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CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT M PLM2003-00169
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 5/1/03
SITE ADDRESS: 12360 SW MAIN ST PARCEL: 2S102AB-05302
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M 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: 119 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 119'private sewer service repair.
FEES
Owner:
"`— Description Date Amount
WISE, RONALD H
FOSTER,LONNIF D/FOSTER,TYRON [PLUMBI Permit Fee 5/1/03 $101.40
6186 ROSEMEADC3W LN NE [TAX] 9%State Tax 5/1/G:1 $8.11
PORTLAND,OR 97301 Total $109.51
Phone . -- --
Contractor:
ED WYANT EXCAVATING INC
PO BOX 1242
SHERWOOD, OR 97140
REQUIRED INSPECTIONS
Phone : 503-625-9294 Water Line Insp
Final Inspection
Reg#: LIC 1 I 1263
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m This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
W 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
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Issued By: t Permittee Signature:
Call (503)639-4175 by 7.00 P.M. for an Inspection needed the next bu;.-,qs day
Site Utilities
Plu fnHng Permit Application Received
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t le/By:56?
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City of Tigard Planning Approval Sewer
y g Uate/F33y: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/8�: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Daty: Case No.:
Internet: www.ci.tigard.ocus Contact 1 See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information. _
TYPE OF WORK FEE"SCHEDULESfor special Information uc.: :hecklist
New COI1SLrUCtlon_ Demolition► Description _t `ply. I Fee(ea� Total
Addition/ilteration/re lacement Other: New 1- ly dwellings
CATEGORY OF CONSTRUCTION (Includes 100 ft..foror each allot connection
SFR I bath 249.20
1 & 2Tamil dwellin Comm_ercial,Rndustiial --- ---_-. - _
_ Y -_ SFR 2 bath _ _ 350.W
Accessory Building 4Multi-Family SFR 3 bath 399.00
Master Builder Othei; Each additional both/kitchen 45.00
_ _JOB SITE INFORMATION and LOCATION Firesprinkler- .ft.: Page')
Jab site address: O Svc �1" i N Site Utilities _ _
Suite#: Bld ./-Apt.#: i Catch basin/arca drain - I6.60
Piojeet Name -'f�V r7.J5 M,9 fL_. A)C F ell/leach no.linear
Ill.drain age 2
----�- -- Footing drain no.linear fl. Page 2 _
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
C,&,) i2 _tJ H PrvYl Rain drain connector 16.40
Sanite sewer(no.linear R.) Ila _PEc 21 J.
Subdivision: !.\ Lot#: Storm sewer no.linear R. Pae 2
Water service(no.linear ft.) Pae 2
Tax map/parcel #: �__1- Futtire or Item
E5CR1 ON OF WORK_ --, Absorption valve _ 16.60
S01AJ-C(L SL7ZV i C-C (ZLSpa!2• Backflow preventer -- Pae 2 _
Backwater valve _ _ 16.60
Clothes washes 16.60
Dishwasher _ 16.60
Drinking fountain 16.60
YROPBhTY OWNER TENANTL"cctors/sump 16.60 _
Name: _::ri L/C,�JS (Y)!ljq,-A-h1E Expansion tank _ 16.60
Address: 9 1 ro D 5f Fixture/sewer cap 16.60
Floor drain/floor sink/hub 16.60
City/State/Zip: ► V Fl
Garbage disposal 16.60
Phone: (o'2)0 -/U 1-�3 1 Fix: Hose bib 16.60
A!IFAPPLICANT - 1 1771 CONTACT PERSON Ice make 16.60
Name:C 1 A y( �(A)l/\1-'I t�- __ Interce for/tease tee 16.60
Address: n (3p)(-_L��_"j_ Medical as-value: S _ Pae 2
City/State/Zip: St1�,Y�y.��p1� c� -7 ) o Roof
16.60
ofd
Roof drain(commercial) 16.60
a. Phone: s'►Z9 q Fax: 113 Sink/basin/lavato - _ 16.60
E-mail: Tub/shower/shower pan -`_ 16.60
CO ACTOR Urinal 16.60
Business Name: Water closet 16.60
-- -- Water heater 16.60
JAddress: _ Other: �T
� Cit /State/Zi �- other: -------
w Phone: Fax: Plumbing Permit Ftlts
J - Subtotal 5 �D ,
CCB Lic. #: // 2(s: Plumb. Lic.#: Minimum Permit Fee$72.50 S
Authorized C? ��q- Residential Backflow Minimum Fee$36.25
Signature- �- Date: / Plsn Review 25%of Permit Fee 5
State Surrhar a 8%of Permit Fee /
(Please print name) _ TOTAL PERMIT FEE 5
Notice: This permit application expires If a permit Is not obtained within All new commerebal buildings require 2 sets of plans with isometric or
Igo days alter It has been accepted as comple.e. riser diagram f-r plan review.
*Fee methodology set by Trl-County Building Industry Service Board.
\Dsts\Permit Forms\P1mPem1itApp.doc 01/03
Plumbing Permit A,p�cation - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression S stems: 4
Site Utilities Qty. Fee(ea) `total Square Footage: _ Permit Fee:
Footing drain- 1° 100' 55.00 010_2,000 $115.00
Farting drain-each additional 100' 46.40 2 001 to 3 600 __. $160.00
3,601 to 7,200 _ $220.00
Sewer-I st 100' 5500 7 201 and greater $309.00
Sewer-each additional 11X1' 46.40
Water Service-1st 100' 55.00 Medical Cas S stems'
Water Service-each additional 100' 46.40 I Valuation Permit Fee:
Srnrrn&Rain Drain- Ist 100' 55.00 1t.�Sl..00 to$5._000.00 Minimum fee$72.50 _
Storm R.Rain Drain-each additional I(X)' 46.40 $5,001.00 to$10,000.00 $72.50 for the int 55,000.00 and$1.52 for each
Fixture or Item Qty. Fee(alt) Total including
$11X).00 or fraction thereof,to and
_ including$10,000.00.
Commercial llaA Flow Prevention Device. 46.40 510,001,00 to 525,000.00 5148.50 for the first 510,000.00 and Sl.54 for
Residential Backflow Prevention Device each additional SI00A)or fraction thereof,to
minimum perm;(Dec$36.25) 27.55 _ dnd irclud;ng$25L(X10.00.
Rain Dra:n,single family dwelling 65.25 525,001.00 to 550,000.00 $379.50 for the 01st$25,000.00 and$1.45 for
each additional$I M.00 or fraction thereof,to
Inspection of existing plumbing or _ and lud�550,000 00.
specially requested inspections- r hour 72,50 $50,001.00 and ;ncup $742.00 for the tint$50,000.00 and$1.20 for
Subtotal: each additional$100,00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
,,yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity b Fixture Work Performed Comments regarding fixture work:
[Fixture Type: Replace 11
_
Ne" Moved [ad n COp 0d ---
Ba tis( /Font
Bath -Tub/Shower
-Jacuzzi/Whirlpool _
Car Wash -Each Stall
_ -Drive Thru _
Cuspidor YVILeLAs irator
Dishwasher -Commercial _ __—
_ -Domestic
Drinking Fountain -- _
--
Floor Drain/sink 2"
1"
4,.
Car Wash Drain J *Note: If the fixture work under this permit results in an
Garbage -(hrnestic
4. Dispn::al -Commercial
increase of sewer EDUs,a sewer permit will be issued and
-Industrial fees assessed for the sewer increase must be paid before the
F— Ice Mach/Rcfr; .Drains ' plumbing permit can be issued.
Oil Separator(Cias Station)
Rec.Vehicle Dum Station
J Shower -Gang
-Stall _
Sink -Bar/Lavatory –
L1J -Bradley _
,,,,t -Commercial
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor
Water Closet-I oilet
Urinal
Otte fixtures:
is\D,Is\Permit Forms\PlmPermitAppPg2.doc 01103
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (563)OW4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP
Received Date Requested '�—s AM PM - BUP `
Location �� C� lGw.14kt----Suite _ MEC
Contact Person __�_ _ Ph( _) 7ZD d _710 PLM �—0!91(q
Contractor _ _ Ph(__�_) _ SWR
BUILDING Tenar )w, - _ tic F_LC
Footing
Foundation ELC --
Ftg Drain Access: �y // __
Crawl Drain ESR
Slab Inspection-Not 9- s: SIT
Post&Beam
Shear Anchors - -
Ext Sheath/Shear
Int ShHath/Shear -�
Framing
Insulation
Drywall Nailing - -
Firewall Ile
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -------------
Roof
Other: ---__._--
Final
PASS PART FAIL
PLUMBING
Post$Beam _- -
Under Slab
Rough-In
Water Service - ------ _
a ew
Rain Drains — -- --__.
Catch Basin/Manhole
Storm Drain -- --- — ----
Shower pan
40 in
S ART FAIL
HANICAL - -------- - -
Post& Beam
Rough-In
IL Gas Line
Smoke Dampers --- _
Final
PASS PART FAIL
ELECTRICAL
Service v -
W Rough-In
u 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 _ Please call for reinspection RE: __ _— []Unable to inspect-no access
Fire Supply Line
ADA ?
Approach/Sidewalk - Q./ — Inspe0eir_ - -_ __- -----fj[t_--—-
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL