15662 SW HALL BLVD-1 I
I
I
N
r
r
cu
O
I c
r
m
r
v
i
s
i
I '
i
I
15662 SW HALL BOULEVARD M
C
CITY OF TIGARD
__ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT;r: PLN12004-00025
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/12/04
SITE ODRESS: 15662 SW HALL BLVD PARCEL: 2S112CG-01200
SUBDIVISION: ZONING: R-1''
BLOCK: LOT JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: NUBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 3ACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF kAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES- OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 1,430 ft
DISHWASHERS. RAIN DRAIN: ft
Remarks: Domestic water for lots 3, 4, 5, 6, 7, 8, 13, 14, 15,16 and 17
------ FEES - -----
Owner:
Description Date Amount
COLLING, JOYCE '!
8255 SW SENECA ST N 1 %1131 I'rrmit I'l'l' 2/12/04 $704.60
TUALATIN, OR 97062 1111 %II%,N1 Plait Roio% 2/12/04 $176.15
1A 18"/,,State Surcharl 2/12/04 $56.37
Phone : Total $937_12
Contractor:
BUMBLE BEE PLUMBING
PO BOX 373
TROUTDALE, OR 97060 REQUIRED INSPECTIONS
Phone : 5111-618-8978 Water Service Insp
Reg #: LIC 113297
11I.M Vit,-59U1'li
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
Issu�d By: _C� ;tQz*0L Permittee Signature: AIL..G•ie.L�
Call (503;639-4175 by 7:00 P.M. for an inspection needed the next bus ness day �
Building Fixtures
111m...hillL, 1'errsiit A licati � f D e
G Received Jr -
City of Tigard nate/B : - `/ �j Fe"""No
13125 SW Hall Blvd.,Tigard,OR 97223h hl C.1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: otherher Permit No.:
,AN
24-Hour Inspection Line: 503,639.4175 Date Ready/By: 0 See Page 2 Aur
CITY
Internet: www.ci ligard.or.us Nutified/Method: Supplemental Inlbrmalion
TYPE OF W FEE- SC EDULE
®New construction Demolition i Forspecial information use checklist.
----- Descri tion i Qty. I Ea. total
❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)hath 249.20
(� 1-and 2-family dwelling ❑Commercial/industrial SFR(2)hath 350.00
- -
❑Accessory building ❑Multi-family SFR(J)bath 399.00- --
Each additio�ial bath/kitchen 45.00
❑Master builder - I El Other: Fire sprinkler(_sq.ft.) Page 2 N
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: j1 Catch basin or area drain 16.60 5.7c 6.2 ��, r//ALL-- ►1--
City/State/ZIP: Drywell,leach line,or trench drain 16.60
Suite/bldg./apt.no.: Project name: hh Footing drain(no,linear fl.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: n e % Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear fl.:_) Page 2
5 Storm sewer(no.linear ft.:,_) Page 2
Lot no.. Water service(no,linear fl.:/ Page 2
Subdivision: -
- - Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK _ Backflow prevcnter Page 2
�yBackwater valve 16.60
�� Clothes washer 16.60
- --- Dishwasher 16.60
-- Drinking fountain 16.60
❑ PROPERTY OWNER -❑ TENANT Ejectors/sump 16.60
Name: - T Expansion tank _ 16.60
Address: Fixture/sewer cep 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone:( ) - Fax:( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON` Ice maker 16.60
Businc:q name;
Cal_ vv_. Fe41 'd COMtrt 4, Interceptor/grease trap 16.60
Contact name: _ Medical gas(value:$ ) Page 2
Address: - - 1 „ --R -^- Primer 16.60
City/State/ZIP: �. f i Roof drain(commercial) 16.60
Sink/basin/lavatory 16.60
Phone:( ) _-eu. _ Fax: :( � ) 9,JQ. 5 0Tub/shower/shower pan 16,60
E-mail: - Urinal 16.60
F
CONTRACTOR Water closet 16.60
Business name: _ Water heater 16.60
L -611_ A Mtn��►nd -
Address: Other:
Subtotal
Ci �� Cf q 7d Ao Minimum permit fce: $72.50
Phone:(5ri1) G( 4d`] '-7 Fax:( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: ( Fax:
Lic.no.:�6,590 Plan review (25°r�of permit fee) /-y
State surcharge(Vo of permit fee)
Authorized signtmturee TOTAL PERMIT FEE 1& ,}
�Print name. Date: t _a This permit application expires if n Permit Is not obtained within
_L!'_t� Tom'- - 180 days after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i\nui!dins\Pemtitt\PLMF-PermitAppdoc 12103 440•I616Tt10ro2iC0MrWEm
Plumbing Permit Application - Citi' of Tigard
2 - Supplenlentai Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities
Qty. Fee(ea) Total Scloare Footage Permit Fee:
55.00 0 to 2,000 $115.00
Puoung dram-I"IUO' _ ---*----
46.40 2,001 to 3,600 5160.00 _
Footing drain-each additional I00' _ 3,601 to 7,200 $220.00 _
Sewer-I st 100' 55.00 7,201 and .eater $309.00
Sewer-each additional 100' 46.40
Water Service-Iat 100' 55.00 ( Medical Gas S litems:
Water Service-each additional 100' 46.40 G' Valuation: Permit Fee: _
Storm&Rain Drain-1st 100' 55.00 $1.00 to$5,000.00 I Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46,40 $5,001.00 to$10,000.00 $72.50 for the first 55,000.00 and$1.52 for cacti
�,y. Fee(ea) Totai additional$100.00 or fraction thereof,to and
Fixture or Item including$10,000,00.
Commercial flack Flow Prevention Device Oct 4u $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 end$1.54 for
each additional$100.00 or fraction thereof,to
Residential Backflow Prevention Device and Including$25,000.00,
minimum permit fee$36.25 27.55
$25,001.00 to$50,000.00 5379.50 for the first$25,000.00 and 51.45 for
Rain Drain,single family dwelling 65.25
each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or and including$50,000-00
a eciall re uested inspections-per hour 72.50 $50,001.00 and up $742.00 for the first S50,000.00 and$1.20 for
Subtotal: each additional S 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*.
uantic b Fixture)Work Performed
Fixture Type: Replace
Nen, Moved Existing Capped Comments regarding fixture work:
Iia tis /Font -
Bath -Tub/Shower
-Jacuzri/Whidl ool - -�
Car Wash -Each Stall ------- -
-Drive Thru
Cu idor/Water As irator - --
Dishwasher -Commercial --- - -
-Domestic ^_
Drinkin Fountain
Eye Wash _ --
Floor Drain/sink -Y -
-4"
Car
-.--_ -- -
Car Wash Drain
Garbage -Domestic
Disposal -Commercial _-_- *Note: if the fixture work under this permit results in an
-Industrial increase of sewer EDUs,a sewer permit will be issued and
Icc Mach./Refri .Drains fees assessed for the sewer increase must he paid before the
Oil Sc orator Gas Station - plumbing permit can be issued.
Rec.Vehicle Dump Station -
Shower 0a»g
-Stall -
Sink Bari[Avatory uantity Total
-Bradley _ Isometric or riser diagram is required if fixture quantity
-Commercial total Is>9.
-Service
swimming Pool Filter
Washer-Clothes
Water Extractor Plan Review
WaterCloset-'toilet Plan review is required if fixture quantity total is>9.
Urinal
other Fixtures:
i\nuitdin{\Permiu\PLM-PermaApp doc 3101
CITY OF TIGARD 24-Hour
BUILDING Inspection. Line: (503)639-4175 MST 4 /-'600-5/
INSPECTION DIVISION Busincss Line: (503)639-4171 `
t*ril o BLIP
Received �_2�3t to Requested AM PM ___ BUP —
Location ;C40 — 15 ' Suite -
�J
Contact Person /r _ Ph ( _) — _�t,�� P M QrJO 25�
Contractor 41� Ph( ) -- SWR
BUILDING Tenant/Owner _-- ELC
Footing — - ELC
Foundation Access:
Ftg Drain ELR _
Crawl Drain
Slab Inspection Notes, SIT
Post& Beam --
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear —
Framing -- - — - --
Insulation
Drywall Nailing -- —� _ --
Firewall ..2 ! �� .�d ee, 'L____.�h
Fire Sprinkler ----
Fire Alarm
Susp'd Ceiling --
Root
Other:
Final
PASS PART FAII..
PLUMBING
Post&Beam
Under Slab zzx —
Rough-In
Water Service
Sanitary Sewer
Rain Drains --- ----" — -
Catch Basin/Manhole
Storm Drain - - --
Shower Pan
OL er: ---
S PART FAIL — -
HANICAL _ -- ---.- ---^_ — ----�� __
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 before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - L I Please call for reinspection RF.: Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Data �` __ ___ Inspector ___.__._ ___—Ext
Other:.-----.----
Final
ther:._----. ___Final DO NOT REMOVE this Inspections record from the job site.
PASS PART FAIL