Permit CI TY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00220
`'` ��' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/27/03
SITE ADDRESS: 13260 SW HOWARD DR PARCEL: 2S103CA -01100
SUBDIVISION: WOODCREST ZONING: R -4.5
BLOCK: LOT: 010 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: Installation of backflow preventer device.
FEES
Owner:
Description Date Amount
JORDAN, MICHAEL P + JENNIFER A
13260 SW HOWARD DR [PLUMB] Permit Fee 5/27/03 . $36.25
TIGARD, OR 97223 [TAX] 8% State Tax 5/27/03 $2.90
Total $39.15
Phone :
Contractor:
DALE SCHREDER LANDSCAPE
29060 SE HEIPLE RD.
EAGLE CREEK, OR 97022 REQUIRED INSPECTIONS
Phone; 503 -RP /Backflow Preventer
Final Inspection
Reg #: LIC 5165
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
/ / 1
Issued By: Gird / Permittee Signature: i A p
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed • • us es d
( ) Y N y
Building _fixtures
Plumbing Permit Application . FOR OFFICE USE ONLY _
R ece i ved �(� Plumbing .
DateBy:` /, 7 -O ? Permit No?L fl4 k90 3 - 061.1-0
Cit of Ti and Planning Approval Sewer
y 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
byiriiNNl�� +1 f\ Date/By: Case No.:
Internet: www.ci.tigard.or.us Contact Juris
I El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
� .. ., ;. �; L b K3° �:.re z- .. ��: �r -. .,.. �p + �� °`a� ^2R �?1s�r�-` aS43St. - 4' Y.�4..<. �'
il MV,, 3T�YP00,188 O 44 «:lip °MNin �, ,; FEE SCHEDULE (fo spec �nformatiRifi ,clieckliOR
Description Qty. Fee(ea)
❑ New construction ❑ Demolition _ P � Qt ,__ � I Total
El Addition/alteration/replacement El Other: ? i ;�c d e s 100:f f ,, e h u ta ty d o p n ectionj ,
Z.-. :,°,WCATEGORY C ! `CONSTRUCTION M IONA* 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
`JOB SITE` NFO L )CATION`' ` ��t i Fire sprinkler - sq. ft.: Page
� tD S E U U)Al� 'D : {Y'°` t iSifeI7iilties} �,.. it" �'k:.
Job site address: Z p 1Z � ������� �� � � � _
Suite #: 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
-C - I Z( e-74. • 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
a U I DESCRIRMSI is OM • < d„�„ _ `' s Fixtare.or;Item.. ®.
�. i =.< °.:
Absorption valve 16.60
Backflow preventer Page •2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
P a1'00MiTY OWNERU N a.07,1 `V ,ri ..g Ejectors /sump 16.60
Name: M CuAeZ. , Dg.b -pJ Expansion tank 16.60
Address:1, 7 4' D '' E t-lo-w h Q. 6? 2 , Fixture /sewer cap 16.60
City /State /Zip: u) . Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
APPLICANZIN'OUN '; E ra CONtTAGT PER$QNi ,a „ „= Ice maker 16.60
Name: DA Le Sail- Interceptor /grease trap 16.60
Address: Z i G O 1E --k-6 1 Ptc x) Medical gas - value: $ Page 2
City /State /Zip: QF Lc C FC_ '1 O' 2 P 16.60
Roomer of drain (commercial) 16.60
_ Phone:(06 ( Fax: 030 645 Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower, pan 16.60
�'Wst _. s a: F *y ,.:.: ,..
=. �:�e� =`"�;� E. �=:,�e; ..�..��. r.l�`ry ` Urinal 16.60
Business Name:. g _Mal ' -,; Water closet 16.60
Water heater 16.60
Address: P p � Other:
City /State /Zip: L" ' Other:
hone: 0 - 30 '0" Fax: : - ''u`� nzit s . 4 klijiiiiiiiiii0oThitiONSM-- il. 37
B Lic. #: 1 („ t 5' Plumb. Lic. #: Subtotal $
Minimum Permit Fee $72.50 $ l
Authori :, . 6 Plan Review (25% of Permit Fee) $
Residential Backflow Minimum Fee $36.25 O(O. d 3
Signature: Na i 1 ` A � , Dat•;..1 _ . '''
/ • � ; _ . II � f v State Surcharge (8% of Permit Fee) $ �C
''1.Pe print name) TOTAL PERMIT FEE $ 3L- / 5
Notice: This permit lication 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:
Q it*
Footing drain - 1' 100' 55.00 0 to $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
. :14 1 4070, 1 11D , =
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 $10 $100.00 or fraction thereof, to and
7.:WN T041t including ,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)
and including $25,000.00.
Rain Drain, single family dwelling $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*.
ORMAS4.;F:R;ri RV* ireai00 d j Comments regarding fixture work:
tqlviitEZALVAILftkti hrwevi
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"
•
Car Wash Drain
*Note: If the fixture work under i
G -Domestic this permit results in an
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
3
-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 3 Date Requested - 3 AM PM BUP
"l
Location , - Ce0 /4-6"362Ad Suite MEC
Contact Person Ph ( ) 3 � 31 `// PLM , aO ��d
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 / ' p
O
.-r:
/3
PART FAIL
HANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL •
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 0 Please call for reinspection RE: LI Unable to inspect — no access
Fire Supply Line
ADA •
Approach /Sidewalk Date � Inspector Ext
Other:
Final D N a REMOVE this inspection record from the job site.
PASS PART FAIL