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7546 SW ASHFORD ST
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CITYOF T I G A R D __PLUMBING PERMIT
"
DEVELOPMENT SERV!('F_:S PERMIT#: PLM2002-00353
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/6i02
SITE ADDRESS: 07546 SW ASHFORD ST PARCEL: 2S112CA-08800
SUBDIVISION: RENAISSANCE WOODS ZONING: R-7
BLOCN:: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE. DISPOSALS: MOBILE HOME SPACE'S:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OrCUPANC f 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 I-INE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential irrgation backflow device.
Owner:
FEES_ — –�--�
— ----- --
VALENTINE, DARNELL
Type By Date Amount Receipt
- —
7':46 SW ASHFORD ST PRMT CTR 9/6/02 $36.25 27200200000
T''3ARD, OR 97224 5PCT CTR 9/6/02 $2.90 27200200000
L-- —� Total $39.15
Phone 1:
Contractor:
c;U,,NER
REQUIRED INSPECT'ONS
Phone 1 RP/Backflow Preventer
Reg tl-
Final Inspection
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: Oreg)n 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 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (50,1) 246-1987.
Issued By: r ____ Permittee Signature: ��
call (503) 639-4175 by 7:00 P.M. for an inspection, needed the next bu iness day
Building Fixtures
P11ilmbing Permit Application
-Date received: 1 G O'L Permit nu i n 104 y-D03 5.3
City of Tigard
Address: 13125 SW Nall Blvd,Tigard,OR 97223 Sewer permit no,: Building permit no.:
City of Tigard Phone: (503) 6394171 Project/appl. no.: _ Expire date:
Fax: (503) 598-1960 1 �' ate issued: By Receipt no.:
1,and use approval: ` Case file no. Payment type:
7Ne%k,
mily dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
struction U Addition/alteration/replacement U Food service U Other:_
JOB OR 1 i F
Job address: 1- Description o i
� �S►ti �}/-e,�r0 1 Qf7• T'ce(ca.) Total
i
Bldg. no.: Suite no.• -�— New -and 2-family dwellings only:
—-— --- (includes 100 ft.for each utility connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath
Project name_ SFR(3)bath --
City/county: ZIP: Each additional bath/kitchcn --
Description and location of work on premises: —_- —_ Siteutilities:
Catch basin/area drain
Fist.date of completion/inspection: Dry—we Ilsileach line/trench drain
CONTRACTOR Footing drain(no. lin. R.) —
Manufactured home utilities —"
BuAriess name:--.---- -- Manholes —�
Address: _ v Rain drain connector
City: _ �— State: ZIP: — Sanitary sewer(no,lin. R.)
Phone, Fe_x: E-mail: Stone sewer(no.lin. R.) —
CCH no.: dumb. bus.reg.no: Water service(no. lin. ft.)
City/metro tic.no.: Fixture or item:
Contractor's represent,ll n c signature: Absorption�on valve
_ _
Print name: --- Back flow preventer
Date: Backwater valve
CONTACT tBasins/lavatory _
Name: Clothes washer
Address: Dishwasher
Citv: ' Drinking fountains)
5t•ite:_ ZIP: _ Ejectors/sump
Phone: Fax: E-mail: Expansion tank
Fixture/sewer cap
_Name(print): a52coof Z!f n e Floor drains/floor sinks/hub
Mailing address: 111U14 US H;bt? Garbage disposal
City: •I��,�L�) State: � ,�� Hose bibb ZIP: Ic k /�.��
Phone:50 -V 2•1 S-1 E-mail: ye�ID ah / n ep o greF' " esetrap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by mea maintenance an pair made by my regular Roof drain"—(commercial)
emplovee on the pr erty I own as pe apter 147. Sink(s),basin(s),lays(s)
Owners si nature: h�ate: `�/� /BZ- Sump
Tubs/shower'shower pan
Name: Urinal _
Address: v Watercloset
Wat --
er heat r
City: State: ZIP: Other: . — —"
Phone: — _ Fax: Total
Nd all jud,diNl xta accep credit cards,please call juriadictirtn for ma
mare infortion. Minimum fee................ S JFG 4+5
Notice: Tl,is permit application %
❑Via. 4 MulerCtud expires if a permit is not obtained Plan review(at _ ) $ --�
Credit card numtarr a i_ L_- within 180 days after it has been State surcharge(13%).... S t7
° TOTAL. Q
game—of car older u shown on reedit—card accepted as complete. ••••••••••••••••••••••• S .�1
Ca�ldeiairi1nalum
$
Amount
410.616(&%'C'OMI
i
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings —
FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixt.ires In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. Q'iN (ea) AMOUNT
Lavatory 18.60 for each utilit --�—connection
—One 1 bath _ $248.20 _
Tub or Tub/Shower Comb 16.60 Two(2)bath _ $350.00 1
Shower Only 16.60 Three 3 bath _ _ $399.00
Water Closet — 16.80 �— SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 ,_. TOTAL
Laundry Trav 16x+0
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 —
3" 16.60 ---- PLEASE COMPLETE:
4" 16.60
Water Heater O conversion 0 like kind 16.60 uantity b Work Performed
Gas piping requires a separate mechanical Fixture Type: Naw Moved Replaced Removed/
permit Capped
MFG Home New Water Service 46.40 Sink _
MFG Home New San/Storm Sewer 46.40 Lavatory
Hose Bibs 16.60 Tub or Tub/Shower
_ Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 1660 Urinal
Dishwasher _
Garbage Disposal
LaundrLRoom Tray
Washing Machine _
Sewer-1st 100' 55.00 Floor Draln/Sink: 2"— 3" --
Sewer-each additional 100' 4640 4-
Water Service-1st 100' 5500 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
(Specify)
Storm 8 Rain Drain-tsl 100' 51 00 —
Storm&Rain Drain-each additional 100' 4640
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55 --- —
Catch Basin 16.60 --- — — —�—
Inspection of Existing Plumbing or Specially 62.50
Re unsted Inspections er/hr COMMENTS REGARDING ABOVE:
R in Drain,sil,gle family dwelling 65.25
Goeasa I reps 16.60 --
QUANTITY TOTAL --
Isometric or riser diagram Is required if -----—
Ouanl Total is >9 ----. --- —-
"SUBTOTAL ----
8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Required only If fixture qty total is>9
TOTAL E
Minimum permit lee Is$72 50-8%state surcharge,except Residential eackfiow
Prevention Device,which is$33 25-8%stale surcharge
"All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
i:\dsts\forrns\plm-fees doc 12/26/01