Permit CITY TIGARD PLUMBING PERMIT
Aki DE VELOPMENT SERVICES PERMIT #: PLM2003 -00336
'�°'` o DATE ISSUED: 7/10/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14835 SW 103RD AVE PARCEL: 2S111CB 00400
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 90 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 90' of sewer line to connect existing house to sewer lateral. Septic tank is to be pumped, filled
and inspected.
FEES
Owner:
Description Date Amount
MCNIERNEY, CHRIS & LISA
14835 SW 103RD AVE [PLUMB] Permit Fee 7/10/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Tax 7/10/03 $5.80
Total $78.30
Phone :
Contractor:
LOVETT EXCAVATING INC
17385 SE TODD LN
GLADSTONE, OR 97027 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 503 - 504 - 2847 Insp existing /capped fixtures
Reg #: LIC 125507 Final Inspection
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 ad 1 a td-by the I regon
1
Issu d By: j�_� G���� Permittee Signature: A w A
Call (503 639 -4175 by 7:00 P.M. for an inspection needed the • xt business day
Building Fixtures
P umbing Permit Application FOR OFFICE USE ONLY
Received Plumbing
Date/By: .7 /U G� Permit No.: a r `5 -e -;o
Planning Approval Sewer
City of Tigard 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 Post Land Use
Ganriv�N1 J � ° ( Contact Case No.: II Internet: www.ci.tigard.or.us .' I 1 Contact Jys,q- ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 -- Name/Method: /C Supplemental Information.
I. l F ,.,
TYPE OF WORD i 4:, .3x r ; . ', '''e FEE* SCHEDULE (for special information use checklist)
Li New construction ❑ Demolition Descri i tion Qty. Fee(ea) Total
ddition/alteration/re.lacement Other: x i* ;°
! . ' t I 9 CONSTRUCTION x: .. g„ ; � SFR (1) bath 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/kttchen 45.00
Pa :e 2 •
i g l � ; �, t }. � .I Fire sInnkler s• . ft
Job site address: / g 35- 5 G A 03 r E x ,
Suite #: I Bldg./ pt. #: Catch basin/area drain 16.60
Project Name: Drywell /leach line /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.) y (f Page 2 ■
Subdivision: I Lot #:
Storm sewer (no. linear ft.) Page 2 ■
Water service (no. linear ft.) Page 2
Tax ma. /• arcel #: or � '
.
z A E is b aw , Mum iteIq. E .,
5 Absorption valve 16.60
S .Q ( r r)N ae i (sy Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
i. _ 1 r'. . 'e?' . . ;.. ! - Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
D., ¢ri i i ,,` ! :i :: " Ice maker 16.60
Name: ov-e -1--T & 2c C O < 1 w Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: ( Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
r = ' » Urinal 16.60
� 16.60
Business Name: L r o V J l - r4 Wat closet
Love � Water heater 16.60
Address: 2-92 c,.5 A� f /-e . Other:
City /State /Zip: G-►- aw , (4 71j gO Other:
Phone: J) / -2 S`/7 Fax: 0 - -6 `3 .__ ,r, h m Ii :. ' .,,_. ,.
Subtotal $
CCB Lic. #: /25 Plumb. Lic. #: Minimum Permit Fee $72.50 $
uthorized Residential Backflow Minimum Fee $36.25
Signature: Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $ 7 Q - 38
Notice: This permit application expires if 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\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
:Site Utilities Qty., F (ea) Total Square Footage: Permit 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: Permit Fee:
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
a additional $100.00 or fraction thereof, to and
Fixture or Item Qty. ;„ Fee' (ea) Total 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 *.
Quantity by (Fixture)" Work Performed " Comments regarding fixture work:
Fix Type: keplaae
New Moved , -. Eaistlri 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"
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic increase of sewer EDUs, a sewer permit will be issued and
Disposal - Commercial
- 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: _
is \Dsts\Permit Forms\P1mPermitAppPg2.doc 01/03
" AliLLPUMP SANITATION SERVICES
Dalko Corp.
E 191
13023 NE Hwy. 99 #7 -
Vancouver, WA 98686 -`_
(360) 887 -2969 Port. (503) 285 -5838
C CUSTOMER'S ORDER NO PONE DATE 1
Lt ti - 5' ZSb / ICY!) 3 ,
NAME
1,_8 ve., - E_� C � 4
ADDRESS
t L k 35 5 4 ro3
t(ccor() D 6R
SOLD BY ASH C. I CHARGE i ON ACCT. MOSE. RETD I PAID OUT
7
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QTY. DESCRIPTION PRICE AMOUNT
1 4 S. I r
I
4 .
i -, ,
PayORIIiis inVOiCe.
NET 30 days. A fire charge of'1 % per month
Cr 96 per Kati) wip Ke c#i2rgerl on unpaid balances. — AZ
CoMection fees w81 be assessed ff necessary. TAX .
RECEIVED BY
TOTAL
,vim
All claims and returned goods MUST be accompanied by this bill.
':; ,x<..s,F; loll
CITY OF TIGARD 24 -Hour
BU4LDlNta Inspection Line: f503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 AM PM BUP
Location 7 3-S Ce-L% - Suite MEC
Contact Person Ph ( ) PLM ?L b 6 3 3 '
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
Post & Beam
Under Slab
Rough -In
W
arter
- am Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin.
dig r. PART FAIL
CHANICAL
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 El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA p
Date l �� Ins ecto/? 6 7 Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL