Permit r
CITY TIGARD PLUMBING PERMIT
Ti I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00081
Hell 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/8/2005
SITE ADDRESS: 10085 SW RIVERWOOD LN PARCEL: 2S114BC -00300
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 058 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: 0 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace: Tub - shower, water closet, lay.
Owner: FEES
BLACHLEY, VICTORIA & STEVE Description Date Amount
10085 SW RIVERWOOD LN
TIGARD, OR 97223 [PLUMB] Permit Fee 3/8/2005 $72.50
[TAX] 8% State Surcharl 3/8/2005 $5.80
Phone : 503 624 - 7904 Total $78.30
•
Contractor:
PETE'S QUALITY PLUMBING
20985 S. SWEETBRIAR RD. REQUIRED ITEMS AND REPORTS
WEST LINN, OR 97068
Phone : 503 -557 -8450
Reg #: LIC 122359
PLM 3 -344PB
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: t Permittee Signature: P___
Call (503) 639 -4175 by 7:00 P.M. for an inspection the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Building Fixtures
A. N
Plumbing Permit Application . FOR OFFICE USE ONLY
City of Tigard
Received ..:‘2, O D ki
DateBy: 1111 rm Pe t No.. /n��n
13125 SW Hall Blvd., Tigard, OR 97223 �w
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �Wa Date/By: Other P ermitNo.:
24- Hour Inspection Line: 503.639.4175 f I 3 ur;s:
www.ci.tigard.or.us ��_ Date Ready /By: H See Page 2 for
Internet: www.ci.ti
g Notified/Method: Supplemental Information
: «'?i €`, > ,,s`� '. d` . .:.T s aca:. ..ism.: iR.O' _ :r a.€g,,eac . . �, Eb :', � 2+, Vi - . - ".rs�.i z_ ::: 4 :P r°:.: z. e, r <..
r fr . , e3 . a TYP OF; �?VO ` "='i:° f i 5 1 ter: :sr, 1 y t . �` , *. •
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. 1 Ea. Total
El Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
Alp 31 A 7 C TLG, ORY OF STRF TT01i 1 1 �t SFR (1) bath 249.20
Q 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other
r - -w:: °ate �.
Fire sprinkler ( sq. ft.) Page 2
' tt,14, �� �� Ar0 STYE - uirt IYJ ION AitIA LO i IO vs t` t s "
A, � . , � ,. S.t- ,.,n .a �.� ..
�.44 �O��. ��si... .n �.- Site utilities
Job site address: No .fa t`SSC3 R i :� Catch basin or area drain 16.60
City/State /ZIP: ',1--\G 6,,n Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no
. . e„,, `Q Absorption valve l 6.60
_ ,fi e .." 'ESA TION O WORK el x
Rip � '
,. �, � . .r..- ,A m . >,, ,:.fz Backflow preventer Page 2
. e_ P L.Acc -Q- P '(C. f S4 a,._-. 4 1 044c13 I 0 A L.(JQ Backwater valve 16.60
PehQ_ W t -1- C ( j Clothes washer 16.60
IA Le`c-V Dishwasher 16.60
': x , x F o w Drinking fountain 16.60
...O P>ROx?� ems E.,. TErlaly X x'
Ejectors /sump 16.60
Name: ms Le ti' 1.),(:),7.1^ C Si-,e. Expansion tank 16.60
Address: ,, 0 CJ /‹ .S L) k v J ,io fl LA) Fixture /sewer cap 16.60
City/State /ZIP: 1 )) co AQ 02 Floor drain /floor sink/hub 16.60
Phone: ( ) vi 7,4_.7 4 u I Fax: ( ) Garbage disposal 16.60
, , t' J LI C a , , a .
ANT' i . ,' ti ` t Hose bib 16.60
- ;ter .., . ,_, -,P ; �� ....:... .... P V. �C �CONTAC R .,:: . ,,
'� Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basi avato i ‘ 16.60
Tub /shower /shower pan 1 16.60
E -mail:
aHt :.in = ~..:. ,4 i:'sF ;R ;:.: "ss" : �" `;'i Urinal 16.60
- ` VA t � .� 'z,_: . <. Water closet I 16.60
Business name: H G'TP_s Qua, t (y, �" N w,i3t,Jc t 7 J Water heater 16.60
Address:20 s" S„
s s a , QA II ev,A.R4 Other:
City/State /ZIP: loran Lev r k (710
Subtotal
Minimum permit fee: $72.50
Phone: �'�3 ) ,,,\ e3 k� Fax: ( ) _ ).. $ y L y Residential backflow minimum permit fee: $36.25
PS Plan review (25% of permit fee)
CCB Lic.: Z23,� Plumbing Lic. no.: 3 ,2 y y V
/ State surcharge (8% of permit fee)
Authorized signature: (^� TOTAL PERMIT FEE
Print name: CD,Li eJLL -° t NA. M u.., Date: - z,e'„p This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Permits\PLMF- PermitApp.doc 12/03 440- 4616T(i0 /02 /COM/wEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su I i ression Systems:
. , r i Qt war, Tio'tal axe Footage Perrnrt 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 r -' >° °� • "`
Storm & Rain Drain - 1st 100' 55.00 � aluat1O11 rte, P.ernlit ee
$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
cif additional $100.00 or fraction thereof, to and
Flll1 e'OItEIIl x
44 ....:,;, ; Q y .s .., ee(ea) al's;
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
Subtotal: $50,001.00 and up $742.00 for the e 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 * .
F pal"' ,t ; _ Quanttt ( Fixture ) 'ork eTfo tti _.
ixtu 77;,S) `12eplace� �r
- e e N d" ' «tExisin 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"
- 4"
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
Quantity Total
- Bradley
Commercial 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:\ Building \Permits\PLM- PermitApp.doc 3/03
CITY OF TIGARD 4_
BUILDING DIVISION PERMIT #: PLM2005-00081
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/0/2005
�/
Phone: (503) 639 -4171 � xamdrypIP
..
Inspection Requests (24 Hrs.): (503) 639 -4175 .'r _
INSPECTION WORKSHEET FOR DATE: 3/24/2005 TIME: 7 :09AM PAGE: 14
SITE ADDRESS: 10086 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.1 LOT #: 058 TYPE OF USE:
PROJECT NAME: BLACHLEY
DESCRIPTION: Replace: Tub- shower, water closet, lay.
OWNER: BLACHLEY, VICTORIA & STEVE, PHONE #: 503 - 624 -7904
CONTRACTOR: PETE'S QUALITY PLUMBING PHONE #: 503 - 557 -9450
Inspection Request Scheduled For: Date: 3/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 002732-01 503 - 939-7604 Y
Corrections /Comments / Instructions:
PA'), Pe+c 503 q39 - 2 6 a y fo✓,9- cc-err-
ct,.fiL,,,i6d,
XI PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l''1 , Date: 3 / Y/ Phone #: (503) 718-