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14375 SW FANNO CREEK LP
CITY OF TIGARD PLUMBINGPERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00142
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4!5/04
SITE ADDRESS: 14375 SW FANNO CREEK LP
PARCEL: 2 S 112 B B-09800
SUBDIVISION: COLONY CREEK ESTATES NO.3 ZONING: R-7
BLOCK: LOT: 080 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
rYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: C. .:CH 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: Irrigation backflow prevenler. _ _
^FEES i�----��
Owner: ---_ --
Description Date Amount
HACKETT, SILVIA (7,TR
14375 SW FANNO CREEK LP I II),I A1141 Pernut I-ec 4/5/04 $36.25
TIGARD, OR 97224 11 A N I x titatc tiurcharl 4/5/04 $2.90
Total $39.15
Phone : ^--Contractor-
OWNER
REQUIRED INSPECTIONS
Phone : RP/Backflow Preventer
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 applicab's laws. All work will be done in accordance with approved
plans. This permit will expire if work is riot started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTEi:TION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: q����-� e3 Permittee Signature:- '--�-
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLV
City of TigardReceived Permit No. Q v
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By G� 1 �r
Phone: 503.639.4171 Fax: 503.598.1960 Plan By
B :
DateOther Permit No.:
24-Hour Inspection Line: 503.639.4175 a 9 Date Readyl8y. 1 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental lnrormatiun
'fl r. OF WOkK -- - FEE` SCHEDULE
❑New construction ❑Demolition For special in oris cion use checklist.
--- -- Descri tion T Qty. I Ea. I Total
❑Addition/altcratiotvreplacement ❑Other: New 1-2-family dwellings(Includes 100 R.for each utility connection)
"1'' CATEGORY OF CONSTRUCTION SFR(1)hath 249.20
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath i 350.00
❑ ccessory building _ ❑Multi-family SFR(3)bath 399.00
❑Master builderOther.- T-" Each additional bath/kitchen 45.00
❑ Fires sprinkler( s R. Pae 2
A�A'I ION` ►'lON
JOB SITE IN NORP 9 ) - 8
raj Site utilities
Job site address: ' 4 3 YE u> �--A W(D 0"MY, Uft ' Catch basin or area drain 16.60
City/State/ZIP: ��G' �r(f(� ) 22 Z' Drywell,leach line,or trench drain 16.60
Suite/bidg./apt.no.: Project name: Footing drain(no.linear ft.:_) Pap.2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(nolinear ft.:_J Page 2
Storm sewer(no linear R _) Page
Subdivision: Lot no.: Water service(no.linear ft. _) Page 2
-- Fixture or Item
Tax map/parcel no.: -
Absorption valve 16.60
R - DESCRIPTION 1f
_--.-_ Backflow preventer Page Z
b t ���L� � 5��(��j ,� Backwa,er valve - 16.60
Clothes wusher 16.60
Dishwasher 16.60
O ;rY O - Drinking fountain 16.60
''--- i Ejeetors/sump 16.60
Name: S IS A )} Expansion tank 16.60
Address: j SV-) Fixture/sewer cap 16.60
City/State/ZIP: ( `�)N Floor drain/floor sink/hub 16.60
,'hone:( 93 e2 9 (151 Fax:( ) � Garbage disposal 16.60
❑ APPLICANT ElCONTA_ OERSON Hose bib 16.60
L "' Ice maker 16.60
Business name:
Interceptor/grease trap 16.60
Contact name: Medical gas(value.S ) Page 2
_ -
Address: Primer 16.60
City/Statr'ZIP: Roof drain(commercial) 16.60
( )--- :( -- -- -
Sink/basin/lavatory 16.60
Phone: _ Fax•
Tub/shower/shower pan 16.60
1>mail:
_. Urinal 16.60
1. Water CONT Af'TOR r Water closet 16.60
Business name: 6)t) rJ ate- Water heater 16.60
Address: _ - - -- Other:
Subtotal
City/State/ZIP:
Minimum permit fee: $72.50
Phone:' Fax:( ) Residential backflow minimum permit fee. $36.25
CCB Lic.: Plumbing Lic.no.: _
Plan review (25%of permit fee)
1 State surcharge(8%of permit fee) )U
Authorized signature � / --
�C� - TOTAL PF.RMiT FEE.
Print name: A ate: This permit application expires if a permit is not ohtained%Nithio
-/ -T- 180 days after it has been accepted as complete.
`Fee methodology set by`fn-County Building Industry Set�tce Board
i kauilding�.oemuntPLMF-PenniUpp doe 1!101 440.46I6T(101QVC0 W WE9)
i
Plumbin PQ ermit Application - City of Tigard
Page 2 - Supplemental Information �
Fee Schedule: Residential Fire Suppressiop Systems:
Site Utilities Qty. Fee(ea) Tota: Sguare4Footage: Perinit..Fee:
Vowing(11 all)- 1"!0!1' 5500 t)to 2,000 $l 15 00
FootingJuin-each additional 100' 46.40 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-ist 100' 55.00 Medical Gas S stems' _
Water Service-each additional 100' 46.40 ' ,Pe. Vee:
–
Storm&Rain Drain-1st 100' 55.00 Valllat �S,I1:, rmit
$1.00 to$5,000.00 Minimum Ice$72 50
Storm&Ruin Drain-each additional 100' V M $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Fixture or item Qty. Fr'C(ea) Total additional$100.00 or fraction thereof,to and
_
including$10,000.00.
Commercial clack Flow I'tr�entwn Device 4o,40 $10,001.00 to$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 permit fee$36.25 27.55 and including$25,000.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000,00 and$1.45 for
each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or and including$50,000.00,
s eci lly requrs!ed insne:ti^ns_:.act nour 72.50 $50,001.00 and up $742.00 for the first$50,000,00 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 fees*.
Quantity by Fixture Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Ba ttsl Font
Bath -Tub/Shower _
Jacuzzi/Whirlpool —
Car Wash -Each Stall _.._
-Drive Thru
Cuspides/Water Aspirator _ --- —
Dishwasher -Commercial
-Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink 2"
4'
Car Wash Drain
Garbage -Domestic
Disposal -Commercial 'Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDIJs,a sewer permit will be Issued and
Ice Mach./Refri .Drains
Gil 5 arator Gas Station fees assessed for the sewer Increase must be paid before the
Rec,vehicle Dump Station — plumbing permit can be Issued.
Shover -Gang
-Stall
Sink -Bar'Lavatory Quantity Total
-Bradley Isometric or riser diagram is required if fixture quantity
-Commercial total is>9.
-Service
Sv%immin Pool Filter
Washer-Clothes _
Water Extractor Plan F -view
Water Closet-Toilet Plan review is required if fixture quantity total is>9.
Urinal
Other Fixtures:
i\nudlinglermiteP6M PennttApp doc 1/01
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST —
BUP
Received -_ —Date Requested_ Y g AM PM BUP
Location Suite` MEC
Contact Person _ Ph( ) PLM
Contractor _ Ph( ) SWR
BUILDING Tenant/qier ��*��r 9 d�- g�1 _ ELC _
Footing ((
Foundation Access: ELC
Ftg Drain
Crawl Drain ELR
Slab Inspection. Notes: '—� SIT
Post&Boam
Shear Anchor
Ext Sheath/Sht ar
Int Sheath/Shear —
Framing
Insulation
Drywall Nailing --
Firewall
Fire Sprinkler -- -- _
Fire Alarm
Susp'd Ceiling
Root
Other: ---
Final
_PASS PART FAIL - _ ---
PLUMBING
Post&Beam
Under Slab —
Rough-In
Water Service
Sanitary Sewer
Rain Drains — ---------
Catch Basin/Manhole
Storm Drain --- --— —
Shower Pen
Others j --——
AHANICAL
PART FAIL
Post&Beam ---- ------ - _ _�-_--
Rough-In
Gas Line -- _
Smoke Dampers
Final
PASS PART FAIL --ELECTRICAL
Service - --
Rough-In _
UG/Slab -
Low Voltage
Fire Alarm
Final Reinspection fee of$ required re
PASS PART FAIL -- - 4 before next ins pectlon. Pay at City Hell, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: _ Unable to inspect-no access
Fire Supply Lint
ADA L
Approach/Slocwalk Date- Inspoctor
Other:_
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL