Permit CITY TIGARD PLUMBING PERMIT
: 'I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00064
� - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/26/03
SITE ADDRESS: 09425 SW 74TH AVE PARCEL:. S125DB 12000
SUBDIVISION: PP1990 -008 ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Replacement/repair of (9) plumbing fixtures. Other fixtures are (1) sump pump and (2) hose bibs.
FEES
Owner:
Description Date Amount
KRAMER, TIM J + RUTH M
9425 SW 74TH AVE CITY OF TIGARD MEI` 2/26/03 $149.40
TIGARD, OR 97223 [TAX] 8% State Tax 2/26/03 $11.96
Total $161.36
Phone :
Contractor:
NORTHWEST WATER WORKS
40110 SE MEADOWSONG RD
SANDY, OR 97055 REQUIRED INSPECTIONS
Phone : 668 Rough -in Insp
Top -out Insp
Reg #: LIC 113197 Final Inspection
PLM 3 -333PB
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
Iss d By 1 p � �` Permittee Signature: G c
N.
Call (503) 6 9 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Pluin Sing Permit Application Received • FOR OFFICE USE QNLY
Plumbing i
Date/By: 2 AN 3 Permit No.: eilbet3-410eay
City of Tigard Planning Approval
Sewer
Date/By:
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 ite1160 i tt Post Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us „itll' Contact Juris.: 0 See Page 2 for
24-hour Inspection Request: 503-639-4175 -"---" Name/Method: Supplemental Information.
:1;::.c. 4.: ,, :,,i f'.47'„,T:' rYPE OFWORK, :!;,:".‘i( . ,, - ."-:; I . : j ,':EEE:cSCHEISM (0-7siiecialliiifOrliiiiiiitOISerelieCkliiV*,=::
[II New construction 0 Demolition Description I Qty. I Fee(ea.) I Total
. ,
i lgAdditiordalteration/replacement 111 nil
Other: ,A,:fei.:.,, .,.,;;,,,,„:,: ,;!,,, iNeyy 144 ;-=farpily clrellipgs,,p
. .",.".:(ideli,cieiaitid ii. for aiif * c onnection)
eATEGORYOF CONSTRUCTION . , ',,, 7 ' '' ; . ' : 4:
SFR (I) bath 249.20
jEfl & 2-Family dwelling Ell Commercial/Industrial SFR (2) bath 350.00
EAccessory Building 111 Multi-Family SFR (3) bath 399.00
El Master Builder El Other: Each additional bath/kitchen 45.00
::' I_INFORMATION'arid LOCATION ,:):;;: ,!:1:;• ,; Fire sprinkler - sq. ft Page 2
Job site address: e i o , ,id 79 it, :,, ,,,.., :
Suite #: Bldg./Apt.#: Catch basin/area drain 16.60
Drywell/leach line/trench drain 16.60
Project Name: 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: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map/parcel #: . T r,fiiiiii
DESCRIPTION OF WORK :' ,....." ..== ':' . - : ,
Absorption valve 16.60
deg 17. 9 1 I , - . 5 7"-- Backflow preventer Page 2
Backwater valve 16.60
Clothes washer / 16.60
Dishwasher / 16.60
Drinking fountain 16.60
lg OWNER :a .;4 : , El .TENOITt; 0:i1 ..-. 1: Ejectors/sump / 16.60
Name: 7 it (L,,..ta, 14,,z2„,,n,c,- Expansion tank 16.60
Address: -Y't-/ 26 5, 14/, Vii ./j Aye. Fixture/sewer cap 16.60
City/State/Zip: .- r; /-,-/ , 0 11 ? 72-23) Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone:5D 3 - -i-Yi; --Li 1 7-1 'I / Fax: Hose bib . 2-- 16.60
APPLICANT ; -;7 "":"',-,, . PERSON,'S, -,,-," Ice maker 16.60
Name: Ce&I'/ 6-7-kr ,' Interceptor/grease trap 16.60
Address: 30.5 t PC&IAA&/(1 Medical gas - value: $ Page 2
Primer 16.60
City/State/Zip: ( (2 (Z (-- '703 D
/. Roof drain (commercial) 16.60
Phone: S3 -6 - & Fax: 5'03- 6 7 - 9'( 7, sinklbasinllavator f 16.60
E 6e-C% 1 fe> 1 ii&wle_ Au_ I a e , Co- 2 v 1- Tub/shower/shower pan / 16.60
CONTRACTOR,' ,i, ; ' F;;.,d, ;.',. '''' ':::., Urinal 16.60
Water closet / 16.60
Business Name:Ai/pi/ 0.57
Water heater / 16.60
Address: /// St /noS0/4.1 Ri- Other:
City/SIate/Zip:S 0 2 5:5 Other:
Phone: a g 0 z 1 ? ._.• Fax: ICS 03 7_5 ,...,.!: ,:,- •„PlUitibin'g: OCriniiFee's
b t $ / q q • 1 /0
CCB Lic. #:// 3 /1 7 Plumb. Lic.# 2 7/.74 Minimum Permit Fee 2o $
Author / rZ ,, Residential Backflow Minimum Fee $36.25
Signature: .‹.) Date: Plan Review (25% of Permit Fee) $ .---t
State Surcharge (8% of Permit Fee) $ //. 94
(Please print na e) TOTAL PERMIT FEE $ /(4 / 30
Notice: This permit application expires it a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\Dsts\Permit Forms \P1mPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard Y 4
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
'Site U_tihttes Qh Fee (ea) Total 5 Square "Footage:" .; Permif Fee
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation :A, ' PermifFee
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
F e e e a Total : additional $100.00 or fraction thereof, to and
Ftxture�oc;itemx, ,,,, e, n Q 1 y (., ,,,,,,_ __ including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $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.
specially requested inspections per hour 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 *.
Comments regarding fixture work:
g g
F�xtur -e Type _ Re aee ,
a Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi /Whirlpool
Car Wash -Each Stall .
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4 „
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\P1mPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • Business Line: - (503) 639 -4171 MST
BUP
Received Date Requested °? AM PM BUP
Location �7 7 7 '' Y Suite MEC
Contact Person Ph ( ) '7 3- 0 ' 7o PLM 3 - oo 0 6 L(
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing •
Foundation ELC
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
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
RT FAIL
/
P MBI
eam
Under Slab
/
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot - - :
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 ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line /,
�
ADA Date V //)/0� Inspector , / Ext
Approach/Sidewalk v
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hou
BUILDING Inspection Line: x (503) 639 -4175 MST
INSPECTION DIVISION Business Lines (t03) 639 -4171
BUP
Received Date Requested 3 7 AM PM BUP
`7`.z
— Location 3 7 '�- Suite MEC
Contact Person 41 Ph ( ) 7 �! 3 / 83 a 1- 0 Ca
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 41V 3 -Zo Q 9'
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
d l�l s/ 0 �- 5 ''C .e r ELR
Slab Inspection Notes: SIT
Post : Beam
Sher An or
:h=uh/: ear
' hear
•
fi 4ciiii
' /� u T ailing /' �/ � v r J
Fire Sprinkler "
' Fire Alarm
\ Susp'd Ceiling
Roof , 1 2 1 (.'. L/ 1 7 LI
Other:
• F
I '>P _7 • a FAIL •
aggim
-o •; •m -
` Under 7ice — W
ug � � a er
Sanitary Sewer ` /� �''�
Rain Drains 7 i /
Catch Basin / Manhole
Storm Drain
Shower Pan f
Other:
Fin -
PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
FAIL
as
Low Voltage
Fire Alarm
Fi ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
$■ „ n Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line ✓�
ADA \A-I Approach/Sidewalk Date � \ \ 1 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lbe:_(503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 3 AM PM BUP
Location / LI a -C 7 Suite 411 000
Contact Person P' Ph ( ) � 3 I ? 3 - -- PL - ocro
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
•
Drywall Nailing / t
Firewall
Fire Sprinkler `��
Fire Alarm -/ 1m1
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
• 0 FAIL
I I i.M'
OCt , am
Oug_ h -I
Gas Line
Smoke Dampers
Fin
PART FAIL
ECTRICAL •
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 Please call for einspection RE: Unable to inspect — no access
Fire Supply Line )77.7�
ADA '�' Inspector Ext
Approach/Sidewalk Dat
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD HERMIT #:
BUILDING DIVISION ATE ISSUED:
13125 SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639 -4171 �i `' " , -8
Inspection Requests (24 Hrs.): (503) 639 -4175 .-' � "'
INSPECTION WORKSHEET FOR DATE: CFi \ o�j_;TIME: �"� +t co (/ _ . n PAGE:
t
` 1
l �f 1
SITE ADDRESS: �''f �� SW C CLASS OF WORK:
SUBDIVISION: . LOT #: TYPE OF USE: 1
PROJECT NAME:
DESCRIPTION: /14.
OWNER: 0_,I f51 010■ PHONE #: 9.05 qJ 3'9
CONTRACTOR: c n PHONE #:45_ g1 Li ,3 ( 2
Inspection Request Scheduled For: Date: I 1 ( _0( Pour Time:
Code # Inspection Description Confirm # Contact # Message
• Corrections /Comments /Instructions:
i1/4761-11•01{--------- 1 ` FLS 95 )
.t
f i I
■
■
❑ PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR REINSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: / ( Date: /7 / / lb (. Phone #: (503) 718- 2
/'
i :\Building\IVR\IVR- InspWorksheet- BlankForm.doc 03/02/2005