Permit CITY TIGARD PLUMBING PERMIT
�
l�i DEVELOPMENT SERVICES DATE PERMIT #: ISSUED: PLM2003 -00276
� =--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13611 SW LEAH TERR PARCEL: 2S109BA 08500
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 011 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
HEIGHTS CONSTRUCTION
1 [PLUMB] Permit Fee 6/19/03 $36.25
PO BOX 91249 [TAX] 8% State Tax 6/19/03 $2.90
PORTLAND, OR 97291 Total $39.15
Phone : 503 291 - 2550
Contractor:
THOMAS CONSTRUCTION
P.O. BOX 91283
PORTLAND, OR 97291 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone : 503 690 4925
Final Inspection
Reg #: LIC 6361
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
/i
Issued By:
i _ 1 � . _4, ` , ,, Permittee Signature: � / � .
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
liulb:ling .r fixtures
Plumbi' Permit Application FOR OFFICE USE ONLY
N� Received Plumbing
DateBy7 - /9 - z'3 1i. Permit PermitNo.: 1 0 03 - OOa7(o
City of Tigard Planning Approval Sewer
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 DateBy: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 t�
Post - Review Land Use
/ / x au , , flMliry�t�° ( Date/By: Case No.:
Internet: www.ci.tigard.or.us .J J Contact J s.: See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: ' J 1(� Supplemental Information.
intitM ,; ., , _ en OFtWORaS ` : M b.t FEE NOMIV,I:E,,(for specta1 infgrmatton use checkl►MU
❑ New construction ❑ Demolition Description I Qty. I Fee(ea) I Total
❑ Addition/alteration/replacement ❑ Other:
gnu„
New l & 2 fa n 137 �` ,, �� a
" (ine1udes.100 ft for e onnection) . . x ,,3
;' WV CAMICO OFvCONSTMe tiN _ ,....: _ i 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
zs, ' :f„J_OB SITES INFORMATION and LOCATION, . -iNtikAi Fire sprinkler - sq. ft.: Page 2
Job site address: 134// /p c:2% gala& . ;.., Thy. Site Llt i tires lt_:i ce `
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
(1% -51 of ,&-9'e-4 Pe .- Manholes 16.60
��' Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) P ge 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: e linear ft. t I e ' 6 2 1
�� Water �,. E.
(no. . Ftx urn Or tll° � � P ����.
service
E N - , s ; ,E411:1 itterION iCWORK . � ,,7... f :�:> _.4 Absorption valve 1 .60
1 ,6,4 /s
dec /r 2�� P Backflow preventer / Page 2
3 S ah Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTX OWNER n . I,,:; ®:;=TEN °ANT 'e. lx ' mi Ejectors /sump 16.60
Name: //e) A ��, j ,, r � ^, 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 LEI APN ICJO .:::. E _ iZi ..'. Es ^CONTACT;PERSON : ` .. Ice maker 16.60
_ Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City/State/Zip: Primer 16.60
y F Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
"fie = `°` `x , it ', CONitkA"OT,O tiegi _ z .MM ry Urinal 16.60
Business Name: Water closet 16.60
i�'fG.S �G� �S / /vCf7G� Water heater 16.60
Address: , /7 >tZ -? Other:
City/State/Zip: W c /? g ]_2 9/
. °, Other:
Phone 3 � 1 � 0 - 9, 2j Fax: ; ;V . ° °.:.`.: PlumRifi ermtti eeit , � pax `� Paz
Subtotal $
CCB Lic. #: j / Plumb. Lic. #: /w2 Minimum Permit Fee $72.50 $
Authorized // � //',4_3
Residential Backflow Minimum Fee $36.25 36 . ,� .,5
Signature: .,/,,,/ Date: Plan Review (25% of Permit Fee) $
J _5' 7ave eipp7 a S - State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL -$ ?- 7 , 1
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 1 110
Fee Schedule: Re sidential Fire Suppression Systems:
.�.� �.. , se a °_ - � �; , - vv�� =^� s�:r ,. : ._ ., °, ,,•q� — �v.:�'s,.*a -
Kea Site iJtillties g Qt9 ; ;Fee= I �v itlA l 'tS, uare F.00ta e: , ,. z t f rer n iit >Eee
� �,� , ���. . � �.:� 1, -.. �.,�. � �..� _. _��:�.::..�. __ g ...�. _.k�. _. �. _ _._..., -. - ._ „ t� gib ,..
Footing drain - l'` 100' 55.00 0 to MOO- $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
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
1t= `F axt a or It ii QtY 'MOAN (ea) ,'Total including l$10,000.00. fraction thereof, to and
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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Comments regarding fixture work:
a +, '� , e ��� �'° Quantity uy (Fixture)�Work;P�erformed" � g g
rFixtare Type r� Re pla$e
° r ' NeYv Moved Exis ,.rCapped
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\P1mPermitAppPg2.doc 01/03
CIT". (C . 24 -Hour
ING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received • Date Requested D �" AM PM BUP
Location / 3( a 1 i {(L--- ��'\) Suite MEC 11
Contact Person Ph ( ) 7 D f q(eo PLM — 0 6 a-7(0
t°
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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
i Water Service � �
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm.Drain
Shower Pan / 2 �—/
O er: LJ r
in
ASS PART FAIL
MECHANICAL
Post•& Beam
Rough-In
Gas Line
Smoke Dampers -
Final
ASS PART FAIL
EL TRICAL 'r° .
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 "J 2L J/13 Inspector 1 1-V } '''v • Ext
Other: •
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL