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13165 SW KATHERINE ST
CITYO F T I GA R D _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM200"-00301
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATL ISSUED: 6/2 /03
SITE ADDRESS: 13165 SW KAT'1ERINE ST
PARCEL: 2S 164AE-07200
SUBDIVISION: MORNING Hl;_L NOA ZONING- R-4.5
BLOCK: LOT: '101 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPI.)SALS: MOBILE HO,;,E SPACES:
Tvnr nc 1'SF.: SF WASHING MACH: BACKFLOW Pk.'-r'NTRS: 1
OCCUPANCY GRP- h , FLOOR AINS: TRAPS:
STORIES: WATER Iir ATERS: CATCH BAS NS:
_ FIXTURES i_A' R f TRAYS. SF RAIN DRAINS:
SINKS: U-0 GR-ASE TRAPS:
LAVATORIES: OTHER IXTURES:
TUB/SHOWERS: SEWED LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RA!N DRAIN: is
Remarks: Install irrigat;rn backflow device.
Owner: _— _—
FEES
"— Description Date Amount
BERGOUISI-, KATHLEEN -- -
13165 SW KATHERINE IPLUMBI 11cm-it Fee 6/25/03 $36.25
1 IGAf2D, OR 97223 TAXI 8"/o St^,e Tax 6/25/03 $2.90
Total $39.15
Phone : 503-579-780:. _
Contractor:
L1F;BAN EDEN LANDSCAPE
4135 NE 18T H AVENUE
PORTLAND, OR 97211
REQUIRED INSPECTIONS
Phone * 503-310-3791 RP/Backflow Preventer
Final Inspection
Reg#: LIC 7200
This permit is issued 5uL;ect to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. Aft work will be done in accordance "ith approved
plans. This permit will expire if work is not started within 180 days of i,.suar:,C, or if work is suspended
for more than 180 days. ATTENTION: Oregon law re-uires you to follow rules adopted by the Oregon
j ?
Issued By: �. _ u��-( (L L - Permittee Signature: A
Call (503) 639-41-5 by 7:C" P.M. for an Inspection needed tht next busines ay
Buitcivig r fixtures
Plumbing Permit Application
Rcc:ived/ I IumhinE,
Datc.'Bv/ Permit NolldL aQ O-�
Planning Approval SCNer
City of Tigard Date/13y: Pern,it No.
1317.5 SW Hall Blvd. ` Plan Review - other
Tigard,Oregon 97223 DatcJB : Permit No.:
Phoney 503-639-4171 Fax: 503-598-1960 Post-Review Land(Jsc
Bate/By: Case No: _
Internet: www.ci.tigard.or.us "011tact - f Juns.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method.: I t _ Supplemental Information.
TYPE OF WORK - FEE*SCHEDULE(for special Information use checklist
Nev-construction -�- Demolition r Description ()t).. Fee(ea.l_ total
a Addition/alteratioti/replacemer'` i ' Other: New t-&2-family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft.for each u flity connection
1 &2-Family dwellin Commercial/Industrial 5r•It 1 hath __- 249.20
1� -�-� SFR 2 bath 350.00
AccessoryBuilding _ Multi-Famil SFR 3 bath 399.00 _
LJ Master Builder Uther: _ Each additional bath kitchen 45.0(1 _
JOB SITE INFORMATION and LOCATION Fire sprinkler-sq.ft.: Pae 2
Job site address: 3 _ $ THE Site Utilities
Suite#: Bld ./A to Catch Wein/arca drain 16.60
Project Name: Drywellileach line/tiench drain _ 16.6)
Footin drain no.linear ft. Page 2
Cross
//streeeet/Directions to job site _ / Manuf'actured home utilities 110.00 �-
Scse - f r►. 3'S 0 Manholes 16.60
s A _ 4/ ('j y f r,;�.� ��" Ram drain connector
_ J� Sanitarysewer ewer(no.linear fl.) _ Pa=age c 2 2
Subdivision: ^- Lot#�_ Storm sewer(no. linear fl.) - - Page 2
Tax map/parcel #: WatLr service(no. linear fl.) Page 2 _
DESCRIPTION OF WORK ^r Fixture or Item
-- AbsorVion valve 16.60 -
_-- kflo- prevenll r -- _ I Page 2 _-
_ Backwater valve _ _ 16.60
Clothes wa,her 16.60
- - - - - Dishwasher 16.60
RpRp nPERTV O�YNI;R `TCITENANT Drinking fountain 16,60
Ejectors/sump 16.60
Expansion tank 16.60
Address: S A Fixture/sewer ca _ !6.60
-.� Floor drain/floor sink/hub 16.60
Citi/State/Zip: „ �.� _ X17._.�_ --
Garbugedisposal _ 1G.�i0
Phone:, 'l� Fax: _ Hose bib - _ 16.60 _
APPLICANT _ CONTACT PPE_RSON Ice maker 16.60 _
_ ame: rl��- C)J��_ A_ Interceptor/grease trap _ 16.60
Address: W3 5" ^/L=Zk M.,dical gas-value: $ Page 2
��-� , �--- -' Primer I6.60
cty/State/Zip: JL goof drain(commercial) 16.60
Phone:0;-34-33 Fax: J��__ S'-k/basin/lavatory 16.60
E-mail: ub/shower/shower pan _ 16.60
CONTRACTOR Urinal 16.60
u 'nessName: �_ , /�V &yc/s) - 'Nater closet 16.60
tA.'eter heater 16.60
A ress: _ r Other:
Cit /StatA/Zip: I Other: �-T_-- ----- --
Phone: _ _ax: Plumbing Permit Fees*
A Lit:. #' 1(. _ �- Subiotal $_
_� lumb. L1C.#: -�-- Mininwm P -it Fee$72.50 5
Authorized tPcsidcntial.=lacktlow"wo tum Fec$36.25 _
Signature: _ _ Date: GS��� plan Review ,. %of Permit Fee) $
Statc Surch.: oe(8%of Permit Fee) $
(Please print name) _ T'IOTAL PERMIT FEF. $
Nollc, this prrnrll application esplrr%if a prrnrl Is rut obtained ssiUrin All new commercial buildings require 2 sets of plans with Isometric or
180 das%Nt1r1 It Ira%bren acrepted as complete. riser eiagranr for plan re,iew.
*Fee melhodolop set by Tri-County Building Industry Sersice lluard.
00stsTermn FormsTimPernmApp.doc 01103
Plumbing-Permit Analication - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppressicn Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: _ Permit Fee: _
Footing drain- 1' 100' 55.00 0 to 7,1X10 $115.00
Footing drain-each additional 100' 4b.40 2,001 to 3,600 $160.00 —
3,601 to 7,200 _ $220.00
Sewer-I.;t 100' 55.00 7,201 and greater $309.00 _
Sewer-each additional 1C 46.40
Water Service-Ist 100' 55.00 Medical Gas Systems'_
Water Service-each additional 100' 46.40 Valuation: Permit Fee:
Storm&Rain Drain Ist 100' 55.00 $1.00 to$5,000.00 Mini num Ice$72.50 _
Strata& Rain Drain-each additional 100' 4640 $5.001.CO to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Fixture or Item — Qty. Fee(ca) Total additional$100.00 or fraction thereof,to and
including$10,000.00.
Commercial(Sack flow Prevention Lkvirc 404P $10,00100 tc$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 pem it fee$36.25 2i 55 _ _ and including$k5 000.00. _
Rlin Drain,single family dwelling r,5.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
— each additional$100.00 or frac ion thereof,to
Inspection of existing plumbing
and including
specially requested inspections-per hour 72 5(t $5 X
Subtotal: $50,001.00 and up $742.00 for the firsrs $50,
t$--50(XX).00 and$1.20 for
J each additional$100.00 or fraction thrreof.—
(Fixture Work:
Are you capping, ntrrving or replacing existing fixtures? If
"ves", please indicate«ork perforated by fixture. Failure to
accurately report fixtures could result in Ocreased sewer fees*.
uautiq b Flrtere Work l'crfortned (comments regarding fixture work:
Fixture Type: Replace
New Moved Eait:qCa r ped — -- — -- —Baptistry/Font
Bath -Tub/Shower—
_
-Jacuzzi/Whirlpool _- --- _----
Car Wash -Each Stall
-Drive Thru -
Cus idor/Water Aspirator
Dishwasher -Commercirl
-Domestic
Drinking Fountain -'
-PYC Wash
Floor Drain/sink 2"
4„ --- —
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage -Domestic
Disposal -Commercial — — increase of sewer EI)iJs,a sewer permit be issued and
-Industrial fees assessed for lite sewer increase must be paid herore the
Ice Mach./Refrig.Drains plumbing permit can he issued.
Oil Separator(Gas Station
Rec.Vehicle Djmp Station
Shower —Gang -
-Stall
Sink -Bar/Lavatory
-Bmdlcy _--
ommtreial
-Service__ _
Swimmin fool Filtcr
Washer-C!uthes _
Water Exiractor _
Water Closci-i odel _
Urinal
tither Oxtures. —
is\Dsts\Permit Fortes\PlmPertnitAppPg2.doc 01/03
CITU' OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST _ —
INSPECTION DfVISION Bus:'ness Line: (503) 639-4171
BUP - --------
Received __ _____ - __.___ Date Re nested—�_ AM--- PM BUP
Location _ _.__l 3c___, - Suite_— _-___ MEC
Contact Person -_-- --_e_._-_-_ -_ _-- Ph(—) ___..__.— - PLM —Q-6,30 I
_ SWR
Contractor __.- __-- .___ P�h�( ---�----- ------
LL -� 73�r1 ELC
BUILDING rr� Tenant/Gwner __. -- — --
Footing — --- -- S 7 -;Z G ,,Z D ELC
Foundation Access:
F'•Drain ELR -
Inspaction Notes: SIT --____--
Posi ..earn - -- ------ -- - ------ __
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing - - -- _—. - + - - - -------- _
Insulation
Drywall Naili ig -- ---- ----- -- ----
Firewall
Fire Sprinkler — - -
Fire Alarm
Susp'd Ceiling -- -- ---- --- —�--- -- -
Roof
Other:
Final L
PASS PART FAIL_
PLUMBING_
Post& Beam —
Ur.der Slab - - - -- --- -
Rough-in
Water Service ----------.__. __-- --_-- --
Sanitary Sewer
Rain Drains --- ----_.__ ___- ----___-- _---- _.
Catch Basin/Manhole
Storm Drain — —
Shower Pan Q
tr S PAHl FAIL_ CHANICAI
Post& Beam
Rough-In ---- --
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
--- -- -------
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final IJ Reinspection fee of$ __ -required before next inspection. Pay at City Hall, 13125 SW Hail Blvd.
PASS _PART FAIL
SITE [� Please call for reinspection RE:__ - ___ Unable to inspeci- no access
Fire Supply Line ,
ADA11)
Approach/Sidewalk Date -- - _ Inspector
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL