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11685 SW NORTH DAKOTA ST
CITY OF T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00459
13125 SW Hall Blvd., Tigard, OR 97223 (50 )639-4171 DATE ISSUED: 10/13/2004
SITE ADDRESS: 11685 SW NORTH DAKOTA ST PARCEL: 1S134CA-00300
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW F REVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 1.300 ft
DISHWASHERS: RAIN DRAIN: buU R,
Remarks: Private utilities for 6 lot subdivision. Other fixture is(1)manhole. _
Owner: _ FEES
Description Date Amount
TODD PAYS
17481 SW HOODOO CT [PLUMB] Pennit Fee 10/13/2004 $885.60
BEAVERTON, OR 97007 [PLMPLN] Plan Review 10/13/2004 $22.1.40
(TAX]9%State Surcharl 10/13/2004 $70.85
Phone: 503-591-5078 Total $1,177.85
Contractor:
TROY ELLIOTT PLUMBING
PO BOX 195d
NORTH PLAINS, OR 97133 REQUIRED INSPECTIONS
Phone: 503-309-5750 Water Service InspWater Service Insp
Reg#: PLM 34-402PB Water Service Insp
IA' 152310 Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Final Inspection
IL
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This permit is issued subject tt, the regulations contained in the Tigard Municipal Code, State of OR.
m Specialty Codes and all other applicable laws. All work will be done in accordance with approved
W 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
Utility Notification Center. These rules are set forth in OAR 952-0001-0010 through OAR
952-0001-0100. You may obtain eopiPs of these rules or direct questions to OUNC by calling 1503)
246-6e99.
Issued By: 2z&uz� Permittee Signature:
Call(503)639-4175 by 7:00 P.M.for an Inspection needed the next business day
Site Utilities'+
Plumbing Permit A n
City otTigard •`— 1RecjeiveVd
1,/0 el Permit No.:AS
13125 SW Hall Blvd.,Tigard,OR 97223200 Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.599.1960 Date/By: p C Ij
l -
24-Hour Inspection Line: 503.639.4175 Date Reody/By �r r 0 see Page 2 for
Internet: www.ci.ligard.or.us Nolilied/Method'v �i�o Supplemcutallnformalinn
rye n�� �Vrgl "N a FEE" SCHEDULE
New construction Demolition _- Forspecial Information use checklist
Descri tion Ea. Tidal
❑Addition/alteration/replacement ❑Other: New 1-1-famlly dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUMON SFR(1)bath 249.20
1-and 2 family dwelling E]Commercial/industrial SFR(2)bath T 350.00
SFR(3)bath 399.00
❑Accessory building ❑Multi-family
_ --- Each additional bath kitchen 45.00
❑Master builder ❑Other:
Fire sprinkler(_sq.fl.) Page 2
JOB SIT' INFORMATION AND LOCATION Site utilities
Job site address: �OCYyt � U , -S1i�'G Catch basin or area drain 16.60 /(p
City/State/ZIP: Drywell,leach line,or trench drain 16.60
Suite/bldg./apt.no.: Project Warne: / Footing drain(no.linear rt.:`) Page 2
�C�f Manufactureo home util lies 110.00
Cross street/directions to job site: Manholes 1660
folie _ Rain drain connector 16.60
e GdrS/ 421��, f/i�'d'1� /ssGrr Sarnlary sewer(no.linear fl.:_� Page 2
Storn.s-wer(no.linear ft.: Page 2
Lot no.: Water servi:P.(no.linear fl./ Page 2 ,
Subdivision: —---
Fixture or Item
Tax map/parcel no.: Absorption valve -_ 16.60
DESCRIPTION OF WORK ' Backflow preventer Page 2
- Zf �'�Si���►�I�� C/ /�� Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
[3 PROPERTY OWNEit ❑ TENANT
�— -- Ejectors/sump 16.60
Name: 1O - _ Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: -` Floor drain/floor sink/hub 1660
Phone:( ) Fax:( ) Garbage disposal 16.60
Hose bib 16.60
n APPL11'4NT ❑ CONTACT PERSON`- ice maker 16.60
Business name: PGS S � isG_t `jG• Interceptor/grease trap -_ 16.60
4. Contact name: � /�/ �G,v s - Medical gas(value:S ) - Page 2
Address: z 5—h/ Primer 16.6^
W City/State/Z[P: �� e7� V 749121 Roof drain(commercial) 16.60
Sink/basin/lavatory 1660
5 Phone:Qp4j) j /` �07� Fax: :(5 ) Z/' ' d S(X!
o Tub/shower/shower pen 16.60
E-mail: /A-GLj ig x !��� D MC.-sit Urinal 16.60
(' CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Other:
Address: &6MIS
Subtotal
City/State/ZIP: Aid A 1/V J -11-3 Minimum permit fee: $72.50
Phone:(Sad) 3 0�� 5-,75-d Fax:( ) Residential backflow minimum ermit fee: $36.25 Q �j
Plumbing Lic.no.: Plan review (25%of permit fee) Z 0
CCB Lic.: D 6(,
G State surcharge(g%of permit fee)
Authorized signature: TOTAL PERMIT FEE /
Print name: �. Date: rf This permit application expires If a permit Is not obtal within
190 days after It has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
iUluildingNpvTntr1PLMII-Pertnh App doc 12/03 44046167(10102/COMMEB)
Plumbing- Permit Application - Uty of Tigard •
Page 2 -Supplemental Information
Fee Schedule:' Residential Fire Supp ession S stems:
Site Uitilitiiii Fed f alt) T`w; rDO
i1_ 1 (xitrta e: Feritnit Fee: _
Footing drain-I"I(X)' 55.00 0 to 2,W', $115.00
Footing drain-each additional 100' 46.40 .001 to 3,600 _ $16 .00
Sewer-I st 100' 55.00 L37,201
,601 to 7,200 $220.00
and greater _ S309.00
Sewer-each additional 100' 46.40
Water Service-Ist 100' / 55.00 S, Medical Gas S stems:
Water Service-each additional I(A) / 46.40 Sts
Storrs&Rain Drain-I st 100' / 55.00 /, WOO Permit Fee:
Y $1.00 to$5,000.00 Minimum fee 572.50
Storm&Rain Chain-each additional 100' 46.40 8s, $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
w A011(a) Total '
additional S100.00 or fraction thereof,to and
including$10,000.00.
Commemia:Rack F,ow Prc,,ention Device 46.40 510,001.00 to$25,000.00 $148.50 for the first$10,000.00 and S1.54 for
F,!�odentisl Bac"ow Prevention Device each additional 5100.03 or fraction thereof,to
minimum permit Cee$36.25, 27.55 _ and including 525,000.00.
Rain Drain,single family dwelling 65.7.5 S25,001.00 to 550,000.00 5379.50 for the first$25,000.00 and$1.45 for
Ins ct,on of existing plumbing or each additional$100.00 or fraction thereof,to
1� g p g and including 550.000.00.
specially re uestea inspections-per hour 72.30 550,001.00 and up $742.00 for the first$50,000.00 and 51.20`, 1
Subtotal: Z, Q each additional$100.00 or fraction thereof. J
i
Fixture Work-
Are you capping,moving o replacing existing fixtures? If
"yes",please indicate work p formed by fixture. Failure to
accurately report fixtures could sult in Increased sewer tees*
a.,.. .
New 1CIf Comments regarding fixture work:
Ba tia /Font
Rath -Tub/Shower _
-Jacuzzi/Whirl ool -
Car Wash -Each Stall
-Drive Thru
Cuspido,fWater As irator
Dishwasher -comvwmMT
-Domestic �\
Drinking Fountain
Eye Wash
Floor Drain/sink 2"
3„
.4"
Car Wash Drain
Garbap,! -Domestic
Disposal -Commercial *Note: IC the fixture work.im'de 44
s permit results in an
-Industrial Increase of sewer EDUs,a sewer per ill be Issued and
Ice SeEaraRefri .Drains fees assessed for the sewer increase must be paid before the
oils aratle Dues Station) plumbing permit can be Issued.
Rec.Vehicle Dump Station P g P ,
Shower -Gang
-Stall
Sink -Har/lavatory OUantitV Total
-Bradle7 - Isometric or riser diagram is required if fixture quantity
-Commercial _ total Is>9.
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor _ Plan Review
=ter Closet-Toilet _ Plan review is required if fixture quantity total Is>9.
Urinal
Other Fixtures:
i\P,ildinaNr"?nlN'LH-PermhAppdm 3103
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)6311-4176
INSPECTION DIVISION Business Line: (503)639.4171 MST
/ / SUP
Received ----Date R uested_/o)�k, _AM _PM SUP —
Location Suite— MEC _
Contact Person Ph( ) J-3 _e- _7 PLM
Contractor Ph(—) 3WR _
BUILDING Tenant/Owner � ELC
Foo"ng
Foundation Access: ELC —
Ftg Drain
Crawl Drain ELR ---
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors —_
Ext Sheath/Shear
Int Sheath/Shear —
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Others —
Final
PASS PART FAIL -
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains _
Catch Basin/Manhole
Shower Pan
Other:
Z" PART FAIL
HANICAL
Post&Beam
Rough-In
Gas Line
IL Smoke Dampers -- _
OC Final
N PASS PART_FAIL -- -- — – --
ELECTRICAL
Sen Ice
W Ro,.igh-In —
a U3/Slab
W Low Voltnae _ —^
F ire Alarm
F.nal Reinspection fee of$� required before next Ina
PASS PART FAIL LJ P — fin• Pay et City Hall, 1315 SW Hall Blvd.
SII•E F] Please call for reinspection RE:_ L7 Unable to Inspect no acorn
Fire Supply Line
ADA t
Approach/Sidewalk pib �wMR
Other:
Final DO NOT REMOVE this Inspktlen nMWfd tr M 8010 OW
PASS PART FAIL
i
October 13, 2004 (OREGON
F TIGARD �
Mike Van Loo
Alpha Engineering, Inc.
9600 SW Oak, Suite 230
Portland, OR 97223
I
Re: Alternate Materials and Methods - Feihrenbacher Subdivision
Dear Mike,
We have received your request for an alternate material to be used for a section
of storm drain located 4t the Fehrenbacher Subdivision in accordance with
Section P2601.2 of the State of Oregon One and Two Family Dwelling Code.
Your proposal is to use C900 PVC as an alternate to 3034 PVC piping due to the
shallow burial depth. We could approve this alternate with the following
documentation submitted for review.
1 Two (2) sets of drawings stamped by an engineer licensed by the State of
Oregon showing the location, extent, material and fittings that are
proposed. All wyes, tees, cleanouts and other fittings associated with the
C900 PVC piping shall comply with the Plumbing Code requirements for
storm drainage installations
If you have any questions, please call me at (503) 718-2448.
Sincerely,
IL Gari Lampella
NBuilding Official
C. Mike Sheehan, Sr. Plumbing Inspector
John Williams, Plumbing Inspector/Plan Review
Mike White, Engineering Tech II
Hap Watkins, Inspection Supervisor
File
13125 SW Hall Blvd., Tigard, OR 97223(503)639A 171 TDD(503)684-2772