Permit CITY TIGARD PLUMBING PERMIT
l l DEVELOPMENT SERVICES PERMIT #: PLM2003 - 00573
agal s �' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/4/03
SITE ADDRESS: 14130 SW 105TH AVE 001 PARCEL: 2S110AA-00200
SUBDIVISION: CANTERBERRY TERRACE APTS. ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R1 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: Install irrigation backflow.
FEES
Owner:
Description Date Amount
OHANESIAN, LEE + DONNA
c/o SKL PROPERTIES LLC [PLUMB] Permit Fee 11/4/03 $46.40
P 0 BOX 230703 [TAX] 8% State Surchaq 11/4/03 $3.72
TIGARD, OR 97281 Total $50.12
Phone :
Contractor:
SHOWPLACE LANDSCAPE SERVICES
PO BOX 746
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 503 - 682 - 6066
Final Inspection
Reg #: PLM ALL PHASE & BAC
LIC 3130
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
Issued B Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection nee e next business day
Buildii !ures
Plumbi 1 erm' tittlifv gry Received FOR OFFICE USE ONLY
Bed a Plumbing
Date/By: /( /`f/D3 6P., Permit No.� -� aUo -'�573
City of Tigard Planning Ap ova Sewer
`J g � O� 4 2003 Date/By: Permit No.:
13125 SW Hall Blvd. `t J Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 50tjlq- QTsWIGA"u r, Post - Review Land Use
Internet: www.ci.tigard.or.us BUILDING DIVI'
NCI s i I Date/By: Case No.:
Contact Juris. ® See Page 2 for
24 -hour Inspection Request: 503 - 639-4175 " ; Name/Method: I I LA Supplemental Information. 1
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
Addition/alteration /replacement ❑ Other: New 1 & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft for each utility connection)
❑ 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (1) bath 249.20
SFR (2) bath 350.00
Accessory Building 31 Multi- Family SFR (3) bath 399.00
El Master Builder Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: _ Page 2
Job site address: ley 130 f O S7"` XJ G Site Utilities
Suite #: Bldg. /Apt. #: ,4 /f Catch basin/area drain 16.60
m Drywell/leach line /trench drain 16.60
Project Name: �'G jar
y Al�1� t Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
1 t ` M I 1 Manholes 16.60
Sojr4 U� I "Cv"'� I,,, , ( d Rain drain connector 16.60
F 1 . 547 -- Gfr, r os Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK Fixture or Item
/ Absorption valve 16.60
ynt _!iT Sy5'T?N'I lo4Clt 2 / - O&) Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
0 PROPERTY OWNER _1 El TENANT
Drinking fountain 16.60
Ejectors/sump 16.60
Name: j& p', ',cc Expansion tank 16.60
Address: Z 3) �1f�f l j y tat P Fixture /sewer cap 16.60
City /State /Zip td / k l , . 21 Floor drain /floor sink/hub 16.60
3 2 O I O ' l Garbage disposal 16.60
Phone: Fax:
Hose bib 16.60
['APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City /State /Zip: Primer 16.60
Roof drain (commercial) 16.60
Phone: 1 Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR r Water heat h Urinal 16.60
Business Name qt -1 CI 4J Ct1PC .5-taice7 Water eat 16.60
er 16.60
Address: 60, � , 7 Ye Other:
City /State/ f p: Ir •, ,// CA 7076 Other:
Phone:$ ? CV • ( Fax:5b3 eV -C Plumbing Permit Fees*
Subtotal $
a CB Lic. # �� Plumb. Lic. #: /�W Minimum Permit Fee $72.50 $ /,
uthorized - Vi Residential Backflow Minimum Fee $36.25 L/ �� )
5 7f Signature: Date: f // Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ Z 7 1 -
(Please print name) TOTAL PERMIT FEE $ •j () / ,--
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.
is \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. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l' 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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total including $10,000.00.
Commercial Back Flow Prevention Device 1 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour _ 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 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 (Future) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved 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
Garbage Domestic *Note: If the fixture work under this permit results in an
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 \PlmPermitAppPg2.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 U /D `L`h uite MEC
Contact Person 92S.1411t- Ph ( ) 7? 3 (.5 PLM 3 .O6 5 7 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain 6
Slab Inspection N. SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ����� �� .4110
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
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 El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspector I - 2 / Ext
Other:
Final ' O NOT REMOVE this inspection record from the Job site.
PASS PART FAIL