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9777 SW JOHNSON ST
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00325
13125 SW Hall Blvd., Tigard, OR _7223 (503) 639-4171
DATE ISSUED. 7'?'V2004
SITE ADDRESS: 09777 `'iVN/ JOHNSON ST PARCEL: 2S102BA-03000
SUBDIVISION: JOHNSON/GRANT MLP ZONING: R-12
BLOCK: LOT: 006 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 i KA';c- SF RAIN DRAINS:
SINKS: 3 v— URINALS GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS. WATER LINE: ft
VISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of(3) sinks.
FEES
Owner: ---`-
�- Description Date Amount
SINGH, MA.IHEN AND ARUNA _ --
9777 SW JOHNSON I'LUN1131 I'Crinit I cr 7/13/2004 $72.50
TIGARD, OR 97223 1 A\1 Mo st,ue surrh.ul 7/13/2004 $5.80
Total $78.30
Phone :
Contractor:
OWNER
REQUIRED INSPECTIONS
Plione . Rough-in Insp
Final Inspection
Reg #
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 do,Ie in accordance with approved
plans. This permit will expire if work is not started within 180 day!-, of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to foiicw rules adopted by the Oregon
Utuity Notification Center. Those ruies are set forth in OAR ;)52-0001-(101f1 through OAR
952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
24 -6699.
_ I
Perrnittre Sign;ature:��.c-- �- ---- ----
Call (503) 636-4175 by 7:00 P M. for an inspection needed the next 'business dtay
Bui4ng Fixtures
Plumbing Permit Applicatio»` FOd OFF-WF USE, ONLY
City g of Tigard Received r� 2
DateB I" �J � Partial Ne � e
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateBy Other Permit No —y ---{
24-Hour Inspection Line: 503.639.4175 Dau ReadyiBy: - � s See Page 2 Cot
�i Su ilementalInformation
Internet: www.ci tigard.or us Notified/Method: �,(�- p{
_ TYPE OF WOxn FEE* SCHEDITLE
rorspecial information use checklist.
❑ New constnrui::n ❑Demolition
--- ------------- Description Ea. Total
Addition/alteration/rc-placement ❑Other: New I.2-family dwellings(incudes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTJON SFR(1)bath 249.20
® I-and 2-family dwelling ❑C'ommcrcial/industrial SFR(2)bath 350.00
Accessory building-- - �-- -- ElMult1-family SFR(3)bath 399.00---�- -
-- — Each additional bath/kitchen 45.00
❑Master builder ,-,_ — ❑Other: _— Fire sprint ler(_,_sq ft.) Page 2
JOB SI'Z'E INFORMATION AND LOCATION Site utilities
-
Job site address: Ot-1-1`1 SW \� S�-. — Catch basin or area drain 16.60
City/State/ZIP:-V i q 1 aag Drywell,leach line,or trench drain 16.60
Suite/bldg./apt.nn.: Project name: Footing drain(no.linear ft.:_� _ Page 2
--- --- Manufactured home utilities 11000
Cross street/directions to job site: ----
( ' — Manhole; 15,60
�►(thkgq a(rr�i, I�pm_-,�}, �(1 , Rain dra,, connector 16.60
Sanitay sewer(no.linear ft.:_a Page 2
Storm sewer(no,linear ft,: ) Page 2
Subdivision: --- — -_ - Lot no.: Water service(no.linear ft.: ) Page 2 J-
Fixture or Item _
Tax map/parcel no.:
Absorption valve 16.60 —
_ _---DESCRIPTION OF WORK _--_ - Backflow preventer Page 2 - -
_ _ -21 d1dd t l 1�(10.� Str1 _--- _ Backwater valve 16.60
It Clothes washer 1660
Dishwasher 16.60
------- --- --- [kinking fountain 16.60 -
® PROP15It.'I'Y OWNER ❑ TENANT - —
__ Ejectors/sump 16.60
Name: M 0.the,��t Expansion tank - 16.60 - -
Address: GiII Flxture/sewercap 16.60 __
City/State/ZIP: t Orel Floor drain/Floor sink/hub 1660
Phone:( q � Fax:( ) Garbage disposal 16.60
�p --- .t•, Huse bib 16.60
�' f�- .',=[I!LICANT —_ ❑
CONTACT PERSON
— _. .....—Y —
- - t Ne maker 16.60
Business namt Interceptor/grease trap 15.60
Contact name! "CLt h,I M SI n0�/) _ —_ Medical gas(value:$ ) A Page 2
Address:01111 Primer 16.60
f drain(cnmmercial) 16.60
City/State/ZIP:T aa3 _ ____
,- —Qom+----'--r' -'------ Sim asin/levatory 16.F,J �j%
Phone:(503) 7 -�1 Fax::( )
` - Tub/show-r/shower pan 16 60
E-mail UHnal 16 60
r Water closet — 16.60
Business name: 0j 014iC/L• rW*Vaterer 16,60Address: -
Subtotal
City/State/ZIP: Minimum permit fee: $72.50 Phone:( ) Fax:( ) dential ba-.kflow minimum permit fee. $36.25
CCB Lic.: Plumbing Lic,no.:i Plan review (2595 of permit fee)
---- -- State surcharge(8110 of permit fee)
Authorized signature: TOTAL PERMIT FEE ,
�Print name:Md/HN Date. This permit application expires If a permit is not obtained within
— -- ���y— ,'�y a 180 days atter it has been accepted as complete.
"Fee methodology set by Tri-Lounty Building Industry Service Board
I tBuilding\Permiu�PI.MF-PermaApp doc 12/03 440 4616T(10/021COR WPB)
I'lumbina Permit Application - Cite of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential_Fire Su ression Systems:
Site Utilities Qfy Bee(ea) Total rS uare Footage_ _ Permit Fee:
I outing drain- I" 100' 5.5 00 0 to 2,000 _ $11500 _
Footing drain-each additional 100' 46.40 2,001 to 3,600 _ $160.00
3,601 to 7,200 $220.00
Sewer-l st 100' 5500 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 h-minium fee$72.50
Storm&Rain Drain.each additienal 100' 4640 $5,001.00 to$10,000A0 $72.50 for the first$5,000.00 and$1.52 for each
Qty. Fee(ea) Total additional$100.00 or fraction thereof,to and
Fixture or Item including$10,000.00.
Commercial Hack Flow Nrevention Device 4640 $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 emit fee$3615 27.55 and including$25,000.00,
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 fc-the first$25,000.00 and$1.45 fo,
each additional$100.00 or fraction thereof,is
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,mr ving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
u,niih bv f)r'fxti re Work Performed
Fixture Type: Reptaee
it, Moved existing Capper) Comments regarding fixture work:
I(a,hs /Font _V -- --------- ---------
Hath -Tub/Shower
-JacuzzVWhirl ool _— ----- - --- --------------
Car Wash -Each Stall --
-Drive Thru
Cuspidor/Water Aspirator -- - - —"_"- --
Dishwasher -Commercial -
-Domestic
Drinking Fountain -- --- - -----�F---Eye Wash --
Floor Drain/sin'.: 2"
-3" -- -- ----
4" - ---- -
Car Wash Drain —�
(iarbage -Domestic
Disposal -Commercial *Note: If the fixture work under this permit results In an
-Industrial — increase of sewer EDUs, a sewer permit will be Issued and
Ice Mach./Refri .Drains
fees assessed for the sewer increase must be paid before the
Oil Separator(Gas Station)
Rec.Vehicle Dump Station _ plumbing permit can he issued.
Shower -Gang _
-Stall _
Sink -Bar'Lavatory Quantity Total
-Bradley Isometric or riser diagram is required if fixture quantity
-Commercial
ecial total iS
-Service ^.
Swinvnin Puol Filter _ —
Washer-Clothes
Water Extractor Plan Rei few
Water Closet-Toilet Plan review Is required if fixture quantity total is>9.
Urinal
Other Fixtures.
i k8t0dinjTenam(PLM.PentetApp doc 3103
CITY OF TIG,ARD 24-Hour _
BUILDING Inspection Line: (503)639-41'75 MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP ---
Received _ _—Date FWested /U A U'VUPM -- BUP ----
Location �L� 71 !J w g�. _'�: —Suits__ _. MEC
!V1A,LN415ty� Ph �
Contact Person _ �Jq.— ( `� ) 1 l��' .�_ ''�.M
�J
Contractor SWR
______– _--_ Ph( ) -------.----- - --
BUILDING Tenant/Owner ___ _.___ _ — ELC
Footing ELC --
Foundation Access:
Ftg Drain ELR _____ -----.___
Crawl Drain —
Slab Inspectior, Nates: SIT
Post& Beam __----_--__ --
Shenr Anchors
Ext Sheath/Shear
Int Sheath/Shear
Frpn ing -
Insulation
Drywall Nailing - - -- -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Hoof
Other: --
Final
S,�
PART FAIL
�AS ------ �
PLUMB
Pos 8 Beam
U ide Slab - - - - - - --- ---- -- -
ough-I
a er Service - - - ---- - - -- -
Sanitary Sewer
Rain Drains -- - -- --- -- -
Catch Basin/Manhole
Storm Drain - --- - - - - -
Shower Pen -
Other: - _ - - - ---
I
-- -- ----- ----- -
PART FAIL
ANICAL _ ----- --- - - -- -
Post R Beam
Rough-In - - ---- -
Gas Line
Smoke Dampers
Final
PASS PART FAIL - - - -
ELECTRICAL –
Service
Rough-In
UG/Slab
Low Voltacde
Fire Alarm
Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_PASS PART FAIT_
-- Unable to inspect-no access
$ITE [� Please call for reinspection RE: -- _- - - --- --
Fire Supply Line
ADA
Date 6 ` -- - Ext--
Approach/Sidewalk
xt -
Approach/Sidewalk _�_- Inspector _ - ___
Other: _
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL