Permit :x.. - ec t A) = 1-61) o ADD . OF 7nc4,<
C ITY OF TI ARD UMBING PERMIT
P ERMIT #: PLM2003 -00462
,RA
1J- DEVELOPMENT SERVICES DATE ISSUED: 9/2/03
13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12540 SW SUMMER CREST DR PARCEL: 1S134CB-00206
• SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 60 ft. of water line. Install one hose bib and 1 irrigation backflow preventer.
FEES
Owner:
Description Date Amount
LANG, KENNETH GARY
12540 SW SUMMERCREST DR • [PLUMB] Permit Fee 9/2/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 9/2/03 $5.80
[PLUMB] Permit Fee 9/5/03 $35.35
[TAX] 8% State Tax 9/5/03 $2.83
Phone : 503- 260 -8637
Total $116.48
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone : 503 Water Line Insp
Misc. Inspection
Reg #: LIC 42671
PLM 34 -70PB
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: ����� ,.?„.9 Permittee Signature:
Call (503) 63 175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures .. .
Plumbing Permit Application FOR OFFICE USE ONLY
Received Plumbing
Date/By: ? l D 3 ~ Permit No.: PL c2Q0 3- D O ` 6
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 1 , A\ Post Land Use
k" '�t 01 Date/By: Case No.:
Internet: www.ci.tigard.or.us - a � A I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 -' Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
El New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
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
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address:// SAPS !a• 31) tw.A^-e vcvt.3 -r 0., Site Utilities
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: DrywelUleach line/trench drain 16.60
1 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
I as `. T' + S' v ..,,,, %...` t , ...rQ Tr ` a N Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) _Page 2
Subdivision: I Lot #: Storm sewer no. linear ft. Pare 2
Water service no. linear ft. , g Pare 2 SIM.
Tax map /parcel #: Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
R e. e I ac., -e w o T C L l �v o Backflow preventer Page 2
pA &j T D g i1 V S „e G. l S ci 1.-1Z.. .0 Backwater valve 16.60
/ a v . � Q S < /312 n Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
IS PROPERTY OWNER f I ❑ TENANT Ejectors/sump 16.60
Name: Kt v , v , ,-r A . 0 %.,.. ck Expansion tank • 16.60
Address4,2 g t,c o S. tom. Yu kc, h^ ev. C v. -e sr D v Fixture/sewer cap 16.60
City /State /Zip:II 7 A a v e, 2. 2 3 Garbage drain/floor disposal sink/hub 16.60
I G 9 7 Garbage disposal 16.60
Phone:Sp 3 - f a, ep o 403? Fax: Hose bib ( 16.60 /j, , Cvo
❑ APPLICANT _ ❑ CONTACT PERSON Ice maker 16.60
Name: S a kA.... 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
CONTRACTOR Urinal 16.60
Water closet 16.60
Business Name: Q,...,-0‘..., Q 1 u L.. (it 9 Water heater 16.60
Address: ` Other:
City /State /Zip: Other:
q Plumbin Permit Fees*
Phone:.S'b 3 7J ( Fax: Subtotal $
CCB Lic. #: a jp 7 I Plumb. Lie. #:314 - 7 0 Minimum Permit Fee $72.50 $ 7 a , s t,
Authorized I '1 Residential Backflow Minimum Fee $36.25
Signature: , . _T if _ 0 / Date: ` 2._ Plan Review (25% of Permit Fee) $
I I (e ,,,...e ,,,...e I--. State Surcharge (8% of Permit Fee) $ 5i b
(Please print name) TOTAL PERMIT FEE $ - V" . 3 0
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 a
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
additional $100.00 or fraction thereof, to and ,
Fixture or Item Qty. F ee (ea) Total 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 Comments regarding fixture work:
Fixture Type: Replace p
New Moved Existing Capped •
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"
-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\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206
Plumbing Signature Form
Permit #: PL M2003 -00462
Date Issued: 9/2/03 - - - - - - --
Parcel: 1 S134CB -00206
Site Address: 12540 SW SUMMER CREST DR
Subdivision:
Block: Lot:
Jurisdiction: R-4.5
Zoning: TIG
Remarks: Replace 60 ft. of water line. Install one hose bib
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the - address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
LANG, KENNETH GARY CROWN PLUMBING
12540 SW SUMMERCREST DR 5429 SE FRANCIS
TIGARD, OR 97223 PORTLAND, OR 97206
Phone #:503- 260 -8637 Phone #: 503- 771 -9449
Reg #: LIC . 42671
PLM 34 -70PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X 4/
Signature of Authorized Plumber
If you have any questions, please call 503.718.2433.
•
I
•
07 �'
•
CITY OF TIGARD 24 -Hour
BUILDING inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ? <P 3 AM PM BUP
Location / S '/0 , S%) CN,.@ St — v Suite MEC
Contact Person 1(t La:v_c r Ph ( S03 ) i 4 0 - (#13-7 PLM 016 o 3 - 1 0 Lill 6
Contractor C % c w `"- _. A v ( O ‘A- Ph (Z ) 7 Z( ?-4, 7 SWR
BUILDING Tenant/Owner 1 Xt. vo- L. 4% - ELC
Footing
Foundation ELC
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
ShowerRan
Other: -
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 111 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 0 ��_ _,/)
ADA / /��
Approach/Sidewalk Date Inspector Ext
Other:
Final D • NOT REMOVE this inspection record from the job site.
PASS PART FAIL