Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00454
,. � I - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/26/03
SITE ADDRESS: 13267 SW WOODSHIRE LN PARCEL: 2S104DC -08600
SUBDIVISION: MORNINGSTAR ZONING: R -4.5
BLOCK: LOT: 023 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install back flow preventer
FEES
Owner:
Description Date Amount
VORWALLER, DOUGLAS F +
KARYN A [PLUMB] Permit Fee 8/26/03 $36.25
13267 SW WOODS HIRE LN [TAX] 8% State Tax 8/26/03 $2.90
TIGARD, OR 97223 Total $39.15
Phone : 503 - 691 - 1871
Contractor:
ESEQUIEL ROBLES LANDSCAPING
7076 RIDGEMONT DR N
KEIZER, OR 97303
REQUIRED INSPECTIONS
Phone : 503 390 4353 RP /Backflow Preventer
Reg #: PLM 7784
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: � Permittee Signature '��
Call (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the xt business day
Building Fixtures
• Plumbin N� Permit App FOR OFFICE USE ONLY
Received p // Plumbing
Date/B : p /atlo O 1 //p I Permit No ° t! / , 003 - 00 l is
City of Tigard Planning Approval ' Sewer
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 Post - Review Land Use
Atthiit■Date/By Case No.:
Internet: www.ci.tigard.or.us �J, 74 I i Contact Juns • Z 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(ca.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
SFR (1) bath 249.20
(r1 & 2- Family dwelling ❑ 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 INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: I 3 a- (o7 Sc.) t....)0(4_541 re b l c Site Utilities
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Drywell /leach line /trench drain 16.60
Project Name: Foohng drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
N Iin CW Manholes 16.60
CJ Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
Backflow preventer ( Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT Ejectors /sump 16.60
Name: r w o, te,y- Expansion tank 16.60
Address: L3 g-(01 4) we Sl.: Ire, I ill• Fixture /sewer cap 16.60
City /State /Zip: ` tS 2u ct Oil% �-j •�aa 3 Floor drain/floor sink/hub 16.60
_ Garbage disposal 16.60
Phone: SO3- Sot ` 5 `( Fax: Hose bib 16.60
❑ APPLICANT co CONTACT PERSON Ice maker 16.60
Name: L t1 Nl (4A.4. Interceptor /grease trap 16.60
Address: ' 354.0 -aw. Qoovte5 rerN k011 Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: �r .4a f 7 j` , 06 Roof drain (commercial) 16.60
Phone: Sb3 - ii -Is 7i Fax: sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Unnal 16.60
Business Name: t ( RR bit Water closet 16.60
SAD Water heater 16.60
Address: `10 7 ( ki c 4_,I to tk-i- Dr. u Other:
City /State /Zip: ke ry,`�,>� Or, X1'7 303 Other:
Permit Fees*
Phone:5D3 -3q0 1 -1353 Fax: P lumbing Per Subtotal $
CCB Lic. #: g 4 -( Plumb. Lic. #: f 1 �J 109• Minimum Permit Fee $72.50 $
Authorized I ) 1 1 / 6 Residential Backflow Minimum Fee $36.25 s • a 5-
Signature: _ ita.[ $ , &mop .. Date: l ! Plan Review (25% of Permit Fee) $
� l4 V ((; r_14 State Surcharge (8% of Permit Fee) $ • q e)
J (Please print name) TOTAL PERMIT FEE $ ... _ / S
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans w i metric 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\PlmPenmtApp doe 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 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
additional $100 00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total includin• $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 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
is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received �'Z _ Date Re • uested AM PM BUP
i
Location _ �� /l� t _ _ __1_' Suite MEC ��,,//
Contact Person - � Ph ( ) 6 9/ — (K 78 PLM �– CO '&5_4
Contractor • - ••A• i • Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access: ae / f
Ftg Drain , / ELR
Crawl Drain
Slab Inspectio . , %tes: ��� �A *"fro SIT
Post & Beam �L
Shear Anchors ,, /
Ext Sheath/Shear i2 t/J [,[. f4;I /l.Gl> 0L
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
'AS T FAIL
- 41
• - -am
Under Slab
Rough -In
•
- Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole // V
Storm Drain
Shower Pan
Other: - (�
Fi •
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 Inspector Ext
Other:
Final • DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL