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10060 SW KENT PLACE
CITY OF TIGARD __PLUMBI'JGPERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00425
13125 SW ;'all Blvd., Tigard, OR 972.23 (503) 639-4171 DATE ISSUED: 8/12/03
SITE ADDRESS: 10060 SW KENT PL PARCEL: 2S1 14BB-04000
SUBDIVISION: PICKS LANDING NOA ZONING: R-4.5
BLOCK: LOT: 0"4 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR URAINS: TRAPS:
STORIES: W/`.TER HEATERS: CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TU!3/SHOVLERC: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflov prevention device for irrigation.
Owner:
FEES
—'-- —
Description Date Amount
ERIC JOHNISEE I PI U M13 Permit Pee 8/12/03 $36.25
10060 SW KENT PL.
TIGARD, OR 97224 8/12/03 $2.90 Y
Tetal $39.15
Phone . 303-6h4-5169
Contr.,ctor:
JAMES R. DENNY
PO BOX 230024
TIGARD, OR 97281 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : �1n) 19.45 Final Inspection
Reg #: 1 I( 5142
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 riot started within 180 clays of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
l
Issued By: F 1 4i _ Permittee Signature:
Call (503) 639-4175 Uy 7:00 P.M. for an inspection needed the next business day
11�
Building; Fixtures
P11--mbina Permit Application_ 7_fP)_anmng7Aprov",a1
I'�u,nlnng
Permit No.:
Sewer
City of Tigard Datc/B :
Permit No.
13125 SW hall Islvd. Plan Review Other
Tigard,Oregon 97`23 Drtc/B : Permit No.:
Phoue: 503-639-4171 Fax: 503-598-1960Post-Review land Use
'^ Date/By: Case No.: _
Internet: www.ei.tigard.or.us contact luris.: sl a Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information,
TYPE OF WORK _ FEE*SCHEDULE forspecial Information use checklist
New construction Demolition Desrri►lion Cltc. _Fee(ca-) 'total
Addition/alteration/rept "' nt Other: New 1-&2-fantliy dwellings
_ JIncludcs 100 ft.for each«Blit connection
CATEGORY OF CONS t RUC':'tON SM(1)bath 249.20
i &2-Family dwelling I _LJ Commercial/Industrial Sr:R(2)bath 350.00
Accessory Buildin Mult -Famil SFR(3)bath _ 399.00 i
Master Builder Other: I-ach additional bath kitchen _ 45.00
JOB SITE INFORMA't_'ION and LOCATION Vire sprinkler-sq. ft.: Pae 2
Job site address: )/_(;_(! Site Utilities
Suite M Bldg./6 L#: Catch basin/arca drain I6.60
Dr eli/icach line/trench drain 16.60
Pro'ect Name: t't' N�'.t_t:. �' �, I ,,"f "1
Fortin drain no. linear ft. Pae 2
C-t-,ss street/Direetions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer no.linear fl. Pae 2 _
Subdivision:� _ __ Lot#: Storm sewer(no.linear fl.) Pae 2
TaX nla /�rcel #: Water service(nu linear 0. Pae 2
_ Fixture ur Item
DESCRIP11ON O►'WORK Absor tum valve _ 16.60
_ Backflow prevctitcr / Pae 2
Backwater valve 16.60
Clothes washer �~ 16.60
Dishwasher _ 16.60
Drinking fountain 16.60 _
pROI'ER 1!Y OWNER __ ��TENANT _ _ E'ectors/sum 16.60
Name:L_l _. �i��_ --. _Expansion tank 16.60 _
Address: f u t t: Tv.t 1'� Fixtute/sewer cap 16.60
City/State/Zip: i t -. t tom, `j 7���'�./ Floor drai^/fluor n_ink/hub 16.60
__A-.------ ___ _ Garba c disposal 16.60
Phone:cx%-� Fax: Hose bib i 16.60
A$PLICANT CONTACT F::I SON Ice maker 16.60
ane: Intcrce tor/ rease trap 16.60 _
Address: Medical as•value. $_ Pae 2
--- ---- -- Primer 16.60 --
Cit /State/Zip: Roof drain commcrc.al 16.60
M')ne: Fax: Sink/basin/lavatory _ 16.60
E-mail: _ - Tu-b/shower/shower pan 16.60
CONTRACT . _ 16.60
er closet 16,60
Business Name:
Water heater 16.60
Address: o I -- _ Other:
City/State V - / 7, Othrr ----- _ _
Phone: ;�3 ii i % '+ ' Fax: _ I'lumbinit Permit Fees*
- Subtotal $
CCB Lic. # "�'. °lumb_Lic.l(: _ - M•:,tmum Permit Fee$72.50 $�� a
Aut',orized Residential Backflow Minimum Fee$36.25
Signature: ` .z t f( C Date plan Review 25%of Permit Fee $
State Surchar cP.,%of Permit Fee S
-(Please print name) --- _ _ TOTAL PERMIT IZVE $ -
Notice: 'rhis permit application expires If■permit Is""t ollta►ned"It""' All nt w commercial bulldlr„s require 2 sets of plans wlth IMmetrlc or
180 days after It has been accepted as con iplele. rises diagram for plan review.
*Fee methodology set by Tri-(ount% Bullding industr.Serslce Board.
0131sts\Permit Form,\PlmPcmritApp.do: 01/03
Plumbi_ng_Permit_Apnlieation - City of Tigard
Page 2 - Suppletnental Infortnation
Fee Schedule: _ Residential Fire Suppcession Systems:
Site Utilities illy. Fee(ea) Total Square Footage: __ Permit Fee: _—
Footing drain- I" 100'— 55.00 — O to 2 OW _ $115.00 —�
Footing drain-each additional 100' 46.40 2,001 to 3,60(
3,601 to 7,200 _ $220.00
Sewer-Ist 100' 55.00 1,201 anddreatei $309.00
Sewc•-each additional 100' 46.40
Water Service-1st 100' _55.00 Medical bias S stems:
Water Service-each additional 100' 46.40 Valuation: Permit Fee: —
Storm&Rain Drain- I st 100' 55.00 $1.00 to$5,000.00 Minimum lee$72.50
Storni&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 Qly. Fee(ea) Total including$10,000.00. _
Coi-imercial Back Flow Prevention Decue 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backfow Prevention Device each additional SIOO.00 or fraction thereof,kr
mmimum (rmit fee 536.25) 27 55_ and including 525,000.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,0110.00 $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. _
s fallrequested inspections-per hour 72.50 550,001.pO end up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixturr Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please indicat,,work ner''^:Med by fixture. Failure to
IRCCUrateiv report in. ,Pres could result in increased sewer feet*.
Quantity b (Flit re)Work 11e_riormcd Comments regarding fixture work:
Fixture Type.- Replace
New Moved Ellian C■ d --- _
Ila tistry/Font --
Bath -"I'ub/Shower _
-lacurxi/Whirl oo' -
Car Wash -Each Stall _ — --- — -
-Drive 111ru
Cuspidor/Water Aspirator
Dishwasher -Commercial _ - ---- -----
-Domestic
Drinkinit Fountain —� � ----------- -Eye Wash —--- -- -
Floor Drain/sink 2"
t,.4" — —
Car Wash exam *Note: If the fixture work under this permit resell-, in an
Garbage 4ximestic _ Increase of sewer LDUs,a sewer permit will be i%suCd :uul
Disposal -Commercial
-Industrial fees assessed for the sewer increase must he paid bclore the
Ice MachJRefri 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 _
Mater Extractor _
Water Closet-Toilet
Urinal
Other Fixtures: _
1:\Dsts\Permit Forrns\PhnPcrmitAppPg2.doc 01103
CITY OF TIGARC 24-Hour
BUILDING Inspection Line, (503) 639-4175
MST
INSPECTION DIVISION Business Line. (503)035-4171
c BUFF — ---
Received Date Requested o Z Z__- AN+--- _--- PPI - ___-___._ BUP
Location - -_--�Q O�0 0 -_ cQirt p L_ - _ Suite—_ _ -- MFC
Contact PersonPh t_ PLM -_6 4 �
Contractor ------- - -- --- Ph( ) -- ----- SWR
BUILDING Tenant/Owner _-_ . .____ __ __ __ ELC _
Footing _ ELC —_
Foundation Access:
Ftg Drain ELF! _ ---
Crawl Drain — — - --
Slab Inspection Notes SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - - -
Fitewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling --
Roof
Other:_ -
Final
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab t - -- -
Rough-In
Water Service — - - —
Sanitary Sewer
Pain Drains
Catch Basin/Manhole
Storm Drain -
Showor Pan
Ot r. 6 - F.
m _
_ASS PART FAIL f
MECHANICAL - --
Pcst& Beam
Rough In - --- - —
GFis Line
Smoke Dampers
Final
PASS PART FAIL - -
ELECTRICAL _
Service ---
Rcugh-in ------- --- -- --
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE -- 0 Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1 ' ' Inspector-at wwi w-2-- _Ext
Other:
Final _-
Final DO NOT REMOVE thin, inspection record .rom the job site.
PASS PART FAIL