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13465 SW NAHCOTTA DR
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. CITY OF T16ARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT M PLM2004-00120
13125 SW Hall Blvd ,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 3/23/04
SITE ADDRESS: 13465 SW NAHCOTTA DR PARCEL: 2S105DD-03400
SUnDIVISION: PACIFIC CREST ZONING: R-7
BLOCK: LOT: 010 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.
FEES
Description Date Amount
Ik . KOODSMA
165 OO NACHUTTA [PLUMB] Permit Fee 3/23/04 $36.25
TiGARD, OR CHO [TAX]8%State Surcharl 3/23/04 $2.90
Total $39.15
Phone : 503-590-8441
Contractor:
PACIFIC GARDENS $ WATERWORKS
PO BOX 2623
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503-682-3370 RP/Backfin-Prc;oiiier
Finai Inspection
Reg#: LIC 5807
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
m Specialty Codes and all other applicable laws. All work will be done in accordance with approved
Wplans. This permit will expire if work is riot 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
Iss d 8y: Permittee Signature:
C I (503 9-4175 by 7:00 P.M.for an Inspection needed the next business day
Btkilding Fixtures
Plumbinp, Permit Application
City of Tigard Received Permit No
13125 SW Hall Blvd.,Tigard,OR 97223 t"Y
Phone 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No
24-Hour Inspection Line: 503.639.4175 —a&_t!!2!Y__ —---_T._r3F0_S_Pale 2 for
A, k Date lkeatdy,By�
Internet: www.ci.tigurd.or.us Notifle ethod. Supplemental Information
F*1
DIM'
�RNew construction F] Demolition For!E!cial information use checklist
Description Ea. Total
"E]Additior,/aiteration/replaceinent ❑Other: New 11-2-family dwellings(includes 100 R.for each utility connection)
SFR(1)bath 249.20
7%1-and 2-family dwelling C1 Commercial/industrial SFR(2)bath 350.00
110 Accessory building C3 Multi-family SFR(3)bath 399.00
0 Master builder El Other: Each additional baMitchen 4500
Ae V, Fire sprinkler sq.ft.) Page 2
441
1W2 11 Site utilities
Job site address: A4Aco-T-r
BLA(05, )(J Catch basin or area drain 16.60
13v--N
City/State/zip: 714-69-b. (32— 972,2,3 Drywell,leach line,or trench drain 16.60
Suite/bldg./apt.no.: Project name: Footing drain(no linear t). Page 2
street/directions to job site: 4-1, - Manufactured home utilities 110,00
Cross s
I"I 1'C Off Manholes 1660
MISTIG Rain drain connector 16.60
Sanitary sewer(no.linear ft.: Page 2
Storm sewer(no.linear ft: Page 2
Subdivision: Lot no.: Water service(no linear fl.: Page 2
Fixture or Item
Tax map/parcel nory.:
Absorption valve 1660
Backflow preventer Page 2
X
LVLA3 I)P( I� Backwater valve 16.60
Clothes washer 1660
Dishwasher 16,60
Drinking fountain 16.60
Ejectors/sump 16.60
Name: ti
NAN o- beBalf, KocimmExpansion tank 16.60
Address: c c o Fixture/sewer cap 16.60
City/State/ZIP: op_ q?2Z3 Floor drain/floor sink/hub 16.60
Phone:(5b3) 4 1 Fax: Garbage disposal 16,60
#K
Hose bib 16.60
Aft, Ice maker 1660
Business name: PACIIVir
Intercepto,' itp 16.60
Contact name: Page 2
0. Address: Primer 16.60
Roof drain(commercial) 16.60
City/State/Z[P: I'L004-4-ripi, 02&-ey" 132104.2— —
I Sink/basin/lavatory 16.60
cn PhC.ie:(5D3 ) -3374)
&a-L-ws Fax: : 5L-;% 4,47
'IN 7 1 . �t Tub/shower/shower pan IE.60
GLS E-mail: ?(.L,3 (a -Oace, '� kc, ne—t — Urinal 1660
Water closet 16.60
Business name: al, Water heater
__ 16,6
LU Other:
_j Address: Subtotal
City/State/ZIP; _fCA4(,r"ipJ 2, Minimum permit fee. $72.50
Phone:(5*) s :(
Fax 3370 Residential backflow minimum permit fee $36.25 21641.
it-it " (VtZ Z9,
CCB Lic.: 5iP97 10 '1 Plumbing Lic.no.: lo*3 S Z_ Plan review (25%of permit fee) .90
State surcharge(8%of permit fee)
Authorized signature:
TOTAL PERMIT FEE
;
Print I
This permit application expires If a permit Is not oblalne3TY
180 days after It has been accepted an comp.... "
*Fee rtr-thodology set by Tri-County Building Industry Service Board
i,Rtiilding\Permhs\PLMfPermitAppdm 12103 440-4616T(l0/02/C0M/WV_B)
Plumbing Permit Application - City of Tigard f -
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
OW
Footing drain-I"100' 146.40
.00 0 to 2,000 _ $115.00
Footing drain-each additional 100' 2,001 to 3.600_ $160.00
3,601 to 7,200 $220.00
Sewer-1 st 100' 55.00 7,201 and greater _ $309.00
Sewer-each additional 100' 46.40
Water service- Isr 100' 55.00 Medical Gas$ stems•
Water Service-each additional 100' 46.40
Storm&Rain Drain-1st 100' 55.00_ $1.00 to$5,000.00 Minimum fee$4.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to 510,000.00 $72.50 for th irst$5,000.00 and$1.52 for each
rdditional 0.00 or fraction thereof,to and
in10
�ludin _ ,000.00. _
Commercial Back Ilow Prevention Device 46.40 $10.001.00 to$25,000.00 $149 5 for the first$10,000.00 and S1.54 for
3esidential Backflow Prevention Deviceeach dditional$100 00 or fraction thereof,to
minimum permit fee$36.25 _ 7.55 .U a, including$25,000.00.
lain Drain,single family dwelling 25 $25,001.00 to$50,000.00 79 50 for the first$25,000.00 and$1.45 for
each additional 5100.00 or fraction thereof,to
Inspection of existing plumbing or and including$50,000.00. _
specially requested insp-ections-per hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and S1.20 for
Subtotal: Z _ 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 f s*.
'. Co ents regarding fixture work:
Be tis /Font _
Bath -Tub/Shower
-Jacuzzi/Whirlpool _ --- —
Car Wash -Each Still
_ -[hive Thru -�- --
Cu idor/Water Aspirator -- —
Dishwasher -Commercial _-
-Domestic —Drinking Fountain
Fye Wash
Floor Drain/sink .2"
4"
IL
— ---
n• Car Wash Thain —
Garbage -Domestic
NDisposal -Commercial _ *Note: if the fixture work un this permit results in an
Industrial increase of sewer EDUs,a sewer rmit will be issued and
Ice Mach./Refri .Drains
Oil Separator Gas Station fees assessed for the sewer increase ust be paid before the
m Rec.vehicle Dump St;&6 plumbing permit can be issued.
Shower -Gang
tU -Stall
J Sink -Bar/Lavatory _ Ouantity Total
-Bradley Isometric or t iser diagram is required If fixture quantity
-Commercial — total i7>9.
_ -Service —
Swimming Pool Filter
Washer-Clothes
Water Extractor Plan Review
Water Closet-Toilet Plan review is required if fixture quantity total is>9.
Urinai
Other Fixtures:
i NB,,itdinaTermiu�PLM-PenneApp da: aro]
CITY'' OF TIGARD 24-Flour
BUILDING Inspection Line: (503)635-4'175
INSPECTION DIVISION Business Line: (%103)639-4171 MST
,�
MOP —
Received �� ► l 2 U//D /
ate Requested?` "V AM______ PM. BUP -_
Location CrE Suite MEC _
Contact Person ._ _ _ ( � _ f.S c D pL �O/2�
Contractor____... Ph( ) _ -_— SWR _..
BUILDING__ Tenant/Owner - __- ELC
Footing
Foundation Access: ELC _
Ftg Drain ELR
Crawl Drain `!
Slab Inspection N jtes: SIT
Post& Beam
Shear Anchors —
Ext Sheath/Shear
Int Sheath/Shear
Framing
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 ----- --
Sh P n
herIJ1 —
in _
S PART FAIL —
HAN1 CAt. -- --- - - ---- - - - — ------
Post&Beam
Rough-In -- ----- ---- -- -- ---
Gas Line
a Smoke Dampers
Final
U) PASS PART FAIL --- ---- -- -- --- — - -
ELECTRICAL — --- __ —_ -- ---.------_-__-- _--
Service
DO Rough-In ------ - - -- - -
a UG/Slab — ---- � - ---
W Low Voltage -__ --------- --__-- _-___
Fire Alarm
Final r] Reinspection fee of$ requh-ad before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: __- - L__.I Unable to inspect-no access
Fire Supply line
ADA &vz
Approach'Sidewalk Datb - ��;P � E>Adt _
Other:
Final DO NOT REMOVE this Inspeadon reooM from the job$Me.
PASS PART FAIL