Permit - { ITY OF TIGARD PLUMBING PERMIT
A L I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00055
- I - ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/27/03
SITE ADDRESS: 12920 SW WALNUT ST PARCEL: 2S104AD -FP001
SUBDIVISION: FLESKES PART /MLP2001 -00007 ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: UNK FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 300 ft
WATER CLOSETS: WATER LINE: 0 ft
DISHWASHERS: RAIN DRAIN: 300 ft
Remarks: Utility work associated with 3 lot minor land partition.
FEES
Owner:
Description Date Amount
RAIN EAGLE VENTURES
12920 SW WALNUT ' [PLUMB] Permit Fee 3/26/03 $461.40
TIGARD, OR 97223 [TAX] 8% State Tax 3/26/03 $36.91
[PLMPLN] Plan Review 3/26/03 $115.35
Phone : 503 888 - 2525 Total $613.66
Contractor:
GREENWOOD INC.
16055 SW WALKER RD.
PMB 401 REQUIRED INSPECTIONS
BEAVERTON, OR 97006
Phone : 503 - 849 - 1475 Sewer Inspection
Rain Drain Insp
Reg #: LIC 131162 Final Inspection
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
Issu d By: Ir;I j� . l j J1 ` Permittee Signature: £ ��
( 503) 6 • -4175 by 7:00 P.M. for an inspection needed the next bu % ness day
Site Utilities -II -- 3 6 L
Plumbing, Permit Appli 'FOR OFFICE USE ONLY '� -
_ Received ti Plumbing .�
T
-7C i ,, / Date/By Q / J Permit No.: V / taed3- CZ) 5 5
Planning Approval Sewer
City of Tigard Date/By: Permit No
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 DateBy Permit No.:
Phone: 503-639-4171 Fax: 503 - 598 -1960 Post - Review Land Use Date/By: Case No.: I l' j �QGYI')7
Internet: www.ci.tigard.or.us j l Contact -Isieis ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method / !Up. Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total c
❑ Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
SFR (1) bath 249.20 '
M11:2-Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 r
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 7
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: 12920 ,1^GA) ia4bukti Jt Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain .2., 16.60 3 . El)
Proje Name: ei n 7-tarJ Drywell /leach line /trench drain _ 16.60
1 w'�� r Footing drain (no. linear ft.) Page 2
Cross street/Directions to job ) ci site: -- , L p / Manufactured home utilities -- 110.00
/vriv�
C c r of- Gth41, U fl^Pe c 4 Manholes ,2 16.60 ;3 d �
Rain drain connector 16.60 E
_ CT/ } 2i C .57Y1^L� Sanitary sewer (no. linear ft.) 3,00 Page 2 r 4 7- go
Subdivision: Lot #: Storm sewer (no. linear ft.) JOB Pa ge 2 f' ®o
i Water service (no linear ft.) Page 2
T ax map /parcel #: SE %;‘ /t(6 /�f 775:, RIw c�roa Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
7-4) 46 /N9 Y u 7i ( rLe_5 Backflow preventer Page 2
5 /-f/Li- _ -1/1-r I rye -tJ Backwater valve 16.60 C'
Clothes washer 16.60 :---
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: R,)„, j 1/44/ n. <-r Expansion tank 16.60
Address: p z 9Zd c ' uJ /F� r 6 % Fixture/sewer cap 16.60
City /State /Zip: j 7 e., 4Q /' QA 7?ZO 3 Floor drain /floor sink/hub 16.60
_ Garbage disposal 16.60
Phone: 3 m e Lsz'r '3 "Fax: 5 5z# - Z2 Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60 k
Name: J". F, (- .'j CoIV stvuei -ioN U.X., Interceptor /grease trap 16.60
Address: i 2 2j St,.) kia rum 56 . Medical gas - value: $ Page 2
City/State/Zip: Primer 16.60
y p : Tl Ta rr?�!� O e l 7 2 L 3 Roof drain (commercial) 16.60 u-�
Phone: 5 - SZL_ �L31 F ax: 5o3 - 524-3(023 sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: (t (V6.2 f d Water closet 16.60
Water heater 16.60
Address: PPM) SDI (iio 5 w Gll.1/rgiti' Other:
City /State /Zip: iN 4 vc., v 6 9 70.6 Other:
Phone: 4753 gi cm_ / '75 Fax: 6D3 c24 -zz? Plumbing Permit Fees*
$
CCB Lic. #: ( 31/ (Z � umb. Lic.#: Minimum Permit Fee $72.50 $
Authori i g -24 - oT Residential Backflow Minimum Fee $36.25
Stgnatur . ,,/ /� - If D ate: _2A.43 Plan Review (25% of Permit Fee) $
j
J e
d �� y 6 7 State Surcharge (8% of Permit Fee) $
(Please print name) /- TOTAL PERMIT FEE $
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.
is \Dsts\Permit Forms \PlmPermrtApp.doc 01/03
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 Fec:
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' I 55.00 5 7,201 and greater _ $309 00
Sewer - each additional 100' 46.40 'i, . ,)
Water Service - 1st 100' � 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' f 55.00 . $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 2_, 46 40 „'Ijj $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. Fee (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: Nra
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
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whiripool
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 *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\P1mPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line:. (503) 639 - 4171
_ BUP
Received q Date Requested AM PM BUP
Location / ? / d / `4 Suite MEC
Contact Person Ph ( ) 5 ( — 510&6 PLM 3
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 -• �'� / 4'
Roof
Other: 7/-%
Final
PASS PART FAIL
PLUMBING
/ 111r
Post & Beam
Under Slab
Rough -In ,
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
or
- 555 - wer
Oth -:
0 4 -- .0010 -
PART FAIL
ECHANICAL
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
ADA
Dat® 7 P� Inspector A Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL