9215 SW Millen Drive (2) 9215 SW MILLEN DR FILMED 2006
3ntua N311IW MS 9626
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9215 SW MILL- . LIR
PLUMBING PERMIT
CITY OF TIGARD -- -
DEVELOPMENT SERVICES PERMIT : PLM2003-00329
1`i- 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DALE ISSUED: 7/8/03
PARCEL: 2S 114AB-02500
SITE ADDRESS: 09215 SW MILLEN DR
SUBDIVISION: KNEELAND ESTATES ZONING: R-4.5
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MAGI: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention dhvice for irritation s stem.
FEES
Owner: -' — - — — _
-' Description Date Amount
GREG LOVELAND
9215 SW MILLEN DR [PLUMB] Permit Fee 7/8/03 $36 25
TIGARD, OR 97224 [TAXI 8%State Tax 7/8/03 $2 90
Total $39.15
Phone : 503-670-9062
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 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
isIued By: k . 1' aaifi, / Permittee Signature: G.111 ��---Lh�
Call (503 .39.4115 by 7:00 P.M.for an Inspection needed the next business day
Building Fixtures
Plumbing Permit Application e Plumbing
Received 7 6 03 Permit No.: e t 01-a'.3 9
City of Tigard Planning Approval - Sit
13125 SW Hall Blvd. A Plan Review Other
Tigard,Oregon 9722 Date/By Permit No.. _-
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land use
Date/By:__ _ Case No:
Internet: www.ci.tigard.or.us ,....1.4... •)I' Contact ® See Page 2 for
24-hour Inspection Request: 503-639-4175Nanr/Method: - __ / Q'• Supplemental Information.
T TYPE OF WORK FEE'SCHEDULE(for 1 al Information use checklist)
New construction Demolition Descrlptloe Qty. FeHa.) Total
Addition/alteration/replacement 8 Other: New 1-&2-faintly dwellings
CATEGORY OF COJ STRUCTIQ_1V pae!ada 100 R.for each utility aaneetion)
• -1 SFR(I)bath__ I 249.20
.. 1 &2-Family dwelling Commercial/Industrial SFR(2)bath _ 350.00
Accessory Building Multi-Family SFR(3)bath 399.00
Master Builder Other: Each additional bath/kitchen 45.00
JOB SITE4FQI�MAT1ON ag11 T1Q1Y _ Fire sprinkler- ft.: Pale 2
Job site address: Ir, ) NIS I- +
Suite#: Bldg./Apt.#: -_- ('etch basin/area drain 16.60
Pio CCt Name: J Drywell/leach hne/trench drain 16.60
1 Footing drain(no.linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60_
Rain drain connector _ 16.60
Sanitary sewer(no. linear ft.) Page 2 _
Subdivision: #: Storm sewer(no. linear ft) Page 2
1 I.ot Water service(no.linear ft. Page 2
Tax map/parcel #: ai m ;} 7r.
Absorption valve 16.60
V.,Alkiat f.4tok‘' Mr ,e^ Backflowyreventer / Page 2 '
Backwater valve 16.60
Clothes washer _ 16.60
Dishwasher 16.60
�T Drinkij fountain 16.60
-• ' 1”-r i r• i, '"1; ',, ....,.•:i., Ejectors/sump _ _ 16.60
Name: (fa Loki Expansion tank 16.60
Address: 57ti (I.) rvlilk'4 QV _ Fixture/sewer cap_ 16.60
City/State/Zip: j; l t . 'i 1 Floor drain/floor sink/hub 16.60
(Garbage disposal! 16.60
Phone: J ' 1,210 - 10to•), Fax: _ Nose bit 16.60
11,i 1. 4_...l..".7, it _ k,a ,I ,., 1 b . ' . 4�. J Ice maker 16.60
Name: Interceptor/g-ease trap 16.60
Address: Medical gas-value: S - Page 2
City/State/Zip: Primer 16.60
y _ p _ Roof drain(commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan _ 16.60
;._..• --_--.._ _-_- Urinal 16.60
Business Name: water closet - 1660
- Water heater 16.60
Address: _ _ slier: -_
City/State/Zip: _ Other
Phone: Fax: ---- ., .
CCB Lic. #: Plumb. Lic.#: -- - Subtotal $
Minimum Permit Fee 572.50 S / gS:
Authorized �) Residential Backflow Minimum Fee$36.25 UtG
Signature: �. ""�e� pti2e: �Q Plan Review(25%of Permit Fee) S
State Surcharge(8•/.of Permit Fee) S e9 7{�
(Please print name) - TOTAL PERMIT FEE S • /
Notice: This permit application'spires If a permit Is net obtained within All new commercial buildings require 2 sets of plane with isometric or
ISO days after It has been accepted as complete riser diagram for plan review.
•Fee method,logy set by Tri-founts Building ladustry Service Beard.
i U)sts\Permit Forrne\PimPermitApp dere 0I/01
Plumbing Permit Application - City of Tigard - •
Page 2 - Supplemental information
Fee Schedule: Residential Fire Su2Jression Systems:
_ Site UtiliHaQty. Fee( .I "ttstli � quare Footage: --- Permit Fee:
Footing drain- 1' 100' 5500 0 to 2,000 _-- $115.00 -- - -----
Footing drain-each additional 100' - 46 40 2,001 to 3,600 S160.00 -_
Sewer-Ise 100' 55.00 3,601 to 7,200 $220.00 7,201 and greater S309.00
Sewer-each additional 100' 46 40 —
Water Service- 1st 100' 55.00 Medical Gas S stems: _
Water Service-each additional 100' 46 40 _Valuation: Permit Fee:
y_
Storm&Rain Drain- 1st 100' 55.00 S1 00 to$5,000.00 _ Minimum fee 572.50
Storm&Rain Drain-each additional 100' 46 40 _{ $5,001.00 to$10,000.00 $72.50 for the first S5,000 00 and$1.52 for each
1 additional$100.00 or fraction thereof,to and
Fixture or Item 7(M1_ IMA 1 including 510.000.00. -
Commercial Hack Flow Prevention Device 46 40 SI0,001 00 to 525.000.00 31411 50 for the first$10,000.00 and$1.54 'w
Residential Backflow Prevention Device each additional$100.N)or fraction thereof,to
(minimum permit fee$36 25) 27.55 _ and includin +5 000.00
Rain Thain,single family dwelling 65 25 525,001.00 to 550,000.00 $379 50 for first 525,000.00 and S1.45 for
.--- each additional 5100.00 or fraction thereof,to
Inspection of existing plumbing or
specially requested inspections-per how71 50 and including(50,0110.00.
Subtotal: 550.001 00 and up $742.00 for the lint 550,000.00 and 51.20 for
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 Performer Comments regarding fixture work:
Fixture Type: Replace
j., New Mored 31atlak^ ed_ -- --- - -
Baptistryl tint - — - - - -----
Bath -Tub/Shower
-Jacuzzi/Whirlpool y-_ -- -- -
Car Wash -Each Stall
-[hive Thru _ J — - ----------
Cuspidor/Water Aspirator -- --- - -- -
Dishwasher -4'ommerciat -- - ------
-Ihnneatic
Drinkin`Fountain _ -- ---- -- --
Eye Wuh .-- - - - - - - - - -
Floor Drain/sink -2"
Car Wuh Drain ~ *Note: if the fixture work under this permit results in fin
cartage -Domestic F
Disposal -Commercial increase of sewer F►lI;s. sewer permit will be Issued and
Induatri - 1 fees assessed for the sewer increase must be paid before the
Ice Mach./Refng.!Nets I plumbing permit can be issued.
Oil Separator(Ota Station)
Rec Vehicle Dutrtp Station _.
Shower -Clang ,- — -w. -.
-Stall _ _
Sink -Bar Lavatory_ __
-Bradley -4-
-('ommercial
______
-
•S-Service
Swimminj Pool Filter r
Washer-Clothes
Water Extractor
Water Closet-Toilet
Urinal
_Other Fixtures.
i\Dats\Permit Foran\FlmPermitAppPg2 doe 01/03
CITY OF TIGARD 24-Hour
BUILDING • Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST —
BUP
Received — Data Requested AM PM BUP
Location 2.1 S "— Suite . MEC q
Contact Person � 1 ll Ph( ) PLM .3 — -3 -!
Contractor —___ ._ _. Ph( ) _. SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation ACCAS3:
Ftg Drain xte,t,_1:621±_idivultet4evt..)1 ELR
Crawl Drain (�
Slab Inspection Notes: SIT
Post& Beam — c
Shear Anchors •
Ext Sheath/Shear loflt.C //?t) _—
Int Sheath/Shear
Framing
—
Insulation
Drywall Nailing —Firewall
Fire Sprinkler — ---- — —
Fire Alarm
Susp'd Ceiling —Roof
Other. 74)/161
FinalA
PASS PART FAIL
PLUMBING
Post 8 Beam
Under Slab -- --- -
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan g — --
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 LI Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hell Blvd.
PASS PART FAIL
g�E _ L_J Please call for reinspection RE: [_J Unable to inspect -no access
Fire Supply Line
ADA
Approach/Sidewalk pate Iwspsctor Mgt
Other
Final DO NOT REMOVE this Inspection record from th.Job site.
PASS PART FAIL