Permit • CITY OF TIGARD PLUMBING PERMIT
14. DEVELOPMENT SERVICES - PERMIT #: PLM2003 -00401
' JII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/5/03
SITE ADDRESS: 13658 SW LEAH TERR PARCEL: 2S1096A -08000
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 006 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 residential irrigation backflow preventer.
FEES
Owner:
Description Date Amount
GEORGE MARSHALL
PO BOX 91249 [PLUMB] Permit Fee 8/5/03 $36.25
PORTLAND, OR 97291 [TAX] 8% State Tax 8/5/03 $2.90
Total $39.15
Phone : 503 768 - 4573
Contractor:
THOMAS CONSTRUCTION
P.O. BOX 91283
PORTLAND, OR 97291 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone ; 503 690 4925
Final Inspection
Reg #: LIC 6361
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued lElyi5 I.tZ) Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application Received FOR OFFICE USE ONLY
eived SAD_ Plumbing TD
Date/By: S-03 / Permit No.: --Vvl o - VC 4/a I
City of Tigard Planning Approval Sewer
ty g F '_` E v Plan ED Pla Review Permit No.:
_ 13125 SW Hall Blud. n Review Other
Tigard, Oregon 9 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: -503-59811960 Post - Review Land Use
� A LL1.10 L1.10 ¢�
u,Xi i � Date /By: Case No.:
�t1 11.. ry�l>bl� � f
Internet: www.ci.tigard.or.us , y, n.' i Contact Juris.: ' ® See Page 2 for
24 -hour Inspection Request: 503; 63,9:4175 " " " "" Name/Method: Supplemental Information.
Li i I I C
BUILDING DIVISION
. ,,... .�..._ - , ; .: -fors eciilii
� � � '_ �" �'�� "� °'. "'':KL�'`�TYPE�OF�W®RK �6= ��� �,���..�: ��,,�..E*�SCHEDULE�(_ _, �__�iuformation�use,checklst)LL� ;.
�c m :.
Description Qty. Fee(ea)
❑ New construction ❑ Demolition p � � 1 Total
New l- 2 family dwel1i gs i :
❑ Addition/alteration/replacement ❑Other r ai t � 1 to f� 'gin t I
r_' , `� CATEGO .OF CON$TRUCTIOIV r_
0 y= , 5e' ,L , inc udes, Orft: or"eac u i t t y c „ s .
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
' ,. `. at4 JOB. $ITE;;I t O TIONPan / d,LOCATION1 ` .;, Fire sprinkler sq ft Page
/3f_5 a Sui G -e4� 7 ,Y, ...: a �"°`a gi*tfaliti : " ' -,. ' .,_ M
Job site address. _ � � ���� ����� � ���� Suite #: Bldg. /Apt. #: Catch basin/area drain _ 16.60 _
o � Drywell /leach line /trench drain 16.60
Project Name: /3
Footing drain (no. linear ft.) Page 2 _
Cross street/Directions to job site: Manufactured home utilities 110.00
66-7c4 a e el..../ 7 " Manholes 16.60
Rain drain connector 16.60
_ Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: 6 Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service � � 0 Fixture or Ite z „ Page
,_„ , 4
e linear
WW2&� DE$CR7TION, OMORTC > Absorption valve 16.60
)n54// /✓bv4 /e C4ea4 G /v=° Backflow preventer t Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
ti k = sI _ / TENANT ," _ ; Vii, Ejectors /sump 16.60
Name: /4 5 4 7 (is7 a- ' i 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
PE APP_I.ICANT . '. . ,: t ❑ CO 14X.0. �PETLSOS Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2 -
•
Primer 16.60
City /State /Zip: R drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E-mail: Tub /shower /shower pan 16.60 -
:t„ ` Z Y `'.S CONTRAC,TORr`l „ r r .. .: Urinal 16.60
Business Name: 7 7 ,nos 6c7.c.; T X Water closet 16.60
rUA ° Water heater 16.60
Address: ,4, , ,pp. 9/2 3 , Other:
City /State /Zip: d 7`l' c/' 7_/ Other:
Phone:3'03 6'- 9 2S Fax: _: , > , , . ' PlumbingFPermtt;Rees* _ ' • _ , ., ,,, .
Subtotal $
CCB Lic. #: 36/ Plumb. Lic. #: /,102 Minimum Permit Fee e $72.50 $
Residential Backflow Minimum Fee $36.25
Signature: Date: r/S/43 Plan Review (25% of Permit Fee) $
5 eG,c:' State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL MIT - FEE - -$ - -- - - -- - - - --
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 Fornms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Vtr : Site iFttl►t�es } _ v '�Qt Fee'(ea) Iotal Square Footage ■, , :; °, ,
Footing drain - l' 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 .
''Vau ation. tPermitFee��, �'���. � �� �`�.
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
s t i .. . r. Fixture 01-0m , s "'. # , Qty AM OS To "t`al >:: including ,., „) �, .. includin $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 *.
Comments regarding fixture work:
�, �� � m t ��� �. Quantttb (�xtiire);Work�P�erformed :� g g
:tRrxtureType: � � � � . t ' Q� ;� � Re lace :..<
Moved. Enshng Gapped;.
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\P1mPermitAppPg2.doc 01/03
IGARD 24 -Hour f -
WING • Inspection Line: (503) 639 -4175
-
INSPE _ DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Reque o ° AM PM BUP
Location f 3C Sg Suite MEC 3 Contact.Person PLM
' Ph ( ) /Oq `C I 3 - be)
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 . f -
Other: (�
" SP' PART FAIL
MECHANICAL -
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA -- - - -- - - -- --- - - - - -- - -- -
Approach /Sidewalk Date )21 ) D3 Inspector 0 r i l d R-^2 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL