Permit CITYbF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00247
411 DATE ISSUED: 6/6/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S104DD -03100
SITE ADDRESS: 13894 SW AERIE DR ZONING: R -4.5
SUBDIVISION: EAGLE POINTE LOT: 022 JURISDICTION: TIG
Project Description: Bathroom remodel.
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SMITH, JAMES N + JULIE A Description Date Amount
13894 SW AERIE DR
TIGARD, OR 97224 [PLUMB] Permit Fee 6/6/2005 $72.50
[TAX] 8% State Surcharl 6/6/2005 $5.80
Phone : 503 - 579 - 8193 Total $78.30
Contractor:
SILVER MOUNTAIN PLUMBING.INC.
14735 SW BONANZA CT. REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97007
Phone : 503 - 644 -2123
Reg #: LIC 156766
PLM 34 -426PB
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 503-246-6,09 o 1- 800 -332 -2 • • .
Issued By: • ,t ,2/ L Alb Permittee Signature: i JLL . . A i
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM : MARINO DESIGNS FAX NO. : 5794021 Jun. 06 2005 07:19AM P1
Building Fixture r -7r/ ` '," ` > ".`'.
Piumbina Permit App 'cation FOR OFFICE USE ONLY •
Re ceived ///��1
3 SW 1 B l vd �U 06 2005 b s� / A romp 19 .947 -9__ 1 � y 7
13125 SW all] Blvd Tig rd, OR 97223 • Dstcrtf ry / )
I De, Y 1Cw
Fhonc: 503.639.4171 Fax: 503.596. TY OF TIGAR
�.n., x1� , Omer Ycrntil No.:
24 .. Hour In section Line: 503.639.41 ��'II�
Internet: www,ei.ti a rd.or.us u ILDING DIVI �_ :A - II. D•rm t ed /Me ll y : 0 See Page 1 for
g Notified/Method: Supplemental lnfOnnaliOn
:Xt' . ' fSF. . y ).Rte 1 (
1,3 New construction ❑ Demolition
For .rpecid! information nee checklist
Dcscri lion T Qty. Ea . Total
-1 Addition /alteration/replacement CI Other: New 1- 2- family dwellings (includes 100 R. for each utility connection)
' . <.;`•. igAGAAT giigt.40.0 iF. ::_ _t :f •_' Sv :v:.• ?;'' SFR ( 1) bath 249.20 •
::, :.>'� : : :...' <� , :. �ri .- • <1: _.:;rn... � .:..: fi: ^J._K.. :...i ` ..:a 2w �,: : :�>�.' t : : :.� : T _..._: I::r': 'Y.'. w.
C F I- and 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
y l a - - n 5 fire sprinkler c____, sq. ft) Page 7
i. : 'F AP :7 A ,A,-.t ii0 1 i3G s' (}-� 7 ,,,, a :...
.. r '$r'r.`,i' .��.� .� ,�<_..ec� :t:F.�c ��,'ut�?+er:
site uSiities
Job site address: 3 8 • Li t,i) ,4 er , r - Catch basin or arca drain _ _ 16.60
•
City / State/ZIP: - A r ' 0 a • a ® Drywall, leach line, or trench drain 1 t,.60
•
Suite/bldg. /apt no.: project name: • Footing drain (no. linear ti.: ) Page 2
ilea
Manufactured home utilities 110.00
Cross street/directions to job site: ..._ .
Manholes 16.60
-
Ruin drain connector 16.60
Sanitary sewer (no. linear ft.: �) Page 2
Storm sewer (no. linear ft.: ) Page 2
EE 1 inear R.: J) Tax map/parcel no.:
valve 16.60
1 0 Backflow prey enter Page 2
IN • . ' aa '4, rAftDO Backwater valve 16.60 _ --
Clothes washer 16.60
Dishwasher 16.60
y • n a Drinking fountain 16.60
Ejectors/ sump 16.60
Name, S L ' if Expansion tank 16.60
Address: 13 S q(-1 S IA.) A e r t e Dr_ Fixture sewer cap - 16.60
City/State/ZIP: '"r 3 0 , ) • . • "7 a Floor drain/floor sink/hub __ 16.60
Phone: (ij_1
6 - a I F ax: ( ) Garbage disposal 16.60
•• • _._ ��•.. - ;......" ::. Hose bib 16.60 • '/�k � ``.3 P� '. ,... • •:2� J : ', :,, .. � A ;P'''- `Ca.* ,
-. ••yrct.
5?ti :.. . . _ : .,..i .$2 .. °� :s� ,� a :: •..F= "._ �t, -ctva' Ice maker 16.60
Business name: Silver- .In o w .,./1 , . e. T. Interceptor /67 ace nap 16.60
a
Contact name: ass - '• 1 Medical gas (value: $ ) Page 2 -
Address: "i 3s SW Primer 16.60
City /State/Z.IP: . a , U O 1Q. A 7 Roof drain (commercial) 16.60
Sink/basin/lavatory a 16.60 R g, ao
Phouc_ (51)3) ; 1 - 4 e 7y Fax:: (50.3 57 q., 3;25 1,b/showcr /showerpan / 16.60 ! icr,
E -mail: : f ), to o ',� a . y ° -,,,./y‘ C_ l Urinal `- 16.60
,.3.. -.),-0 -y r :. [1 _.i-r 74. "' -Pr i '�r ; .., : a
�' i$' i s «- a.zi . 4 .14 * - . 4 ,, ET . . �� . ++pp .O B , -s }:_ ' _ " . ° . %t :: s : : : ; _ : •' :;=' Water clo / 16.60 Bo „ (4) 0
.:4 .. i�z. 'ati t � � -h...° : 5T t oa -• �i;�[a' : � -5 :,?..'c iF ti �? = . . --,..
Business name: ' A I ^ a ' _ r Water heater- 16.60
Address: 1 L d I , Other:
a -C Z r Subtotal 6 to O
City/ State/ZIP: - p „a ,- - 1 R G f ' 700 7
Minimum permit fee: $72,50 -1
Phone: (5b3 t l!L( - ) a....3 Fax: ( 3 5 79 _ a- ' Residential back(luw minimum permit fee: $36.25 7 a. 50
CCB Lie.: U ) t Q ya
Plumbing Lie. no.: 3L �'
I_ Plan review (2(25% of lacrmit fcc)
Authorized signature: n slip
.--/ f ' �!
State surcharge (6% of permit tee) 5,510
Gc/ L r /` '1'07'AL PERMIT FEE 7 �
Print pause: b ‘1._.. ii! 1 . Date: ( D Thu permit Application expires if a permit is not obtained within
` i80 days after it has been accepted as complete.
'Fee methodology act by Tri- County Building Industry Service Board.
iABuitding1Pcrrniu \PLMP- Fm,ittAWd°e 12103 440- 4614T00/OVCOww59)
•
FROM : MARINO DESIGNS FAX NO. : 5794021 Jun. 06 2005 07:19AM P2
Plumbing Pcrmat Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
..
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
Sewer • 1st 100' 55.00 3,601 to 7,200 $220.00
7,201 and . ter $309.00
-
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical G as S st ems:
Water Service - cch additional 100' 46,40
Storm @ [fain Drain - 1st 100' 55.00 1..'Y0_1 . ° ":: ;: : ei it �lt e: '
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 572.50 for the first $5,000 -00 and $ 1.52 for each
r ,.; r , x - • (� additional $100.00 or fraction thereof, to and
!'lixfit a OT Itf.TU:Y.' ` t ;:Fee. ea 1 trial';
>'. .�'.. _ .,.. ... ", a._ . - ....._._:'Y, • kw,;,. -- .....� including $10,000.00 -
Commercial Back Flow Prevention Device 46.40 $10,001.00 t , $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential tlackflow Prevention Device each additional S100.00 or Inaction thereof, to
(minimum permit fee 536.25) 27.55 _ _ and including $25,000.00.
Rain Drain, single family dwelling 05.25 525,001.00 to $50,000.00 $379.50 for the first $25.000.00 and $1.45 for
each additional $100,00 or ttaction 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 550,00000 and 51.20 for
Subtotal: each additional $100.00 or fraction thereof.
•
Fixture Work:
Are you capping, moving or replacing existing fixtures'? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *,
5:; ::•c;.: ' uYS+�- '; '_ a '= atttat'.t, xiul e)l�. `.Urk FeiiM i d :3
„Crxtuke ype: ° "yic c
. 4g: . ;21:4).1-FA
- <•SVx x < % {; °. ;?:�; Mgvcd Fosfi!!g :w'ptilr` Comments regarding fixture work:
Baptietry/Font
Bath - Tub/Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall _
-[hive Thru
Cusp dor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drin king)'ountain
Eye Wash
Floor Drain /sink - 2"
-3"
Car Wash Drain
Garbage -Domestic
- Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Tee Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/lavatory X Quantity Total
- Bradley
- Commercial Isometric or riser diagram is required if fixture quantity
S ervice
total is >9.
Swimrnin$ Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet X Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
\ auiidiagN.PcmriulPtM- Pernti[AppAoe Y0;
CITY OF TIGARD
BUILDING DIVISION.. PERMIT #: PLM2005- 00247
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2005
Phone: (503) 639 -4171 �� „ U - �4puyp,i�,�'
Inspection Requests (24 Hrs.): (503) 639 -4175 'I �..
INSPECTION WORKSHEET FOR DATE: 7/7/2006 TIME: 7:10AM PAGE: 9
SITE ADDRESS: 13894 SW AERIE DR CLASS OF WORK:
SUBDIVISION: EAGLE POINTE LOT #: 022 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Bathroom remodel.
OWNER: SMITH, JAMES N + JULIE A, PHONE #: 503-679-8193
CONTRACTOR: SILVER MOUNTAIN PLUMBING INC. PHONE #: 503 - 6442123
Inspection Request Scheduled For: Date: 7/7/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
•
399 Plumbing final 010953 -01 503-621-8901
Cor ections /Comments /Instructions:
•
•
PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / // Phone #: (503) 718-