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9360 SW OAK ST
CITY OF TIGARD __ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT M PLM2003-00037
13125 SW Hall Blvd., Tigard, OR 97223 (503)$39-4171 DATE ISSUED: 2/3103
PARCEL. 1 S135AC-03500
SITE ADDRESS: 09360 SW OAK ST
SUBDIVISION: ASHBROOK FARM ZONING: R-4.5
BLOCK: LOT: 016 JURISDICTION: TIG _
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRA.INS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIX1 URESLAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: w_ URINALS: GREASE TRAPS.
LAVATORIES: OTHER FIXTI'RES:
TUB/SHOWERS: SEA ch LINE: ft
WATER CLOSETS: WATER LINE: 60 ft
DISHWASHERS: I RAIN DRAIN: ft
Remarks: R_u.-(cA�x�st-�la+,�.c, �lr U.igtn,l _ FEE$ _
Owner:
Description Date Amount
DAVIS,EUGENE L [PLUMB) Permit Fee � 2/3/03 $72.50
10875 SW 89TH AVE
TIGARD, OR 9722:; ["TAXI R"/"State Tax 2/3/03 $5.90
Total 578.3d
Phone : c )1-246-5962
Cuntractor:
UNIVERSAL PLUMBING
(DAVID RAY OAKLEY)
8811 SW SPRUCE STREET REQUIRED INSPECTIONS
TIGARD, OR 97223 - --
Phone : 452-7480 Water Service Insp
Final Inspection
Reg#: M FT 00004191
LIC 111472
PLM 26-589PB
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a0 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
wSpecialty 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!he Oregon
Issued By: `1
Call(503)639-4175 by 7:00 P.h`, tar ata inspection needed the next business day
Building Fixtures
klu- D�I1g Permit Ap�lie;�ltlon Received , Plumbing
:�'J-•-0 -",� Permit NOJ--�,rr 1 t-xo?=Oov,?
Cit of Tigard Planning Approval Sewer _
Y i; Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review other
Tigard,Oregon 97223 Date: Permit No.:
Phone: 503-6394171 Fax: 503-598-1960 Post-Review i.And Use
Internet: www.ci.tigard.or.us DatcMy: Case No.: _
Contact Juris.: See Page I for
24-hour inspection Request: 503-6394175 Name/Method: - Supplemental information.
TYPE Or WURK EDULE(t►` 'ipeclal Gro- ., R, eckllrtt -
El New construction Demolition _ Description Qty. Fce(ea.) Total
ddition/alteration/re lacement fl�Other: New 1-dr 2-family dwellingo, ; 1
CATEf30RY O CONSTR U dtlei l90 Ilt.Corea !1 .cv�en - --
`;Pit�hath _
&2-Familydwelling Commercial/Industrial 249.20- SFR(2)bath 350.00
Accesso Buil Multi-Fami� _ SFR 3 bath _ 399.00 _
Master BuilderOther: Each additional bathlkitchen _ 45.00
_ OB SITE INFORMATION and LOCATION Fires rinkler- ft.: Page 2
Job site address: q3ie6
Suite#: Bid ./A #: _ Catch basin/area drain 16.60
Project Name: Drywell/leach linettrench drain 16.60_'-
-----
Footing drain no.linear ft. Pae 2 '
Cross strect/Dircctions to Job site Ma,tufact ured home utilities - _110.00 _
Manholes 16.60
Rain drain connector 16.60 _
Sanitary sewer no.linear fi. Pae 2 _
Subdivision: Lot#- Storm sewer no.linear fl. Page 2 -_
Tax map/parcel#:
Water service no linear ft. Paw 2
'6 17,
- Absorption valve 16.60
Backflow preventer_ Paje 2 - -_
Backwater valve 16.60
Clothes washer 16.60
-- - - DishwaEher 16.60
Drinking fountain 16.60
-.-- -rs/sump, 16.60
Name: -k V ioay, Ltx' 0(.3 Expansion tank 16.60 -
Address: Fixture/sewer cap 16.60
City/State/Zip: Floor drain/floor sink/hub 16.60
-- Garbage dosal _ _ 16.60
Phone:,;?[)0-S�,l��: ] Fax: Hose bib 16.60
,1,14 CONTACT V O Ice maker - -_ 16.60
Name: Interceptor/grease trap 16.60
Address: Medical gas-value: S Pae 2
City/State/Zip: u Primer 16.60
Roof drain commercial) 16.60d Phone: J Fax: Sink/basin/lavato 16.60
E-mail: Tub/shower/shower pan 16.60
v~pUrinal 16.60
Water closet 16.60
Business Name: 1/js(,(�(u�- L' -/
Water heater 16.60
Address: + ^;�,(�e S Other:
City/Stat,/Zip: -Tj .Ct r 0 G 7'A-A 3 Other: -�
>'Sa- v Fax: 991J
W Phone: L! '4q I/
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CCB Lic. #: I(l -1 plumb. Lic.#: 2,& SK Subtotal $
-� Minimum Permit Fee$72.50 S
Authorized Q Residential Backflow Minimum Fee$36.25 _
Signature: �{/�,�,�_ 1� .���� : 3r _ Plan Review(25%of Permit FeeL- _
� -LjQ State Surcharge(8%of Permit Fee) S r .
(Please phnt name) �- TOTAL PERMITFEE S
Notice: This permit application expires If a permh is not obtained within All new commercial buildings rquire 2 seta of plana with Isometric or
190 days atter It has been accepted as complete. riser diagram for plan review.
*Fee methodology set by TA-County Building industry 3ervi-e Board.
is\Dsts\Permit Fomu\PlmPemtitApp.doc 01/03
Plumber Permit Application -City of Tigard
Page 2 -Supplemental Information "` r
Fee Schedule: _ Residential Fire Suppression Systems: _
Site Utllhies Qtr. F!a ta) 'Paul Square Faoxges P_ermlt Fee:
Footing drain- I'l00' 55.00 0 to 2,000 $115.00
Footing dram-each additional 100' 46.40 2,001 to 3,600 $160'00
—_
3,60-1 to 7,200 _ 5220.00
Sewer- I at 100' 55.0(1 _ 7,201 and jne Sr _ $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' ` 5`to Medical G s Systems:
Water Service-each additional 100' X46.40T Valuation•_ Permit Feet _
Storm&Rain Drain-Ist 100' _ 55.00 $1 90 to$S .00+ Minimum fee$72.50 _
Storm&Rain Drain-each additional 100' 46.40 $5,001. to$10,000.00 $72.50 fw the first.$5,000.00 and$1.52 for each
uMiticnal S100A0 or fraction thereof,to and
,.`britdth QTY•. F �� T� including$10000.00._ _
Commercial Rt .rlow Frevention Device 46+40 ,001.00 to$25.000.00 $148.50 for the first S10,000.00 and$1.54 for
Residential backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum rmit fee$36.25 _ 21.55 _ and including$25,000.00.
Rain train,tingle family dwelling W,25 $25,001.00 to$50,000.00 $374.50 for thr first$25,000.00,and$1.45 for
each additional 5100.00 or fraction thereof,to
Inspection of existing plumbing or and includint$50,000.00.
s cull re eTi ions-2cr hour 72.50 $50,001.00 and up $742.00 f 1,the fret$511,000.00 and$1.20 for
Subtotal: each add xmI 5100.00or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing t s? if
"yes",please indicate work performed by fixtt e. Fat a to
accuratel report fixtures could result in incl . xcd sewer s*.
py, Comments i egarding fixture work:
baptistrytFont --•- _�.
Bath -Tub/Shower
_-Jacuzzi/Whirlpool
Car Wash -Each Stall
Drive Thru
Cuspidor/Water Aspirator
Dishwasher -Commercial -- ---
-Domestic
Drinking Fountain
Eye Wash _
Floor[rain/sink -2"
i„
.4"
Car wash Drain — *Note: If the fixture rk under this permit re+ulty in an
Garbage .Domestic
a Di.poral -Commercial increase of server Fnt1s, sewer permit will be .rfsued and
-Industrial fees assessed for the sewer nerease must be tiara before the
N Ice Mach✓Refrig.Drains_ _ plumbing permit can be Issi d.
�. OiI Separator(C s Station) _
Rec.Vehir'a Dump Station
�) Showy, -Gang
tD -Stall
0 Sink -Bar/lavatory -
ul -Bradley
Commercial _
-Service
Swimming Pool Filter
Washer-Clothes _
Water Extractor
Water Closet-Toilet
Urinal
Other Fixtures:
I:1DstAPerrntt FormslPlmPermitAppPg2.doc 01/(13
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