor /grease trap 16 60
Contact name: Medical gas (value. $ ) Page 2
Address: Pnmer 16.60
City/State/ZIP: Roof drain (commercial) 16 60
Phone: ( ) I F es:: ( ) Sink/basin/lavatory 16 60
Tub /shower /shower pan 16.60
E -mail:
Unnal 16 60
,r-:4. C • . 1: -' . +-? , CONTRACTOR . : y: . - ,_r' :• '
+d �"i :i.. „ - " d
"`` , ' 16 60
s �___:�: ;r'� =` . + . ��= i , r.,�•,��: .;. �., Water cl oset
Business name: �L. -T p.., ,[1. L._ 1 - 11f pi kt Water heater 16 60
Address: 0 )[ a,$ (5 J Other
Subtotal
City/State/ZIP: a 1 . /� M icy � 2 Q 701 —
rl / a Minimum permit fee. $72 50 � •
i 5
Phone: ( `�3) 7q' .. QgS� Fax: ( ) _ Residential backflow minimum permit fee $36 25
CCB Lic.: '. g 0 / Plumbs.g Lic. no - Plan review (25% of permit fee) 1
i m�/
” State surcharge (8% of permit fee) A- 96
Authorized signature: t
_ I ∎ _ / TOTAL PERMIT FEE .39./ 5
Print name: We i ` . 6 U � ClA Date: • Z This permit application expires if a permit is not obtained within
/ • f 180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
i \ Buiiding\Pennits\PLMF- PermiiApp doc 12/03 440- 4616T(10 /02/COM/WEB)
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 - I 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
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
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 * .
Quanti by (Fixture) Work Performed
Fixture Type: Replace
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
Dnnking 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./Refng. 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\Perrruts\PLM- PermitApp doc 3/03
CITY OFTURD 24 -Hour
BUILDING - Inspection Line: (503) 639 -4175 "
INSPECTION DIVISION Business Line: (503) 639 -4171 MSJ
BUP
Received Date Requested AM PM BUP
Location / 3 a y I Suite MEC
Contact Person Ph ( ) PLM , 7 0 O 9 0038 y
Contractor Ph ( ) SWR
BUILDING Tenant/O& ELC
Footing -g ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing "r -r Qevic a- S1 �e�T ( r - r C'-� 0 r T•
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
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
O
411411 PART FAIL
ANICAL
Post & Beam
Rough -In -
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Q Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA I ;) I
Approach /Sidewalk Date r 2 t) oy Inspector � 1),. w Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site. •
PASS PART FAIL