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CITY O F T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00601
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE 13SUED: 11/21/03
SI)E ADDRESS: 12435 SW KNOLL DR PARCEL: 2S101t3C-03200
SUBDIVISION: PP1994-025 MLP93-00012 ZONING: R-4.5
BLOCK: LOT: 0r,1 JURISDICTION: TIG
CLASS OF WORK: HLT GARBAGE DISPOSALS. MOBILE HOME SPACES:
TYPE OF USE: SF WAS HING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GKP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXT'_'RES LAUNDRY -PRAYS: SF RAIN DRAINS: 1
SI 4KS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LIWE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 300 ft
"< marks: Replace rain drains system.
Owner: _FEES
Description Date Amount
REID, CHARLES 0. - -- —
1243b SW KNOLL IPLUn11ii Pernut Pee 11/21/03 $14780
i l:3ARD, OR 97223 1('"AXI 8 State.Surcharl 11/21/03 $11.82
Total $159.62
Phone : not a%uilable
Contractor:
PACIFIC GROUND WORKS
12435 SW KNOLL DR
VERNONIA, OR 97064
REQUIRED INSPECTION:
Phone : 503-649-8002 Rain Drain Ins
Final Inspection
Reg #: PLM 152746
This permit is issued subject to tht regulations contained in the Tigaru 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 days of issuance, or if work is suspet;ded
for more than 180 day:,. F,TTcNTION: Oregon law requires you to follow rules adopted by the Oregeri
Issued By: Permittee Signature: IN
Call (503) 639-4175 by 7.10 P.M. for an inspection needed the next business day
Quildin; Fixtures
Plumbhi2•Permit Apylication Received . lumbina ) �
Date/ft • 0 Permit N..:"I L41 Wo 00 IV,
City of Tigard Dae/By:Approval Sewer
—Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-6394171 Fax: 503-598-1960 ,:_- Post-Review Land Use
Date/By: Case No:
Internet: www.ci.tigard.or.us Contact Juris 0 See Page 2 for
24-hour Inspection Request: 503-6394175 Name/Method _ __�:: ► lemental Information.
TYPE OF WORK P t'E*SCHEDULE(forspecial Informs ion use checklist)
New construction Demolition Description Qh. 4ec(ca.) Ioi.i
New 1-&2-family dwellings
Addition/alteration/re lacement Other:
CATEGORY OF CONSTRUCTION (Includes 100 ft.for each utility connection)
_ 1 &
2-Family dwellin Commercial/Industrial SFR(1)bath — 249.20
-- � SFR(2)bath 350.00
Al Building Multi-'.until SFR(3)bath 399.00 �7
Master Builder ❑_Other: Each additional bath/kitchen _ 45.00 _
JOB SITE INFORMATION and LOCATION Firesprinkler-sq. ft: Pae 2 —
Job site address: 1 ' c ��:' Site Utilities
Suite #: _ $ld ./A t.#: Catch basin/area drain Iii 01)
Protect Name: Dr well/leach line/trench drain 16.60
Fcoting drain(no.linear ft.) Pae 2
Cross streetTirections to job site: Manufactured home utilities 110.00
Manholes _ 16.60 _
Rain draw connector 16.60
Sanitary sewer(no. linear ft.) —t _ Page:. _
Subdivision: Lot#: Storm sewer no. linear ft.) Pae 2 ___
Tax map/parcel#: water service(no linear ft.l I I Pae 2
-
DESCRIPTION OF WORK Absorption valve Flztut a or Item 16.60
r ix JCC \iV u--l:\Nom, Backflow reventer Page 2
G; Backwater valve 16.60
F Clothes washer 1660
-------- — — Dishwasher --- 1660
Drinking fountain 16.60
PROPERTY OWNER TENANT _ E'ectors/sum 16.60 _
Name: C t-I lift\Z. LU S Ci =19 it) _ Expansion tank 16.60
Address: k 3- 9_3!� . ►tj Fixture/sewer cap 16.60
City/State/Zip: a C, 2 - Z Floor drain/floor sinV, -tb 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib !6.60
APPLICANT CONTACT PERSON lee maker 16.60
Name: AC l C Ccs�LLV zi ul ok'44. Interco toN rease trap 16.60
Address: W L Medical gas-value: 5 Pae 2
City/State/Zip: Primer _ 16.60
Roof drain winimercial) 16.60
Phone: Fax: Sink/basindav:tory 16.60
v E-mail: Tub/shower/shower an 16.60
I
CONTRACTOR Urinal 16.60 _
Business Name: 1i Z' kc,. (, t12-C J ua. a�Z water closet _ In.60
�
Z Z water heater 16.60
Address: 7i � ► M t3C(_ Other:
Cit /State�E N C 'N OVY I C(- Other: L
Phone:`>c> ;, y ' •• yL_( Fax:'i 4, l T,, ( Plumbing Permit Fees*
Subtotal S
CCB U.c, #: , Plumb. Lic.#: Minimum Permit Fee 572.50 5
Authorized / Residential Backflow Minimum Fee$36.25 /q
Signal re: 'r G-rr•/r �'G �ute: s_ Plan Review(254'0 of Permit Fie) 5
State Surcharge(8°0 of Permit Fee) 5 8 3-
- '-- —� (Please poet name) TOTAL PERMIT FEE I 5 S > (t3_
Notice: Tlds permit application expires If it permlt if not obtained within All new commercial buildings requlre 2 sets of plans with Isomctrle or
IN dai%after it alas heen accepted as complete. rlscr diagram for pian renew.
*Fee methodology set h% Trl- ounh Building Induslry Service Board.
i\DstsTermtt 1 arms Plml'ermnApp dig 01 I)1
Plumbing Permit Application - Cite of Tigard
Page 2 - Suppl?mental Information "+
Fee Schedule- Residential Fire Su ) ression Systems:
Site Utilities T—(1ty Fcc(es) TotalS uare Footage• Permit Fe
Footing drain- I" Itx)' 55.00 0 to 2,000 _-- SI 15.00 i
Footing drain.path additional 100' 46.40 _2.,()O I to 3.600 $160.00
Sewer-I st 100' 55 -- 3,601 to 7,200 $220.00
.00 $309.00
S7,201 and eater ewer-each additional 100' _ 46.40 -
Water Service-Ist IM' 55.00 Medical Cas Systems:
Water Service-each additional I00' 46.40 Valuati.m: PerrrJt Fee:
Storm&Rain Drain- Ist 100' 5500 $1,00 to$5 000.00 ".;.aimum fee$72.50
Storm&Rain Drain each additional 100' 46.40 9. so $5.001.00 to$10,000.(x; $72.50 for the first$5,000.00 and$1.52 for each
Fixture or Item OtY. Fee(a) Total additional$100.00 or fraction thereof,to and
Commercialial pack Flow Prevention $10,000.00.on Device 46.vU $10,00100 to$25.000.00 $148.50 for the first$10,000.00 and$1.54 for _
Residential Backflow Prevention Device each aduitional 5100.00 or fraction thereof,to
minimum emit fee$36.2.5 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 525,000.00 and$1.45 for
Inspection of existing plumbing or each additional$100 00 or fraction thereof,to
specially r.quested inspections•per hour 72 50 _ and including$50,000.00.
Suhtotal: $50,001.00 and up $742 00 for the first$50,000.00 and$1 20 for
each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing; fixtures:' 11'
"yes please indicate work performed t;� fixture. Failure to
accurately report fixtures could result in increased sewer fees`'.
oantlty xturej Work Performed ('nnunenls veg;arding fixture work:
Fixture Type: Replrree
New Moved- Balxtln Capped -- — _
I4a,tis! iFont
Hath -Tub/Shower - -- -�---�----Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive 1'hru __.— _ ----------__.__
Cus idol/Water Aspirator
Dishwasher -Commercial
-Domestic — — - -'
Dnnking Fountain ---- -_- `—_-
Eye Wash -
Floor Drain./sink -
" -.— --�
Car Wash Drain
Garbage -Domestic -^ *Note: If the fixture work under this permit results in an
I isposal -Commercial _ increase of sewer EDPs,a sewer permit will be issued and
Industrial fees assessed for the sewer increase must be paid belt.:„ the
Ice Mach Refri .Drains plumbing permit can be issued.
Oil Se arat4w(Gas Station)
Rec.Vehicle I)ump Station
Shower -Gang
-Stall
Sink -Bar Lavaton �-
-Bradley _
-Commercial
-Scr%icc
Swmmniing Pool Filter
Washer.Clothes
Water Extractor
Water Closet-Toilct
Unnal _
Other Fixtures:
i Dst Vermis Forms,PImPermit.4ppPg2 doc M 03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business L-_: (503)639-4171 MST _
BLIP
Received Date '
_ _ � AM ___ PM ___- BLIP
Location 13 � n, J__ _ _ Suite.__— _ MEC _
Contact Person -_ Pi; PL
' 3-,064 ,01
M
Contractor _.� -- -- Ph ( -- --) .��1-_s�`��?�. SWR
BUILDING Tenant/Owner ELC
Footing —
Foundation Access: ELC
ctg Drain / r ELR
trawl Drain �- IZI�� —---
Slab Inspection Notes: SIT _
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywal!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 —
rai
'� 7"
Catch Basin/Manhole
Storm Drain
Shower Pan
Other: __ - -- - — _
Final'')
PAO PARI FAIL'IW --
CH_ANICAL _
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 Fall, 13125 SW Hall Blvd.
PASS PART FAIL,
SITE Please call for reinspection RE:- � Unable to Inspect-no access
Fire apply Line
p r i
Approach/Sidewalk bate1_ `! Inspector ��� Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hoar Inspection Line: 639-4175 Business Line: 639-4171 ____ -----
BUP _
_—_Date Requested �� '~0 _ AMPM _ BLD
Location— 3S � Iil� . Suitr; iEC q"i ' ,2.,2
Contact Person _ Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner � ELC
Retaining Wall ELR
F ooting Ac
Foundation FPS
Ftg gain NOT F�EQUESTED
Crawl Drain ins FOUND DURING RESEARCH SGN _
Slab NO INSPECTION(S) FOUND IN FILE SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear I /�
Framing �-✓u / -I? 174-,?,
Insulation --
Drywall Nailing 1 Q '�3 G'�� 2 ;Z _
Firewall
Fire Sprinkler _ v �tl �1 U ZL �--cry -�-r
— — — __
Fire Alarm
Susp'd Ceiling
Roof —._--
Misr,.
Final
PASS PART FAIL
PLUMBING
Post&Beam -
Under Slab
Top Out -
'."later Service
Sanitary Sewer
Rain Drains
Final
PASS PART PART FAIL ,
os eam --- -
Rough In
Gas Line
Aoke Dampers
ART FAIL
MEC I RICAL
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final - - — -- -��
PASS PART FAIL
SITE
Backfill/Grading — -- ----
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$ —required before next inspection. Pay at City Hall. 13125 SW Hall Blvd
Catch Basin
Fire.upply line I 1 Please call for reinspection RE— ] J Unable to Inspect-no access
ADA
Approach/Sidewalk _ Q
Other Delta Inspectors V C___- Extt 1
_
Final
PASS PART FAIL DO NOT REMOVE this inspect-on record from the job site.
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Pacific GrOUnd Works, tnr,.
Purchase Order Request
Dirt Removal
1
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Date Sub-Division Lot # Off-site 0*1-situ Total Loads
i