Permit CITY OF TIGARD PLUMBING PERMIT
rl6. DEVELOPMENT SERVICES PERMIT #: P 6/2005 -00007
-��� 13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/6/2005
SITE ADDRESS: 10710 SW RIVER DR PARCEL: 2S115AD -05700
SUBDIVISION: DOVER LANDING ZONING: R -4.5
BLOCK: LOT: 040 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Water service replacement.
FEES
Owner:
Description Date Amount
CROWDER, BARBARA
10710 SW RIVER DRIVE [PLUMB] Permit Fee 1/6/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchari 1/6/2005 $5.80
Total $78.30
Phone : 503 624 - 8951.
Contractor:
ARS RESCUE ROOTER
PO BOX 1728
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone : 503 - 685 - 9050 Water Service Insp
Final Inspection
Reg #: LIC 127325
PLM 34 -168PB
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
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699. .
•
, Issued By � „ r Permittee Signatures
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the et business day
l .., , ._ .
RECEIVED
Plum Permit Aup ati n FOR ()1.1.1C1.: O
FIC1.: I SI.: \1.1
City of Tigard I " ()1.1.1C1.: 1005 Received ? 'p Permit No.: _ QC�OU7
13125 SW Hall Blvd., Tigard, Oji,Q3 D BY _ L., - c75 4) �G n'1 a Q�
Plan Review
Phone: 503.639.4171 Fax: 5 0jj 8-.196o0F TIGA ' D- iii+, ,(� I _ � 4. i p gy Other Perrot No.:
ection Line: 5
'24- Hour Ins 1
Inspection Lr +'C�T� .� �.�
�0 n tY 1 r"/ ` .; I �.. Date Ready/By. ]wiv: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: - T - 1 ( -1 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1)bath 249.20
,g1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /0 7 / 0 5 W R 1ve r OR Catch basin or area drain 16.60
City /State/ZIP: -c", 5 Ar a OR. q7 2,19 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
ex Udirections to job site: Manufactured home utilities 110.00
Cross street/directions i� �� Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Water service (no. linear ft.: (s0) Page 2 s5,
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
^ DESCRIPTION OF WORK
Back flow preventer Page 2
Ret AGe. W 'At, S et V ■ L2 ay AoR i n f1 elf1• Backwater valve 16.60
40 Cv Alan S PAct2 v Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Q b ltf/i C rowelZ Expansion tank 16.60
Address: i cri t o S w RI Ulf O Fixture/sewer cap 16.60
City /State/ZIP: • G 9 C / LZ y Floor drain/floor sink/hub 16.60
Phone: (Sb3) (p$ y - $ is-) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
�,�7 Ice maker 16.60
Business name: A RS Q eSCue- \ czt7t7AQt�. Interceptor /grease trap 16.60
Contact name: QAy 1. P sJ 6 tf l.■% Medical gas (value: $ ) Page 2
Address: f D &K nag Primer 16.60
City/ State/ZIP: \A s or 1)1 e ag 97070 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (513) 6g5--9oso I Fax: : ( )
Tub /shower /shower pan 16.60
E-mail Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Al-45 62.0.5 c, gc0 ifik___ Water heater 16.60 -
Address: Other:
Subtotal
City / State/ZIP: Minimum permit fee: $72.50
Phone: ( ) I a� --p "(p Fax: ( ) g_.-31 -05 Residential backflow minimum permit fee: $36.25 r / r , 2 . 5
( -7 3� Plu mbing Lic. no.3y- ) ba p 13 Pla review (25% permit fee)
CCB Lic.: �j- _
State surcharge (8% of permit fee) 6 '(J
Authorized signature: NWfil TOTAL PERMIT FEE 7'
Print name: (`.Ay pt r 41N I Date:0 / -0(, -, 0 S This permit application expires if a permit Is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
i:\ BuildingTermits \PrM- PennitApp.doc 12/03 4104616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit 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
Valuation: Permit Fee:
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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof; to and
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 *.
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
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
Garbage - Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley Quantity Total
-Commercial
al Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ BuildinggPennits \PLM- PennitApp.doc 3ro3
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested l — AM PM BUP
Location I 0 7/ 6 ieL A, K ) Suite MEC
Contact Person Ph ( ) PLM d�� "667
Contractor Ph ( )7 9 3 Z(p SWR
BUILDING Tenant/0 p C, _ ELC
Footing 1 , ?-- O r `J 1 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
0" 111.1."'
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling '—
Roof
Other: /
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
er ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin
1 '
PART FAIL
CHANICAL
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
/7"yz.2
ADA
Approach/Sidewalk Date F Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL