14321 SW RACELY PLACE 14321 SW RACELY PLACE
�� ������ PLUMBING PERMIT
CITY
DEVELOPMENT SERVICES PERMIT#: PLM2003-00319
�-- 13125 SW Mall Blvd., Tigard, OR 97223 (503) 639-4171
DATE ISSUED: 7/2/03
PARCEL: 2S 109 BA-06600
SITE ADDRESS: 14321 SW RACELY PL
SUBDIVISION: HILLSHIRE SUMMIT NO. 2 ZONING: R-7
BLOCK: LOT: 052 JURiSDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNI RS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES !_AUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXI URES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install backflow preventer.
FEES
Owner: Description Date Amount
MAGNUSEN, DOUG 1P1,1 1%11;1 Prrmit Fee 7/2/03 $36.25
14321 SW RACELY PL ITAXI x°b Statr'Fil\ 7/2/03 $2.90
TIGARD, OR 97224
Total $39.15
Phone : 50-579-4861
Contractor:
REQUIRED I:JSPECTIONS
RP/Backflow Preventer
Phone : Final Inspection
Reg#:
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 Bye. i .: ; << � . Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the nexf bLm ne 4v
Building Fixtures
NLY
Plurnbior Permit Application ' ' '
,�. Received - !'lumbmg_.
Date/By: Permit No.� �a
City of Tigard Planning Approval Sewer
V Date/By: Permit No.:
13125 SW Hall Blvd. 1 Plan Review Other
Tigard,Oregon 97223 Date/By:. -- Permit No.:
Phone: 503-639-4171 Fax: $W-598.1960 Post-Review IAnd Use
J t._ Date/B _ Case No.:
Internet: www.ci.tigard.or.us ris.:(. r rN
tact --� JuSee Page 2 for
24-hour Inspection Request: 5(13.634-417.5)��'•,. mc/Mr.thod �� Su elemental Information.
TYPE OF WORK FEE*SCHEDULE(forspecial information use checklist
New construe Demolition Description I Qty. I Fee(ca.) Total
Additio a t. eration a placement Other: New 1-&2-family dwellings
Y OF
--- STKUCTION (Includes 100 ft.for each unlit connection
CONSFR(1)bath 249.20
1 & 2-family dwelling Commercial/Industrial SFR 2 bath _ 49.00
Accessory Building_ Multi-Family - SFR 3 bath 399.00
Master Builder Other- Each additional bath/kitchen 45.00
_ JOB SITE INFORMA'T'ION and LOCATION Fire sprinkler-sq.R. Pae 2
Job site address: 0/341 'S�,l 24cio Y V1._ ((aka Site Utilities
Suite #: Bldg./A#: Catch basin/arcadrein IG.60
Protect Name: Dr well/leach line/trench drain 16.60
Footing drain no.linear ft. Pae 2
Cross strect/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer no. lirr R.) Pae 2
Storm sewer no. lir Pae 2 _
ti:ihrin isiun. Lot#: �..- ----
- -- - --- - i--
lax ti Water service(no. i. �_- Pae 2
/ arccl #: -
---��------ Fixture or Item
DESCRIPTION OF WORK
Absorption valve I6.60
Backflow preventer Pae 2 _
Backwater valve 16.60
Clothes washer 16.60
- - - ---- - - Dishwasher 16.60 _
PROPERTY OWNER TENANT
Drinking fountain 16.60 -
-- ----------- Ejectors/sump 16.60 _
Name: DpyC�- �� - _ Expansion tank - 16.60 -
Address: ),13k4 S,r.I �►e r: W. Fixture/sewer cap 16.60
7 ZZ
City/State/Zip: TIU t) Oft `�' y� Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: 579 - AJ mI Fax: ?SCS -76 V1- Hose bib 16.60
EJ APPLICANT _- CONTACT PERSON Ice moker 16.60
Name: _ - - - - Interce tor/ rease trate_ 16.60
Address: Medical gas-value: $ Pae 2
City/State/Zip: - Primer 16.60
Roof drain commercial _ 16.60
Phone: Fax: Sink/basin/levator 16.60 -
E-mail: Tub/shower/shower pan_ 16.60
CONT1tACT0� Urinal 16.60 _
-- - v- Water clos=t16.60
Business Name: Water heater _ 16.60
Address: __-- ----__-- Other -_-----
7it /State/Zip: _ --_ Other u ---�- -- _ ---
Phone: .Fax: Plumbin Permit Fe es*
C_CB Lic. #: Plumb. Lic.#: S2 $
r.- -- Minimum Permit Fee$7$72.?00 $
Authorized Residential Backflow Minimum Fee$36.25r-
Signature: -- Date: - -- - - Plan Review(25%of Permit Fee) $
CTU State Surcharge R%of Pcrmit Fee) $
(Please print name) _ TUTAL PERMIT FEE $ ='(7.
Notice: This permit application expires Its permit Is not obtained within All new commercial bolldings require 2 sets of plans with Isometric or
Igo days after It has been accepted as complete. riser diagram for plan r evlew.
*Fee methodology set by Tri-County Building Industry Service board.
is\Dsts\Permit Forms0mi'ermitApp.doc 01103
Plumbing Permit Application - City of Tigard
PP,ge 2 - Supplemental Informatian
Fee Schedule: Residential Fire_Supp ression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Pouting dram- I" I(N) 55,00 0 to 2,(Nx1 $115.00
–
2,00 Ito 3,600 _$160.00
Footing drain-each additional 100' 46.40 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 S stems:
Water Serv`.cc-each additional 100' 46.40 Valuation: Permit Fee:
Storni&Rin'.)rain-I st I(N1' 55.00 — $1.00 to$5,000-00 Minimum lee$"r 7.50
Storm&R:m Drain-each additional 100' 4(,40 $5,001.00 to$10,000.00 $72.50 for the firs.$5,000.00 and�i.52 tier each
additional$100A)or fraction thereof,to and
Fixture or Item Qty. Fee(es) Total including$10,000.00.
Commercial(Sack Plow Prevention Device 46 40 $10,(1)1.0(1 to$25,0(x).00 $148.50 for the first$10,000.00 and$1.54 for
Residential each ncladditional ng $1 Wo
.UO or fraction thereof,t
Backflow Prevention Device
(minimum permit fee$16.25
27.55 and includin $25,000.(x)
Rain Drain,single lunuly dwelling 65.25 $25,001.00 to$50,000.00 $379.50 fou the first$25,000,00 and 51.45 for
each additional$1000)or fraction thereof,to
inspection of existing plumbing or _ and includingMOW)00
specially requested inspections-per hour 72.5(1 $5(I,Onl UO and up $742.00for the first$50,000.(!0 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 fres*. Comments regarding fixture work:
uontl. b Fixture Work Performed k g
Fixture Typel Replace
New Moved E11%tin Ca cc
Ba till /Punt — ---
Both -Tub/Shower
-Jacuzzi/Whirl pool _ __—
Car Wash -Each",tall -
-Drive Thru —
Cus idor/Water As irator
Dishwasher -Commercial
-Domestic — --
Drinkin Fountain
.ye Wash
Floor Drain/sink 2"
3"
4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage -Domestic increase of sewer EDUs,a sewer permit will he issued and
Disposal -Commercial — fees assessed for the sewer Increase must be paid before the
-Industrial _
ice Mach.ntefri .Drains plumbing permit can be issued.
Oil Separator Oa. Station
Rec.Vehicle DuniStation
Shower -Gong _ _-
-stall ——
Sink -Bar/l avolory
-11radley
-Commercial
-Service
Swtmmin Pool Filter
Washer-Clothes i —
Water Extractor --
Water Closet-Toilet --
Urinal -- —
other Fixtures: --
i:\Dsts\Permit Forms\PlmPermitAppPg2,doc 01/(13
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST —
INSPECTION DIVISION Business Line: (503)639-4171
Received ___ Date Re uested____-L- /0—AM__.___--_ PM_ - BLIP
Location _._�u 3 2 + PL MEC n/l c�
� _L--
Contact Person ._ Ph( ___) _
A VS �40C) OLM 3-- 12Q
Contractor _ ---—_ ph(_ ) 140 S'NR
BUILDING Tenant/Owner ELC __--
Footing EI-C
Foundation AccesS;4--/ ' E L.R
Ftg Drain U -
Crawl Drain S'T
Slab Inspecti otes:
Post&Beam —_ -_ — ---- _
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler -------- ---
Fire Alarm
SusN d Ceiling -
Roof
Other:
Final _
PASS PART FAIL y
PLUMBINti -.
Post&Beam
Under Slab —
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Cdsin/Manhole
Storm Drain
Shower Pan
O - .
PART-- FAIL
MECHANICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampers —----
Final
PASS PART FAIL - ---
ELECTRICAL
Service
Rough-In --
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspectinn fee of$_�_ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE:__— F-] Unable to inspect-no access
Fire Supply Line
AA
G /
ADproach/Sidewalk Dute ' -- inspector
Other:
Final DO NOT REMOVE this Inspection record from the Joh site.
PASS PART FAIL
Gras, Natalie
From: Tim Carr ftcarr(c_depaulindustries.comi
Sent: Wednesday, April 07, 2004 11:55.AM
To: 'natalie.;aras@acs-inc.com'
Cc: phillip.wristradowski@acs-inc.com'
Subject: 2 rush file look ups for City of Tigard
HI,
I need to have the following files picked up today and del..vered to City
of
Tigard. Metro courier will pick up when ready. Please call me at
8G6-3538
when ready.
13066 Raptor Place
and 13076 Raptor Place
Thanks, Tim
Tim Carr
DePaul Industries
9950 NE Martin Luther King Jr. Blvd.
Portland, OR 97211
Phone: (503) 33-1-3808
Mobile: (503) 866-3538
Fax: (503) 282-162.5
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