13455 SW NAHCOTTA DRIVE-1 I
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13455 SW NAHCOTTA DR
CITY OF' TIGARD PLUMBING PERMIT `
DEVELOPMENT SERVICES PERMIT#: PLM2003-00590
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 11/13/03
SITE .ADDRESS: 13455 SW NAHCOTTA DR PARCEL: 2S105DD-03500
SUBDIVISION: PACIFIC CREST ZONING: R-7
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREV`:TFS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: -RAPS:
STORIES: WATL-:R HEATERS: ;'ATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
T' ;HOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of irrigation backflow.
Owner. FEES --
Description Date Amount
D R NORTON —
4386 SW MACADAM AVE., STE 1( [PLUMBI Permit Fc. 11/13/03 $36.25
PORTLAND, OR 97239 [TAXI 8/,,State Surchart 11/13/03 $2.90
Total $3915
Phone : 244-522
Contractor:
ESEQUIEL ROBLES LANDSCAPING
7076 RIDGEMONT DR N
KEIZER, OR 97303 REQUIRED INSPECTIONS
Phone : 503-390-4353 RP/Backflow Preventer
Final Inspection
Reg#: PLM 7784
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
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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
Issued By: !�`` �� Permittee Signature:
ARA
Call(503)639-4175 by 7:00 P.M.for an Inspection needed the next
ss day y
Building Fixtures
Plumbing Permit Application Received QQ Plumbing
Dated // � �� V Permit N -OL }BO
City of Tigard Planning�A�pm 1 Sewer -
DateB�: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit Na.: _ -
Phone: 503-6394171 Fax: 503-598-1960 Post-Review Land Use
DateiBy: Cue No.:
Internet: www.ci.tigard.or.us cc'usct Juns.: I a See Page 2 for
24-hour Inspection Request: 503-6394175 Name/Method I su lemental Information.
TYPE OF WORK_ _ FEE*SCHEDULE(for special lnformAlao we decklist
New construction JHDemolition I Description Qty. Fede..) Total
Addition/alteration/ 1p°cement Other: 1 New I-A 2-family dw•ellim�p
CATEGORY OF CONSTRUCTION (Included 100 ft for tacha txeataeeM4
SFR I bath _ _ 2�9 20
1 &2-Family dwelling Commercial/Industrial SFR 2 bath _ 350.00
Accessory Buildin Multi-FamilySFR(3)bath 399.00
Master Builder F1 Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Firesprinkler .ft.: Pae 2
Job site address: 1'`•I 5's S Cts )V Q Co Q a F, Site Utilltla
Suite #: B ldg./Apt.#: Catch basin/arra drain 16.60 _
Pro ect Name: - Dr ell/leach line/trench drain 16.60
_ -- I Footing drain(no.linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Spit sewer(no. linear ft. Pae 2 _
Subdivision: Storm sewer no-, linear f. Pae 2
---
Tax map/parcel #: Water service no. linear R. +Page 2
DESCRIM'TION OF WORK Fixture or Item
-1- -
Absorption valve 16.60
Cr. r PY�u1 _ SQr nC 1C Srslo Backflow preventer Pae 2
Backwater valve 16.60
�- Clothes washer 16.60
- - Dishwasher 16.60
_
Drinking fountain 16.60
PROPERTY�OWNER TENANT Ejectors/sump 16.60
_Name: foa61 r1 0 r Q✓1 Expansion tank _ 16.60
Address:I:51{$ C S(11����� OL Fixture/sevrer ca _ 16.60 -
City/State/Zip: j (I rd OF, 472,'- Floor drainifloor sink/hub 16.60
16.60
- Garbage disposal _
Phone-.5%t • 51 Fax: hose bib 16.60
APPLICANT - I Ll CONTACT PERSON Ice maker 16.60
Name: _ _ Interceptor/grease trap 16.6A
Address: Medical gas-value: S Pae 2
City/State/Zip Primer _ 16.60
IL Roof drain(commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
N E-mail: Tub/shower/shower pan 16.60
} CONTRACTOR Urinal 16.60
JBusiness Name:i_$_ ;Q _�(e S I Water closet 16.60
mWater heater - 16.60
Address:? 76� t�nT V?-.Al other: �
0 City/State/Zip: i fetr d --17303 _ other:
J Phone: Fax: t Ftea'r
77
CCB Lic. #: Plumb. Lic.#: subtotal S
_ � Minimum Permit Fee 572.50 S
Authorized Residential Backflow Minimum Fee$36.25 16,05
Signature: Date: I}-t1 Plan Review(25%of Permit Fee S _
AMState Surcharge 8%of Permit Fee Sa�
(Please print name) _ TOTAL PERMIT FEE I LIG
Notice: 'this permit application expires ire permit Is not obtained within All new commercial buildings require 2 sets of plat s with Isometric re
ISO days after it hrs been accepted as complete. riser diegram for plan review.
'Fee methodology set by Tri-County Building Industry Servit, hoard.
i^Dsts'Permit Fonrtq�PlmPermitApp,doc 01103
Plumbing Permit Application -City of Tigard
Page 2 -Supplemental Information '
Fee Schedule: Residential Fire Su ression Systems:
Site Utilities Qty. Fee(t o) Tow Square Footage: Permit Fee:
Fooling dram- I'100' 55.00 0 to 2,000 — $I 15.00
Footing dram-each additional 100' 46.40 2,001 to 3,u00 $160.00
Sewer- I st 100' 5500 MAI to 7,200 $220.00 –
_ 7,20 t and greater 5309.00 –
Sewer-tach additional 100' 46.40 ---
Water Service-Ist 1(Kl' 55.00 Medical Gas S4
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 fee$72.50
Storm&Rain[rain-each additional IiVY 4640 55,001.00 to 510,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Fixture or Item _ Qty. pee(es) 'total additional S 100.00 or fraction thereof,to and
Commercial Back Flow Preventi,a lit'ice X6,40 including$10,000.00.
510,001.00 to 525,000.00 5148 50 for the first 510,000.00 and 51.54 for
Residential Backflow Preven:,on Device each additionidl$100.00 or fraction thereof,to
(minimum 2Mt,fee SY 25) 27.55 and including 525,000.00. _
Rain tram,single family dwelling --j 65.25 525,001 00 to 550,090.00 5379.50 for the first$25.000.00 and 51.45 for
Inspection of existing plumt,ing ar each additional 5100.00 or fraction thereof,to
woolly requested inspections-per hour 72.50 and including 550,000.00.
Subtotal: 550,001.00 and up $742.00 for the first 550,000.00 and$1.20 for
-- each additional SI00.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? if
"yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
uaatl b Fixture Work Pertained Comments regarding fixture work:
Fixture Typt Replsee
New MovedItch
Ba tis /Font_- -
Both -Tub/Shower — -' — -
-Jacuzzi/Whirl pool
Car Wash -Each Stall
-Drive Thru — —
Cus idor/Water Aspirator
Dishwasher -Commercial
-Domestic --
Urinking Fountain
Eye Wash
Floor Dmin/sink -2"
-4" `
Car Wash Drain
Ga.-Nage -Domestic *Note: If the fixture work under this permit results in an
Disposal -Commercial _ _ increase of sewer EDUs,a sewer permit will be issued and
-Industrial fees assessed for the sewer increase must be paid before the
NIce Mach./Reffi .Drains plumbing permit can be issued.
Oil Separator Gas Station
Rec.Vehicle Du Station
Shower -Gang
-Stall
Sink -Bar/lavatory
W -Bradley
J -Commercial
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor
Water Closet-Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPeimitAppPg2.doc O1i01
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