14650 SW 106TH AVENUE 14650 SW 106"' Avenue
CITYOF T I GA R D _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003-00152
13125 SW Hail Blvd., Tiyiird, OR 97223 (503) 639-4171 DATE ISSUED: 4/22/03
SITE A.^.DRESS: 14650 SW 106TH AVE COMMUNITY CTR PARCEL: 2S110AD-09600
SUBDIVISION: LANG HILL ZONING:
BLOCK: LOT: 00E JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: M F WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS- CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXI URES:
TUB/SHOWERS: SEWER LINE: ft
WATFR CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIIJ: 100 ft
Remarks: Repair of less than 100'of story line.
(.')�.o k 15-hAAIoj f NoC "'e' Dhoti_ FEES
Owner: bfN"J�7 &)"Ha&',ry L A),-fQ, -- -
Description Date Amount
CALWAY HILL HOMEOWNERS ASSOC Cc 4/22/02 $72.50
BY STAN ADKINS BUILDER, INC I I I N 8'I , I law I \
8459 SW BARBUR BLVD I I��l R tiiui 1,�� 4/22/03 $5.80
PORTLAND,OR 97223 Tot it $78.30
Phone :
Contractor:
D + F PLUMBING
4636 N ALBINA
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone : 501-282-0993 Storm Drain Ins'
Final Inspection
Reg#: LIC 465
MCT 0-1002033
I'I.M 26-23ph
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: �_. ` •� .77L�1Permittee Signature:,�
Call (5031639-4175 by 7:00 P.M. for an inspection needed the next Wsiness day
Building Fixtures
USE ONLY
Plfihctllng Permit Application Received , , , Plumbing
Date/By: Permit No.: lr� -C,6
Planning Approval Sewer
City of 'igard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review other
Tigard,Oregon 97223 Date/By: Permit No.:Post- __—
se
Phone: 503-639-4171 Fax: 503-598-1960 _fi Date/ y: tame o.:
Internet: www.ci.tigard.or.us Contac : _ case No.:
g Contact Juris.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Namc/Method: Supplemental Information.
TYPE OF WORK FEE*SCHEDULE(forspecial information use checklist)
New construction I H Demolition I Qty. I Fee(ca.) Total
Addition/alteration/re lacement Other: New 1-&2-family dwellings
CATEGORY OF CONSTRUCTION Includes 100 ft.for each u llity connection
1 &2-Faniil dwelling Commercial/IndustrialSFR(,1 bath 240.20
SFR(..)bath 350.00
FlAccessory Building Multi-Family SFR 3 bath 399.00
Master Builder Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION And LOCATION Firesprinkler-sr fl.: Pae 2
Job site address: JJ( St) Std 101pTh libar�q122q Site Utilities _
Suite #: B1dg.lApt.#: —_ Catch basin/arca drain 16.60
S --
SuiteProject Name: l5 COM pp Ur ell/leach line/trench drain 16.60 _
Footing drain no,linear fl. Pae 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Pain drain connector 16.60
Sanitary sewer(no. linear fl,) Page 2
Subdivision: Lot#: Storm sewer no. lineal t Pae 2 _
---- —— � Water service no. linear fl. — Pa c 2
Tax map/parcel#: Fixture or Item _
DESCRIPTION OF WORK Absorption valve _ 16.60
Backflow prcvcnter Page 2 _
Backwater valve 16.60 _
Clothes washer 16.60
-- —--- —-- — Dishwasher 16.60
PROPERTY OWNER TMENANT Drinking fountain 16.60
Ejectors/sump 16.60
_Name: %VA ( N beExpansion tank 16.60
Address: I qt.y pn S LO I p(,TN Fixture/sewer cap 16 60
City/State/Zip: "{,�, . o R, . Gj 7. Z„9 Floor drain/floor sink/hub 16.00 _
- ---- --"� - Garbage disposal 16.60
Phone: —Fax: _ Nose bib 16.60
APPLICANT _ CONTACT PERSON Ice maker 16.60
Name: Interco tor/ reuse trap 1660
Address: Medical gas-value: S Page 2
Cit /Stale/Zi Primer 16.60
— -- Roof drain commercial 16.60
Phone: Fax: Sink/basin/lavatory 16.60
1'-mail: Tub/shower/shower pan 16.60
CONTRACTOR Urinal 16.60
Water closet — _ 16.60
Business Name:
Dfi,F ------ - Water heater 16.60
Address: y *!� 14. A!b —_ Other:
City/State/Zi r� „ •o L- 9 2.1'1 Other:
Phone: W3.2z2.0 q3 Fax: —_ Plumbing Permit Fees* —
CCB Lic. #: 4(0$ Plumb. Lic.#: Z� 23P Subtotal S
_ Minimum Permit Fee$72.50 S
Authorized l Backflow Minimum Fee Safi 25
Signature. _�9 ' Dater 03 Residential
Review 25%of Permit Fee) $
State Surcharge 8%of Permit Fee) S
(Please print name) ____ TOTAL PERMIT FEE S _� __
Notice: Tols permit application expires If a permit is not obtalned within All nev commercial buildings require 2 sets of plan with Isometric m
180 days af.t•It has been accepted as complete. riser diagram for plan review.
'Fee methodology set by TN-founts Building Industry Service Board.
011stskPermit FormsTimPermitApp,doc 01103
Plumbing Permit Application - City of'Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Uressiontems:
Site UtilitiesQtyFee(ca) Total S uare Foota e:Footing drain-I"100' 55.(x) 0to2,000 46.40 2 001 'o3,600 Footing drain•each additional 100' 3,601 to,,�00 Sewer-Ist 100' 55.00 7,201 and realer
Sewer-each additional 100' 46.40
Water Service-Ist 100' 55.(X) Medical Gas S Stems:
Water Service-each additional 100' 46.40 V:.luatio,tt: Permit Fee:
Storm&Rain Drain-Ist 100' 55.00 $1.00 to$5,0)0.00 Minimum fee$72.50
Storm&Rain Drain•ench additional 100' 46.40 $5,001.00 to$10,00U(X) $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(ca) Total includin $10,000.00.
Co nrr^rcinl Back Flow Prc Mention Lpcvicc 46.40 $10,001 AO to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
_ each additional$100.00 or fraction thereof,to
Residential Backflow Prevention Device and including
minimum rmit fcc$)6.25) 27.55
Rain Drain,single family dwelling 65.25 $25,001 00 to$50,000.00 $379.50 for the first$25,000.00 and$1. for
_ each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or _ and_including$50,000.00,
s eciall re ucstcd ins eclions- r hour 72.50 $50,001 PO and up $742.00 for the first$50,000.00 and 61.20 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*. t otnments regarding fixture work:
uantit b Fixture Work Performed
g g
Fixture Type: Replace
New Moved Exlxlln Ca Md
Ba Mist /Pont —
Will -Tub/Shower — --
-Jacuzzi/Whirl oul
Cor Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher -Commercial
-Domestic
Drinkin Fountain _
I'.ye Waah
I loot Drain/sink 2" --
-
4"
('at Wash Drain *Note: If the fixture work under this permit results in an
Garbage -Domestic _ — Increase of sewer E:bUs,a sewer permit will he issued and
Dispusal -Commercial fees assessed for the sewer increase must be paid beforthe
-Industrial _
plumbing permit can he Issued.
[cc Mach./Refrie Drains
Oil Se armor Oas Station —. —
Rec.Vehicle DuniSlut in
Shower -(long
-Stall _
FSink_ -Bar/Lavatory
-I;radlcy
-('ommcreinl _
_ -Servicc _
4.vimming Prwl Filter �—
Washer-Clothes _
Nater Extractor
Water('losci-Toilet
Urinal r _
Other Fixtures_
i:\[),ts`.pemlit Fomis\l'ImPcrmitAppl'g2 drx: 01/03
DI rY OF TIGARD 24-Hour
BUILDING Inspection Line: (603)639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
BUR _
Received -- -- Date Requested_ AM
�PM BLIP�-- ��(.o ,� U / � (� �-
MEC
Contact Person r
Ph ( PLM ` "-
Contractor Ph( _) SWR 5,
BUILDING Tenant(Owner �- r1 ELC
Footing _ --
Foundation ELC
Ftg Drain Access: - —
Crawl Drain ELR
Slab Inspection Notes: SIT
Post& Beam —_
Shear Anchors
Ext Sheath/Shear -
Int Shea,h/Shear
Framing
Insulation _
Drywall Nailing
Firewall -- -- - - - -- --
Fire Sprinkler
Fina Alarm -
Susp'd Ceiling
Roof —
Other:__-
Final
PASS PART FAIL --•-- _
PLUMBING
Post&Beam:
Under Slab
Rough-In
Water Service
"',anitary Sewer ---
F',ain Drains
Catch Basin/Manhole -
etorm ITrajn>
Shower Pan -
Other
F. ---—- --- _
PA _PART 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 r -- r-- --
I� Reinapectlon fee of$_�_- required before next Ins ectlu... Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL - - q p
SITE Please call for reinspection RE:^_
Vire-Supply Line n Unable to inspect -no access
ADA
Approach/Sidewalk �at� _� _ InspedOr�_ Ext
Other: _
Final DO NOT REMOVE this, Inspection record from tiro job site,
PASS PART FAIL