Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00046
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/10/03
SITE ADDRESS: 07540 SW BONITA RD 016 PARCEL: 2S112BD -00100
SUBDIVISION: TIFFANY COURT APT. ZONING: R -12
BLOCK: LOT: 065 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: R
FEES
Owner: -
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 2/10/03 $83.00
#200 - MS63 [TAX] 8% State Tax 2/10/03 $6.64
HILLSBORO, OR 97124 - 3082 Total $89.64
Phone : 503 846 - 4794
Contractor:
ALBERTA PLUMBING
LEWIS TRANER
PO BOX 55031 REQUIRED INSPECTIONS
PORTLAND, OR 97238
Phone : 503 Top -out Insp
Final Inspection
Reg #: LIC 96782
PLM 26 -707PB
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
•
Is. ued By: A ,�i'�,%il l Permittee Signature: _ _ -
a I (503) 6 ° -4175 by 7:00 P.M. for an inspection needed a ir ext business day
Building Fixtures
• Plumsbin Per m it A pliCation FOR OFFICE USE (ONLY •
N Received 0 Plumbing
Date/By: er / Q Permit No.: el ` la ' iv 3- - -cb0 �D
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Post - Review Land Use
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 � I ��� Date/By: Case No.:
Internet: www.ci.tigard.or.us A �' Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
PY •` � � �':' _ '� ,:.�x
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❑ yew construction ❑ Demolition Description 1 Qty I Fee(ea) I Total
Addition/alteration/replacement 111 Other: . ° , New L ;°& 2 t`amtty d w� l ` j - - r§
, e , - �_ v f orr eac uti : connecti n . 21i',', .
' „` .' eATEGORX' OT CONSTRUCTION ; ; OM SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ ommercial /Industrial SFR (2) bath 350.00
❑Accessory Building Multi- Family SFR (3) bath 399.00
❑ Master Builder Other: Each additional bath/kitchen 45.00
z a;ri,m n" ._, FF ire sprinkler - s ft.: Page 2
��� - �.� _ JQB.SIT'E;INFORMATIONxand�l=OCA ION ; _ p q• g
Job site address: .� J- , i-.: 5 k , ,,4- - , �
.- .. ?Utlhtle k'' .: . a, q , . »,,0= - , . : tr
Suite #: 1 4� Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach 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
Sanita sewer no. linear ft. Pa• e 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #:
Water service (no. linear � Page 2 ' A SCR � rs
W ice inear ag
�� ��b n -M T 'EYxtnre.or�tem a
K :: 11 ".:0: DES,CRIPTION�'at:W®WMZ N .sue, p
Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer / 16.60
Dishwasher / 16.60
P _ Drinking fountain 16.60
PRORERTIyaOWNER tli =TENANT °�. S :, Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
k Ant COragAg _,. ;' ; I A, COI TACT PE "= Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Clt City/State/Zip: Primer 16.60
Y p Roof drain (commercial) / 16.60
Phone: Fax: Sink/basin/lavatory i/ 16.60
E -mail: Tub /shower /shower, pan 16.60
s; `` tE s :MCO w TRWCTOR ' -, ':.:P' Urinal 16.60
/ j � Water closet 16.60
Business Name: f Et n+.c`1�1 Water heater 16.60
Address: 1 hn ( (� a C. J Other:
City /State /Zip: 62�,, ,� A✓ q72.4 Other:
� •a .s `� � ,: ".'" •'.�.."� * ''3 � � � �� � "`" kit a
Phone: r7� - Fa : : ,, (t ^ 0 ,: Plumbing PermrtlFe'' "es - , `'� � :" , . s:$_
CCB Lic. #:.. G, ' � �P 4 b. Lic. #: 2c, -7 7 ` 5 Subtotal 72.50 $ _co
Permit Fee $72.50 $
Authorized t / Residential Backflow Minimum Fee $36.25
Signature: _ Date: �a �� /
Plan Review (25% of Permit Fee) $ &.. 67 `f
00` h 7 -,.../ State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $ . aT
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:
' s S►teUtdtt,0 s, Qty Fee (ea) ' total: aS ware. F,00ta a Per "i ut,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 _ 'rte '
V alpat�on: Pe r mit Fe
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
'. . 3„ Fture;or Itern* Qt g Fee,( ea ) ,, Total 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 $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
C omments regarding fixture work:
a _ Quantityby (Frxture)WorkPerformed . g g
Frxture Type ,$ Repiace
New 3 . Moved` Ezr h gg tte4,i6tatil
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 2 _( AM PM BUP
Location 1 S LID Suite t/ MEC
Contact Person Ph ( ) 7 q'U + 9 / - ' PLM 3 — 00O
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
• Foundation Access:
Ftg Drain ELR
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 PART FAIL
PLUMBING
- Post & Beam
Under Slab
Rough -In •
" Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
j'r
•�•ART FAIL
C' ' NICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Ei 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
Approach /Sidewalk Date J Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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