Loading...
Permit A CITY OF TIGARD PLUMBING PERMIT Iw DEVELOPMENT SERVICES PERMIT #: PLM2003 -00400 u 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/5/03 SITE ADDRESS: 13691 SW LEAH TERR PARCEL: 2S109BA -09200 SUBDIVISION: DAFFODIL HILL ZONING: R -7 BLOCK: LOT: 018 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 backflow preventer. FEES Owner: Description Date Amount HEIGHTS CONSTRUCTION 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 : 503 291 - 2550 Contractor: THOMAS CONSTRUCTION P.O. BOX 91283 PORTLAND, OR 97291 REQUIRED INSPECTIONS Phone RP /Backflow Preventer hone : 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 By: � / / 4 4110 Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Pluwbing Permit Application FOR OFFICE USE ONLY �� Received t .- _ Plumbing a- 3 --d 0 4 70 Date/By: � -S -0 � � B Permit No.: Planning Approval Sewer City of Tigard RECEIVED Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax•: 503 €59-8- -1'960 Post - Review land Use �:+ � �.+�� G�imu�Nl i Internet: www.ci.tigard.or.us � CI :11 V "\F TI�`h Date/By: Case No.: Contact Iucis ® See Page 2 for �D 24 -hour Inspection Request: 503- 639 - 4475 Name/Method: / Supplemental Information. BUILDING DIVISION _� "�y... � °< ,, _�.�._� �� -«� _ "' "" � i" �.� �°`������ � '�;EEE* SCHEDULEfor s ectal"` informations 'uschecklst)�„���:,-': �� �"���..�r�.:�..`��,,,, .T „Y�PEI.OF WORK.x�� �.b. ��.� .;.�..k�� :,....�..._.,� ., �... ( P Description Qty ❑ New construction ❑ Demolition p � I Fee(ea.) Total El Addition/alteration/replacement Other : z New l "& (faintly d litngs ° ` 4 `, ^ ; ,,,. _(mcl'udes:100,fta , .each utih ;connection), ,- ' t: CA 00:0 /0 OF CONST RT !VOW" " 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 . __._. EiiI Ii i • i Fire sprinkler s ft Page 2 �, � Pa `70 dress: / .3 �, RI ! 54.i n / e ti T TA- P 51 . _ Srte;Uttltties" > .. <a: t Job site address: _ ° °` " "` Suite #: Bldg. /Apt. #: Catch basin /area drain 16.60 Drywell/leach line /trench drain 16.60 Project Name: / :, �/ Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 /3e,y Ci -747?c v /' Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: /24,/-4,// Lot #: /er Storm sewer (no. linear ft.) Page 2 Water service (no linear ft.) Page 2 Tax map /parcel #: .i tii a oi4WIN - . aR .� "J . ";' . . . . .DESCRIPi ON YIP WMRK V fir , . _, Absorption valve 16.60 Backflow preventer J Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 - Drinking fountain 16.60 QtPROPERTY ,O,WNomveil , TENANT" "£", t... , Ejectors /sump 16.60 Name: /�a 4/ �o ••j7 rtc.7.5ii 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 APPLEVOiT V . .1 .? El WINVAV,Oft0M1 Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone: Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower. pan 16.60 E € ��,:� .....,��„ "w�: � C(aNrTRACTOR :..� :��'?,�. ._ � ..i W.« Urinal 16.60 Water closet 16.60 Business Name: 716wfas , ..9,s7 L is r-%cv, Water heater 16.60 Address:/,' O, /30A- y /2e3 Other: City /State /Zip: 7A,,t/ c, Q/' 2'729/ Other: r ,Pluinbiiia0"mtf Fees'* Phone: ,503 �ti '/92 J Fax: k _ �e. e� �. .. _ ` ` Subtotal $ CCB Lic. #: 634/ Plumb. Lic. #:/2 ©2 - Minimum Permit Fee $72.50 $ r% Authorized ' /'i %� Residential Backflow Minimum Fee $36.25 ` i 6 a - `� Signature: r Date: e"/.� /C�3 Plan Review (25% of Permit Fee) $ . S"-Af�12 1i 0I State Surcharge (8% of Permit Fee) $ 0,490 / (Please print name) TOTAL PERMIT FEE $ ,3°J - / < 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: a' %74` ,%i'a � e . *,;, , �,.. . �g!s,;. .• �`.' '�':,% , T" >.� � " ..3- .:.:,;T . .� ,. =r ; $1te Util'►ties , r Qty Fee,(ea} I ,T,ot"aqSquare Footing drain - I 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 Valuat10I1 <, m ' 3 { ,, P'ermtf�F,ee � 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 i a A ...Fixture ijr;'Itei & >. W Qty ° IFe 003 . t')iotal 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 *. " Quant►tyby (Facture) Work "Performed '. Comments regarding fixture work: � �� R e lace^ FrxtnieType _� i p ;-� . New Moved 0,1 = Existing 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" 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\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 Req F- a' AM PM BUP Location / • — • —.2/1/1—J Suite MEC , Contact Person Ph ( ) - 74 �— `'C r 6 1/0 . PLM 3 - `7 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: • r i AS 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 - SUN - AS/Line "- Approach /Sidewalk Date Z 1 b3 Inspector Yom' �'�'' Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL