Permit CITY TIGARD PLUMBING PERMIT
1 DEVELOPMENT SERVICES PERMIT #: PLM2003 - 00262
` '- 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 DATE ISSUED: 6/10/03
SITE ADDRESS: 14617 SW 126TH AVE PARCEL: 2S109AD -10200
SUBDIVISION: MCCLINCY MLP2001 -00008 ZONING: R -7
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 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: Install irrigation backflow preventer.
FEES
Owner:
Description Date Amount
MATT CRINO
3 MONROE PKWY STE P [PLUMB] Permit Fee 6/10/03 $36.25
PMB 335 [TAX] 8% State Tax 6/10/03 $2.90
LAKE OSWEGO, OR 97035 Total $39.15
Phone : 503- 244 -0052
Contractor:
JOHN DARBY LANDSCAPE INC
13867 SW BENCHVIEW TERRACE
TIGARD, OR 97223
REQUIRED INSPECTIONS
Phone : 579 5298 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7110
PLM 12319LCL
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 Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (,503) 246 -6699.
Issued By: '&1-et C-,A— ) C-6 , -.6 PermitteeSignatur `, f, iC1 i,!,L
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building. Fixtures
Plumbing Permit Application Received FOR OFFICE USE ONLY
/ / , r '
Date/By: kid £6 Permit No.:
City of Tigard Planning Approval
Date/By:
Pennit 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 .
/iH,1h1�, ��, �, � i � , � *+, DateB
Internet: www.ci.tigard.or.us � Contact Juris.: _0 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ' __ Name/Method: Tail Supplemental Information.
_ - iiliZ,g TYPE OF ' VOA ., . `.. ' FEE *SCHEDULE (for special infor p0 use checkl t)
:l New construction ❑ Demolition Description I Qty. j Fee(ea) I Total
❑ Addition/alteration/replacement ❑ Other: .. - _ .. ncl�des Q� �aut�i ty �n"'n , ;:7i .
Aid .. k
A'�Cr+l t?Ft ! t ' ,� ' . 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/kitchen 45.00
.„ $ �.U' l t `RMVIA 1`IQ tip. 1ZON i.... _. Fire s irin1der sq. ft Page 2
Job site address: He S�Ui, l'� ��° . I : � ���, 3x',.° � g .�.`ytl�s.�,..��� � . � , t �4. �t. ,�,.,.
Bld ./A t. #: Catch basin/area drain 16.60
Suite #: g p 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: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax ma / • arcel # Water service no. linear ft. Pa :e 2
qe if 'r- ` -
�, °� l' • • • ' Absorptionvalve 16.60
. :7F 5Q U 0 (m
Backflow preventer Page 2
Backwater valve i 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
>: too • o o z ' - _ Ej ectors/sump 16.60
Name: I i ` /a, 14- Ntly 0 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
i . `�.. a • Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip:
Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
.., r,. ,.. ;_ . ' 1, -3 x Urinal 16.60
Business Name: n I ` a UC-‘1912-1---. Water closet 16.60
I : �. Water heater 16.60
Address: 1 CoCo L (,fi . 1 ' i - Other:
City /State /Zip: r W , a;('--) Other:
Phone Fax:
Subtotal $
CCB Lic. -III 0 Plumb. Lic. #: Minimum Permit Fee $72.50 $
Authorized Dat . (/ O -- Q J Residential Backflow Minimum Fee $36.25 3( , 0 -
Signature: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permif Fee) $ .cZd
(Please print name) TOTAL PERMIT FEE $ 7 . (`D
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:
Fa) , 44-tat. 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
additional $100.00 or fraction thereof, to and
,04,0437, 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
accuratel re ' ort fixtures could result in increased sewer fees *.
Comments regarding fixture work:
Ba•tis• /Font
Bath - Tub/Shower - - --
-Jacuzzi/Whirl. • .I - - --
Car Wash -Each Stall -_ --
-Drive Thru - - --
Cus • idor/Water As. irator - - --
Dishwasher - Commercial _ - --
- Domestic - - --
Drinkin: Fountain - - --
E e Wash - - --
Floor Drain/sink - 2" - - --
- 3" _ - --
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./Refri:. Drains plumbing permit can be issued.
Oil S .arator Gas Station _ - --
Rec. Vehicle Du t. Station _ - --
Shower -Gang - - --
-Stall - - --
Sink - Bar/Lavatory - - --
- Bradley - - --
- Commercial - - --
- Service - - --
Swimmin: Pool Filter - - --
Washer - Clothes - - --
Water Extractor - - --
Water Closet - Toilet - - --
Urinal - -_-
Other Fixtures: _ - --
is \Dsts \Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 63' ;175 0 M "'a
INSPECT:'ON DIVISION Business Line: (50 '63,- 7t
Received Date Requested A PM / �� '
q BUP
Location /47/( �'& /7 6 114 // Suite MEC
Contact Person Re CI" /Al v Ph ( ) 3/Z ? PLM ''' - /2.-
Contractor Ph ( ) SiOfr
UIL Tenant/Owner ELC
Footing
Foundation i ELC
Ftg Drain Access: gog
�/
jar — ELR
Crawl Drain
Slab Inspection Notes: ,� SIT
Post & Beam g7 / -���e /reef /a< y
Shear Anchors /G 41�4�rA 0- Ext Sheath/Shear '
Int Sheath /Shear -pLA, q L v
Framing �� � v'C/ Insulation g7 ` o / 2--3 (� & J
Drywall Nailing f U"' l
Firewall �I
Fire Sprinkler
Fire Alarm W ��- V . • ,
Susp'd Ceiling ,
R
•
oof 4 1 W GL r o P P r
PASS PART FAIL
U
Post & Beam
Under Slab
Roush -In
-- Se - - (\--ZS)
Sanitary Sewer — - b/ /c)-3
Rain Drains ✓l
Catch Basin / M. ' ole i * ‘
Storm Drain
Shower Pa
Ot -
I inal , q ,-- vs X ---(sCi S _-Q. - --t--V:-0—Q 0 L.A...42:_e_af
SS PART FAIL
L
Post & Beam C �� - -7-7/1/C Rough -In (-.)
Gas Line
Smoke Dam � C-74) -
Dampers
e.. p _ /ne /
49 PART FAIL
RICAL
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 ,a � `� � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
FROM : JOHN DARBY LANDSCAPE IN FAX NO. : 5035246613 Oct. 22 2003 09:02AM P1
FIRE EXTINGUISHER SVC CENTER INVOICE #: 1.451_
3460 SW 209TH BEAVERTON OR 97007
BEAVERTON (508) 6433309 VANCOUVER (206) 695 -9371
EAST PORTLAND (503) 231 --053$ TOLL FREE: (BOO) 234 -7317,
ACCOUNT NUMBER: SERVICE AOORESS:
0.51 045E50
JOHN DARBY LANDSCAPING RESIDENT
13867 SW BENCHV.IEW TER 14617 SW 126TH AVE
TIGARD OR 97223 TIGARD OR 9722:3
TERMS ::: N E'"1- Vii,.
i
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INVOICE DATE TELEPHONE CONTACT PERSON PURCHASE ORDER
05/17/03 503- •579 --5298 JOHN DARBY
QTY. DESCRIPTION PRICE EACH TOTAL.
P'E RIFTORMEDC)
BACK FLOW TESTED $ 37.50 $ 37.50
COMPLETED BY:
•
1417 DOUG
c r "4 IL.. ArioluNir o
Ea 46
PEAS REMIT TO: P.O. BOX #1391 - BEAVERTON, OR 97075 -1391
TO INSURE PROPER CREDIT PLEASE INCLUDE ACCOUNT NUMBER ON PAYMENT
THANK YOU FOR YOUR BUSINESS