Permit i 1
C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2004 -00170
� ��;► DEVELOPMENT SERVICES DATE ISSUED: 4/19/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4
SITE ADDRESS: 11355 SW TIGARD ST PARCEL: 1S134DC -00600
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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: 126 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 126' of sewer line to connect existing house to sewer. Septic tank is to be pumped, filled &
inspected.
FEES
Owner:
Description Date Amount
ANDERSON, LARRY R AND
CYNTHIA M [PLUMB] Permit Fee 4/19/04 $101.40
11355 SW TIGARD ST [TAX] 8% State Surcharl 4/19/04 $8.12
TIGARD, OR 97223 Total $109.52
Phone :
Contractor:
ISLAND MECHANICAL INC
PO BOX 17264
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 503
Insp existing /capped fixtures
Reg #: LIC 64254 Final Inspection
PLM 26 -234PB
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
Is ued By: � I i Permittee Si nature: Y , /L ...... 9
Call (503) • • -4175 by 7:00 P.M. for an inspection nee •,the next business day
Building Fixtures
Plumbing Permit Application F / OR OFFICE USE ONLY
City of Tigard Date/By Received / p Q �" Permit No , Gr,I/ /70 13125 SW Hall Blvd., Tigard, OR 97223 /
Plan Review
Phone: 503.639.4171 Fax: 503 598 1960 // Other Permit No. Q��2
. ' `� Date
24- Hour Inspection Line: 503.639.4175 ■ � I I JAS
W Date Ready/By El See Page 2 for
Internet: www.ci.tigard.or.us Nottfied/Method Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft for each utility connection)
� .
y 5��.3r„?4 _:d. ��,�.�� ��. ,. _- �•_ " - r,- .rs,,,_ � _ r �n- S- .•= M�- a:.r;��.r.�,.�E, ^s -•,',S SFR
'zn - 1 x 3 I§ C001: RY0OF'.COIVSTRCJC FION'-, �- -,t;= t- ' +is=z�:
is ,.� =u�:�` >.:_a�'�,:�•a�&ec�F s�r��iz:.:,; �.:,. u- -a•��xs <•:a ^,zF w. •� �.:....n+s�A��i•.6�° = _r,>"�ar': �,..t::.e:mr�,v3,�,; ( 1 bath 249 20 )
❑ 1- and 2- family dwelling ❑ Commercial/industnal 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
<:;- c ,-,- �<s ,w ti' 1 , - •<,: 4- '., - ^.;*Jp" 5'q ' ='0-- '- "a43..,t,y. -g1a a' ' `•" *;x'., .l w '
Y ;�,�, G i *,, , "J JOB- SITE'1INFRMATIOI kN1 LOCATION= F 6 - ," 1
- ��,�.�k . ,� ., >� �:�,.. ., � . O <a� � �,�.�,r,�.,��.,�.:. �:.� :.� -._ � . �> . , .. „• o- • �. , ? �� Site utilities
Job site address: //3 55 S, Cs Q�r,Q p $" :`,�� Catch basin or area drain 16 60
City/State/ZIP: !' �v ell, leach line, or trench drain 16.60
y �� G�, Drywell,
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.• ) fa,' Page 2 .
Storm sewer (no linear ft.. ) Page 2
Subdivision: I Lot no. Water service (no linear ft : ) Page 2
Fixture or item
Tax map /parcel no.:
valve
16.60
, � .,: x 1 =u� _..-; oW z:i"- ; . , ; : : :V - q. , r_><. 4 �., ; rY Absorption a e
� 1;'; `�t"TM:T �L �M,i:�AP �i TY . � �.J�`•:, q �'^ �..
101 1 .. ` 3 - DESCRIPTION "OF, W.ORIG;'� 'e;Ir _4`''' 1
:• tz , � `t ��;�" � �• �K;��- ,>� ,�: _, .���'Y ��.��•, � Backflow preventer Page 2
_ t k , 114 �,(L, � C fi v} _•,Backwater valve l6 60
Clothes washer 16 60
Dishwasher 16.60
• a u <_�r
g;� ; ® ,!PROPERT. , : . : ,'s -;' . :; Drinking fountain 16.60
". '•,;; f, ftY � ;:i: i� ��'TE = '� ��. •mot: .�
,- �. ` x� - �t��,�,_ �,��s.�...�,,.z:c�.�,�- ;��;•r Ejectors /sump 16.60
Name: .L 9.e r 1 c,, .9ND J SCW' Expansion tank 16.60
Address: // . 4�!' . e,,L) .7, 44ten 6e Fixture/sewer cap 16 60
City/ State/ZIP: G'op a ;p R 97 Z1:1 Floor drain/floor sink/hub 16 60
Phone: ( ) g 37 — 6az , Fax: ( ) Garbage disposal 16 60
@as.`^ " ^ :s , g y.tF a a .� N . -' _ : •a .;r,? .h . ,. � c - r;s_ "r s:....� __ :ts �r ..,�.- �,:�..,• .. �,. H06e bib 16.60
"n' a,; ;;- : ,';•;; ).'1 - Ii rAE ELIC ?:iV7:*.asi ' A 41 0 s: , ' ®<.CO E ERSON' :
ro.t_ ..ys.i,: . cm, _w- v.ar.,..=''tiAt :�,', � ittk ,...< ,*,,. :,,, ..•�n_,.•..a- >., „,...,., ice maker 1660
Business name: /J
S C/IaMM $`,„.S' Interceptor /grease trap 16 60
Contact name: 4i,,,,, Rsr 1�/���jV Medical gas (value $ ) Page 2
Address: b 61, 2 / No c,�O.4.�t6al ,O �/ Primer 16 60
City/State/ZIP: 'p leThom" twe j _Roof drain (commercial) 16 60
Phone: (5 2 S7 w 14 * 44 I Fax:: (.593) 2 8 j _ /o fq? Sink /baste/ lavatory 16.60
Tub /shower /shower pan 16 60
E -mail:
Unnal 16 60
.� .:'P 1..� vi`r`•'. i - -Z.. ;. .: .. ? • t e #aS`s' z ' -i p.34`,. 'va _- r.
- 3 M Y- '' . ., , rr• � v.: ;,� ` ?,.��.' -� ,.s; .ij��:.:.,��'�SSaT.' x "'V`.- m' ,°
t . . ' =, ` .f J:7 . ; 'CO]V s , ' � ,,, a , .7 = �`r' 1. Water closet 16 60
� t;. s� si^ •���la, � f�ku; ?,l ?>�•r « «ar -.� -• :-zo:��. - +� • a. -.� �����k4:s9�eia^�w�rB
Business name: /!-) .pt i _4 JLtJ1 _ , Water heater 16 60
. Address: 5 / G ,J ft Dr-! : a ib .,N- Other.
City/State/ZIP. - .�, 1Z. 9�� Subtotal -
/ Mi nimum permit fee $72.50
Phone: (5O5) z' 5-). 5 Fax: ( 3') '. ��/ z Residential backflow minimum permit fee $36.25 70 7. k?
CCB Lic.: 4014 , gC� / p e , Plumbing Lic. no.: _�gq p Plan review (25% of permit fee)
Authorized signature: j...6.4.41 ff ° fff l t ?/3 `V State surcharge (8% of permit I
/ e TOTAL PERMIT / p
Print name: --n 1.41 ea e1-/( P3 Date. L2 /iQ /vel 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\ Building \Pennits\PLMF- PermitApp doc 12/03 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
, .
Fee Schedule: ' Residential Fire Suppression Systems:
citsrie, 41Fie-"()%
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 6
Medical Gas Systems:
Water Service - each additional 100'
46.40 4 11 t —
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
t?ei ;AQtylT, additional $100 00 or fraction thereof, to and
r 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*.
FixtiiTyDe [170.1*,zigsjingiq4 RiIe
W=0 4 A :W5-01),-V7) 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"
Car Wash Drain
Garbage -Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
- Industrial
i
Ice Mach./Refrig. increase of sewer EDUs, a sewer permit will be issued and
Drains
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
Isometric or riser diagram is required if fixture quantity
-Commercial
- 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 \BuddIngTeroutAPL.M-PerrrutApp doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received l - Z Date Requested S 2 5-U `t ,/ AM PM BUP
Location reLL Suite // MEC
Contact Person Ph (5 ) c-C) C --�Y �-5 PLN � S� -C�Z� ! 7 66
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam J �� L � p , � J � Q � A � .1/ I
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler �r„Kt-A — „V
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P ASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In /
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• er:
, r S PART FAIL
CHANICAL •
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -ln
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 TY
Approach/Sidewalk Dat : Inspector � Ext
Other:
Final DO •NOT REMOVE this inspection record from the Job site:
PASS PART FAIL