Permit CITY 'TIGARD PLUMBING PERMIT
l DEVELOPMENT SERVICES PERMIT #: PLM2003 -00484 - - All SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/16/03
SITE ADDRESS: 11030 SW 106TH AVE PARCEL: 1S134DA -00800
SUBDIVISION: NORTHERN PINE ZONING: R -4.5
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 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: Conversion of water heater from electric to gas.
FEES
Owner:
Description Date Amount
RICHARDS, JOHN A + JULIE A
11030 SW 106TH AVE [TAX] 8% State Tax 9/16/03 $5.80
TIGARD, OR 97223 [PLUMB] Permit Fee 9/16/03 $72.70
Total $78.50
Phone :
Contractor: nn
E/`-,
REQUIRED INSPECTIONS
Phone : Rough -in Insp
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
Or
ued By: ' /4tid'ud! Permittee Signature: ` o
C • 03) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
Received ,..,
Date/By: / ' / 6 Permit No.: ' 0' 1, } 4 1 1' j --C (_/, /
CI of Tigard Planning Approval Sewer
`J g 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- Review Land Use
I /yi gelll' r' �A I ry�l �,h Date/By: Case No.:
Internet: www.ci.tigard.or.us • '
Inspection Request: 503- 639 - 4175 ` " " "�
Contact J � Su See Page l n for
24 -hour Ins
p q Name/Method: ' (r � Supplemental Information.
t - 4 sv iA " _ .... ; q .t 8 a . : r a aer a r as Z fps < �a
11] New construction ❑ Demolition Descri • tion Qty. F ee ea. ( )� "�
Total
❑ Additlon/alteration/ s lacement ❑ Other: c. 7 . , : , 2 , : r : ; 45,..L i tili, I t ' w4 1 . ,,, A ' ' ' )411 .. ," 17 . c i .7. i r1 1 -6.* - 7 i - : : : i i:1-4 2 .:' : i : : : : ; 4 : 1,: Pi , -', , 47,t ri
El 1 & 2- Family dwelling ill Commercial /Industrial SFR (1) bath 249.20
SFR (2) bath 350.00
❑Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
t !'_' . s .', ' xn Fire s.rinkler - s•. ft.: Pate 2
Job site address: k `' ° = _, ��t
t(O � (� IC��R - . ��� basin/area drain 16.60
t �� }
Suite #: I Bldg. /Apt. #: I Catch
Project Name: Drywelllleach line /trench drain 16.60
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: I Lot #: Storm sewer (no. linear ft.) Page 2
Water service no linear ft. Pate 2
Tax map /parcel #
,', ` 1 t.' °` " r . ;%. Absorption valve 16.60
� Backflow preventer Page 2
C-bN d - -- G&S Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
" 11 " Ef Zt 4, Vi a, * ,. . _ '^ 7 . Ejectors/sump 16.60
N. e: J F (CAA �5 Expansion tank 16.60
Address: < (t_Dv 4v3 hail l^ J4 JE Fixture /sewer cap 16.60
City /State /Zip :116 .. > Ca. q7 2-2) Floor drain/floor sink/hub 16.60
Phone: , s/ i Garbage disposal 16.60
hone:
(h (Q 3-- FaX Hose bib 16.60
: g ' ' ` 1 ` 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: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
Urinal 16.60
Business Name: ` Water closet 16.60
Address: OtC/ E Water heater / 16.60
Other:
City /State /Zip: Other:
Phone f Fax ` _ radii, _ u s._ `. .s
A Subtotal $
CCB L1C. #: P b. L1C.#: Minimum Permit Fee $72.50 $ 7
O` n �j
S
Authorized Residential Backflow Minimum Fee $36.25
Signature: at, \ Date: (-1-(16(0,3 Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ 5, ea
(Please print name) TOTAL PERMIT FEE $ 7e. . ?p
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 Su . s ression _S stems:
....; ter,, >, s=°
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
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
b 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 .ermit 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
and including $50,000.00.
s.eciall re.uested ins.ections - .er hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first 0 0 and for
each h additional $10 $100.0.0 or fraction or fraction thereoereo f.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accuratel retort fixtures could result in increased sewer fees *.
A . ;, m ; , „ Comments regarding fixture work:
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\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 / 7 AM PM BUP
Location / A O / 7 l l ) / 6 " '4 Suite MEC 3 - 00 5-40 - 5- -a( O S
Contact Person ( 2 1 J€ Ph ( ) WfS PLM 3 -- Q
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ` , � / ELR
Crawl Drain
Slab Inspec / "o ' Notes: - SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
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
Othe •
S PART FAIL
MECHANICAL —
Post & Beam
Rough -In
Gas Line
Sm • . - P ampers
PART FAIL
- - -# TRICAL
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: Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector /7 Ext
Other:
Final DO OT REMOVE this inspection record from the job site.
PASS PART FAIL