Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00279
All DATE ISSUED: 6/19/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14226 SW 132ND TERR PARCEL: 2S109AB 09300
SUBDIVISION: RAVEN RIDGE ZONING: R -7
BLOCK: LOT: 022 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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Add bathroom plumbing to finish basement.
FEES
Owner:
Description Date Amount
MARC MOORE
14226 SW 132ND TERR [PLUMB] Permit Fee 6/19/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Tax 6/19/03 $5.80
Total $78.30
Phone :
Contractor:
DMS PLUMBING INC
12602 NE 28TH STREET
VANCOUVER, WA 98682 REQUIRED INSPECTIONS
Phone : 360 Rough -in Insp
Final Inspection
Reg #: MET 00002458
LIC 80744
PLM 37 -271PB
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
9
Iss d By: ` 4 �� i �, - f I ' Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi -ss day
Bunning r ixtures
Plumbing Permit Application FOR OFFICE USE ONLY
M Received / Plumbing
Date/By: 4// ' 7 7 !03 Permit No.: r a l o o -' 7 ?
City of Tigard Planning Approval Sewer
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/13y: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
//ei �
Contact ase No.:
Internet: www.ci.tigard.or.us ■ o f I I t':
Contac 7u ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ` " " "' �" Name/Method: 7 i9 Supplemental Information.
' :,4 ` " =�'. . � >" ` `i =��� . • " ° FEE'°=SCHED 01 fors . eciAt inform Lion. as� likg1ht ° M
; ∎, r,� . -� ._ a. � ��� =t.= �....TvYRE,OF,�WORK..��` -� , ���q �,,. ���, -.:� "• � _,: ,. -,. -ti_ _ _�.. ...._ :�. _ _ , r � __v � .. _ - - _� __._..... _ _� _.. _. �).��� -� .
I ITKrew construction ❑ Demolition Description • - I Qty. I Fee(ea.) I Total
Addition/alteration/replacement Other: ;� • -�r ` '• °' 'New'.i° 8&, a
= fi`itily dwellings,
„k "r ` `' C�►TEGORY OF CONSTRUCTION" „ ': ; � (i n cl ud es100 i ft ,f M' '�„ s•
U 1 & 2 Family dwelling ❑ Commercial /Industrial SFR () bath 350.00
SFR (22) bath 350.00
❑Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
`4, a0B >SITE INFOIRMATIONIarid41LO :CATION' : , „' .._ Fire sprinkler - sq. ft.: Page 2
Job site address: / ��--6 Sc0 /3). 7 #-)' ' x ':. , ' ` ' ` ' . v..":Site Ut'ilities' x i° : d .t ,;N
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Pro ect Name: Ce Drywell/leach line /trench drain 16.60
j !K(jpYG � P� � Gi fin Footin • drain no. linear ft. Pa• e 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
Tax map /parcel #: Water service (no. linear ft.) Page 2
"';,:` •� ns-''�e�', s r..x,.., : ^`, %- ;: , r<;;5^� r�'y '' ' . ��£1 " .,; „
' �t . i ^::V °'�DESCRIPTIONs.OFiWORK 4 , , s ...�.... ,. n .. .
`���..�.�.._ =� v� t y � Eixture''oraItem .�
Absorptio valve 16 60
7i7tr l C P34eh1 Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
afaci ERTY'OWNEaki :; : ® TENANT"` ' `„i •� ". ' "
' � � `� "� - �d °�' `'` ,
� - �« Ej ectors/sump 16.60
Name: /L(Qi i ir.z- c /5!o spore$ Expansion tank 16.60
Address: e_ . Fixture /sewer cap 16.60
Clty/ .tats /Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Ph e: Fax: Hose bib 16.60
*ARPLIC -M4V,, ,_ : :." : ,i ® „CON.TAC MIZS' ON °i =:: 4 Ice maker 16.60
N ame: e1Je -r rrep;iL e /7K= • / hr,S LeC Interceptor /grease trap 16.60
Address: (< 0 5t) ,g /r ,isl_. .p7 . Medical gas - value: $ Page 2
•
City /State /Zip: T(Sd 3 Roo urer ro( a /72 P ) 16.60
of drain c ctal 16.60
Phone: c o,3 ) 307-- 7(/ 7 Fax:,( -a3) s 79.t7 77,x' Sink/basi vato / 16.60
E -mail: Tub /shower /s ower.pan / 16.60
' a '` 1. * , 5 T .CONTRACTOR ° ,,, a';xa r. {_.,> . • ... Urinal 16.60
Business Name: ph,f,„,h� water closet / 16.60
Water heater 16.60
Address: /.z /iJ z6tl (¢ . Other:
City /State /Zip: t4ncouvo./ 11J/ 9 6x'2 -- Other:
Phone: i 360) yea 4z /3 Fax: 6o) -'s3 i .�� ,, °i < � � tenVAN����° �°
�..� .,,, ,�.�k. . � �:_ PlumbtngPermit�Fees:•., ���.�`�.��,,�.���:
CCB Lic. #: 007 , Plumb. Lic. #: Subtotal $
Minimum Permit Fee $72.50 $ .7 , , `J Q
Authorized o� 37 - - /Pd Residential Backflow Minimum Fee $36.25
Signature: �� .,, �� S Gv
Date: l Plan Review (25% of Permit Fee) $
d� ve • )v1S oYl - 9I 3t i State Surcharge (8% of Permit Fee) $ 6 . $ 0
(Please print name) TOTAL PERMIT FEE $ 7 g , o ()
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:
Situ blip e q n = Fee= ea
:u ;��,•.z „U N es?,,�..,� ,_. �,��� ��:Qty�� � ;t. )'��
Footing drain - 1' 100' 55.00 0 to 274300- • $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 Valuatlont;� ° '� � ' P.erlriitvFeet= .
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
s ;" " EFixtai a or Item aN" ,: Feed ea ,A ":Total additional $100.00 or fraction thereof, to and
tR �.� QtY,:. s,� 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
Subtotal: $50 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 *.
_ (F �xtui - e) Work Performed';.: Comments regarding fixture work:
F�Xture ype e a_ ( F ; r. Replaee �
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: .
is \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 a I AM PM BUP
Location / c/ 22, (7 / 3 7TN Suite Mi 75- 66 33
Contact Person Ph ( ) 3 0 71(7 41 3 - CO cP 9
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC - 00 370
Footing ELC
Foundation Access: Q C
Ftg Drain 1 `
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
PASS RT FAIL
U■BI
Post & Beam
Under Slab ?
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
d Oth�er:
PART FAIL
miq•arl. L
Rough -In
Gas Line
Smoke Dampers
r ;,;41: ; ,,, PART FAIL
Service
Rough -In
UG /Slab
ct Volt e
Fire
`:%
PART FAIL � . Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line,
ADA (g /2' 7/
Approach /Sidewalk Date v Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
lr