15905 SW OAK MEADOW LANE-2 NI MOV3W NVO MS 5065
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15905 SW OAK MEADOW LN
CITY O F T I G A R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00149
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 4/8104
SITE ADDRESS: 15905 SW OAK MEADOW LN PARCEL: 2S111DC-13300
SUBDIVISION: SUKIMERFIEI.D NO.11 ZONING: R-7
BLOCK: LOT: 629 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WAS14ING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOUR DRAINS: TRAPS-,
STORIES: WATER HEATERS: CATCH BASINS:
_FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: JRINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow preventer.
FEES
— Description Date Amount
MARSH, CHARLES & DIXIE IPLUMB] Permit Fee 4/8/04 $36.25
15905 SW OAK MEADOW LANE
TIGARD, OR 97224 ('1'AXj 8"/,State Surchari 410/04 $2.90
Total $39.15
Phone : 503-968-6817
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : RP/Backflow Preventer
Final Inspecti^n
Reg#:
IL
ac
ut "c t the regulations contained in the Tigard Wnici r I Code State of OR.
op This permit is issued s�b� �t o g g p ,
ca Specialty Codes and all other applicable laws. All work wiil be done in accordance with approved
J 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
JI
Issued By: �r.�U�t '/L ��a�ttil .0 ^ Permittee Signature• Q _
Call (503)639-4175 by 7:00 PASA.for an Inspection needed the next business day
Building Fixtures
Plumbing Permit Application
City of Tigard PReceivee
h' Pemn1 N, 'a.�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev'
Phone: 503 639 4171 Fax: 503.598.1960 Date/By. Other Hermit No
24-Hour inspection Line: 503.639.4175 pate Ready/By: w t°P)(31 ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method. Supplementallnfortranon
❑New construction ❑Demolition -_Por opeciel le ormatfom use checklist.
---- -- Descri tiont Ea -Totr,--�
d;jLdditi ❑Other: New i-2-family dwellings(includes 100 It.for each utility connection)
SFR(1)l�atlm 249.20
t (11 and 2-11b mily dwcitinp ❑CommetitliltVlOdnlMii SFR(2)bath - 350.00
❑Accessory building ❑Multi-family SFR(3)bath 39900 -
- ----- Each additional bethAdtchen 45.00
❑Muter builder ❑Cther: Fire sprinkler(-sq.ft.) Page 2
Site utilities
Job site address: r r [) � n (tyW �, Catch basin or area drain 16.60
city/State/ZIP: or d a Drywcll,leach line,or trench drain 16.60
Suite/bldg./apt.no.: Project name: �" fid Footing drain(no.linear fl.:_� Page 2
r� f/er _ Y� Manufactured home utilities 110.00
Cross street/directions to job site: u hc4.�n,r 5-4) /4 Manholes 16.60 -_
eAS&Ac � � P..in drain connector - 16.60
Sanitary sewer(no.linear ft.:_) Page 2
- J Storm sewer(no.lineal ft. Page 2
Water service(no.linear R. -._) - Page 2 _
t"e-t"" h" �''•#�1 P �`�' Fixture or Item
Tax map/pan^el no.:
Absorption valve 16-'
Backflow preventer
"T�,A/_, t`d2./��✓ -S�h�.d�/e r �S feM Backwater valve 16.60
Clothes washer 16.60
- Dishwasher 16.60
Drinking fountain 16.60
Ejectors/sump 16.60 --�
Name: L�a /t s `fin jet / A t p, �-„r s h _ Expansion tank 16.60
Address: 0 � Fixturelsewer cap 16.
N.
City/State(Z P: tc,h d OK? fL Floor drain/floor sin.-,/hub tu.60
Phone:(,503) 96$ (6 ! 7 Fax:( ) Garbage disposal - 16.6C -
Hose bib 16.50
Ice maker 16.60
Business name: kiterceptot/grease trap 16.60
Contact name: Medical gas(value:f ) Page 2 -
d. Address: Printer 16.60 _
lY S Roof drain(cortunercial) 16.60
1- City/State/zip: -
�
Sink/basin/lavatory 16.60
Phone:( ) Fax: :( )--- Tub/shower/shower pen 16.60
E-mail:
„J Urinal 16.60
m Water closet 16.60
ILII Business name: SC Water heater 16.60 _
-` Other:
Address: --
City/State/ZIP: _ _ Subtotal
Minimum pertnit fee $72.50
Phone:( j Fax:( ) , R:sidentini back,.. -inimttm t fee: $36.25
CCH Lic.: Plumbing Lic.no.: - Plan review (25%of permit fee)
---- ---- State surcharge(8%of permit fee) d
Autl otized signs a,, , TOTAL PERMIT FEE
Print name:�. y �� �G YS ��•- Dste - $-d f/ 9 his permit application expirm If a permit Is not obtained within
180 days after it has br n accepted as complete.
*Fee methodology set by Tti-County Building industry Service Board
i\Bttitding\Permits\PI-MF•P n kAppdo 12/11 400-4616T(1AA)VC0M/W1!R)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule Residential Fire Suppression S stems:
4krlee:
Footins drai:i- I*100' 55.00 U to 1L000 $115.00
46.40 2,O I to 3,600 $160.00
Footing drain-each additional 100' 3 601 to 7,200 S220A0 _.
Sewer-lst 100' _ 55 01 and Qreattr—5309.00 —
Sewer-each additional 100' 46.40
water Service-Ist 100' S` _ Medical Gas S stems:
Water Service-each additions j' 46.40 tom!
Storm&Rain Drain-I st 100' 5500 _ $1.00 to SS,000.a00rnrrr+ Minimum fee 1$72.50
Storm—&Rain Drain-earh additional 100' 46.40 55,001.00 to 510,000.00 $72.50 for Lse first$5,000.00 and 51.52 for each
17 additional$100.00 or fraction thereof,to and
_ including$10,000.00.
Commercial Back Flow'',evention Device 45.40 $10,001.00 to$25,000.00 5148.50 for the first 510,000 00 and 51 54 for
each additional$100.00 or fraction hereof,to
Residential Backflow Prevention Device and including$25 000.00. _
minimum it fee 536.251_ 27.55
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first S2,.'00.00 and SI.45 f)r
each additional S 100.00 or fraction thereof,'o
inspection of existing plumbing or and inciudirill 550,000.00.
s ecially requested inspections-per hour 72.50 ;50,001.00 d up S742.addi00.or the first$50,000.00 and$1.20 for
Subtotal: each tional$100.00 or fraction thereof.
Fixture Work.
Are you capping,moving or replacing existing fix res? If
"yes",plessr,Indicate work performed by fixture. ilitre t
accurate) re rt fixtures could result in increased se er s*.
Commenis regarding fixture work:
a tis_/Font
Bath -Tub/Shower
Car Wash Each Stall -
-Drive T'hru _
Cuspidor/Water Aspirator
Dishwasher -Come ercial
-Domestic
Drinking Fountain
Eye Wash -
Floor Drain/sit k 2"
IL
IL Car r'.ash Drain
F.. Garbage -Domestic
U) Disposal -Commercial *Nate: If t se fixture rk under this permit results In an
-ittoastrial increase of fewer EDUs, ewer permit will be issued and
J
lee Mach.IReftig.Drains — -- fees assessed for the sewer 11nesse must be paidbefore the
Oil Separator(Gas Station) plumbing permit osis be issue
Rec.Vehicle Dump Static.
Wd.
Shower -Clang
W -stall
Sink -Bar/Lavatory �1uanti ty'Total
-Bradley Isometric or riser diagram Is required If fixture quantity
-Commercial tot al is>9.
-Service _
Swiffuning 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.\But1dtea\Perm1u\P1 M.Pmrdtnpp doe 3/03
3
CITY OF TIGARD 24-Hour
BUILDING i+ Ir:spection Line: (503)63x-4175
MST
INSPECTION DIVISION Business Lina: (503)63F'-4171
,B
�P r Bri1P
Received t -_ —_-.
__._.� 1_ Date Requested AM- __._ PM. BUP _
Location LJ ite _— MEC
Contact Person _ Ph(--.) _ P1.07-eZeir��f y f
Contractor //��P''h(�.G1,�)/I����� � _ SVVR
BUILDING Tenan er CA"_ - J l - - �- -- ELC
Footing - ELC -
Foundation Access: _
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT ------------
Post&Beam - �-
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shenr -- —
Framing ------- --
Insulation
Drywall Nailing -- - --
Firewall
Fire Sprinkler - ----- -- -
Fire Alarm
Susp'd Ceiling -- --- - -
Roof
Other:
Final -_- ��—
PASS PART FAIL -^
PLUMBING
Post 6 Beam
Under Slab
Rout.n-In
Water Service —
Sanitary Sewer
Rain Drains -- - - —
Catch Basin/Manhol9
Storm Drain -
Showerean
WOther: _ - -- —
Fi
AS PART FAIL
MIMMANICAL
Post&Beam
Rough-In - -- -
Gas Line
d Smoke Dampers - ------- —
1!C Final
PASS PART FAIL - - -
ELECTRICAL -- —
Service
m Rough-In _-_---
US/Slab
WLow Vcltage
Fire Alarm
Final Reinspection fee of 5 ____ __.required before next inspection. Pa'i at Cite Hall, 13125 SW Hall Blvd.
PASS_ PART FAIL
SUE Please call for reinspection RE: _ _.___- Unsbls% inspect-no across
Fire Supply Line
ADA ��,�„i t
Approach/Sidewalk DauST,d _pNIt -- Ext.
Other•
DO NOT REMOVE this Inspection rmwrei Siem the job site.
PASS PART FAIL