13178 SW TAMERA LANE 13178 SW 'fatnera Lane
CITYOF TIGARD __PLUMBINCA PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00019
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/21/03
SITE ADDRESS: 13178 SW TAM(-RA Lfv
PARCEL: 1 S133DC-17800
SUBDIVISION: VILLAGE AT SUMMER LAi,'E PARK ZONING: R-12
BLOCK: LOT: 033 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MA^.H: BACKFLOW PhrVNTLtS:
OCCUPANCY GRP: R:3 FLOOR DRAINS. TRAPS:
STORIES: WATER HEATERS: CA''-'H BASINS:
FIXTURES _ _ LAUNDRY TRAYS: :;r FAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES. OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
F emar ks: Installation of 45'of wator service.
--_— --�— FEES.______-------- - --
Owner: - ----- ----- -- — --
Description Date Amount
MARK HUPP —`-
13178 SW TAMERA LN [PI.UMBJ i'crmit Fee 1/21/03 $72.50
[TAX] 8,%State Tax 1/21/03 $5.80
TIi:ARD, OR 97223
Total $78.30
Puane : 503-579-1949
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD#344
MILWAUKIE, OR 97267 REQUIRED INSPECTIONS
Phone : 503-653-5301 Water Service Insp
Final Inspection
Reg#: LIC 138941
PLM 3-43411113
This permit is issued subject to the regulations contained in the Tigard 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 not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law rmquires you to follow rules adoptee by the Oregon
Issiied By; '�-- r Permittee Signature: -
Call (503) 639-4175 by 7:00 P M. for an inspection needed the next busln ss day
IFOR.OFFICE.(ISE ONLY
Plumbirpgo- Pennit A ; i>Ication
Received -Plumbing
- -- Date/By: l/ G Permit No.
6 41001
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Post-RevPhone: 503-639-4171 Fax: 503-598-1960 DatDate/e/B y: laud Use
'�-'� Case No.:
Internet: wwW.ci.tigaid.Or.us Contact Juris.• � See Hale 1 for
24-hour Inspection Rquest: 503-639-4175 Name/Method: -T/ Su Icmental Information.
TYPE OF WORK FEE"SCIIEDULE(forspecial Information use checklist)
New construction Demolition Description 11ry. Feetea.) Total
.Addition/altcratiunhe lacement Other: New 1-&2-family dwellings
CATEGORY OF CONSTRUCTION Includes 100 ft.for each utIIH connection
SFR I bath 249.20
1 &2-Family dwelling Commercial/Industrial SFR(2)bath 350.00
Accessory Building Multi-Family - SFR(; bath 399.00
A 0
_❑_ Master Builder Other: Each additional bath/kitcheu 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler-sq. ft.: Pae 2
Job site address: J�)O_b _ �J� v Site Uiuitles
Suite#: Bld /A it.#: Catch basin/arca drain 16.60
-��- -- Dr well/leach line/trench drain _ 16.60
o
Prect Name:
_ .,1 ----- Fouling drain(no. linear fl.) Page 2 _
Cross street/Directions to job site: Manufactured home utilities 110.00 _
Manholes - 16.60
Rain drain connecter 16.60
Sanitary sewer no. linear ft. Pae 2
Subdivision_ - - Lot#: Storm sewer(no.linear R.) Page 2
--- -- --- �� - Water service no. linear ft. Page 2
Tax map/parcel #: Fixture or Iter
DESCRIPTION OF WORK Absorption valve _ 16.60
Backflow prevcnter Page 2
Backwater valve 16.60
- Clothes washer 16.60
-------- - ---- Dishwasher _ _ 16.60
Drinking fountain 16.60 _
M.PROPERTY OWNER TENANT F'cctors/sum 16.60
ame: � Expansion tank 16.60
Fixture/sewcr cap 16.60
/State/Li : "7 - hloor drain/floor sink/hub 16.60
Cil -
_-Y_. ��-- Garbe�r.disposal 16.60
Phone: >'�_ / / Fax: Hose'aib I6.60
APPLICANT 0 CONTACT PERSON Icc rrakcr __ 16.60
Name:y��QS�, ' -��1�+Y� Interco tor/ reuse trap 16.60
Address: _%�j3 ,"�'�'� `n'�t �J`� Medical gas-value: S Pae 2
Primer 16.60 _
-City/State/Zip: VY) W^N4-A Roof drain commercial 16.60
Phone: 1053-5 3p Fax: Sink/basin1avatot 16.60
E-mail: T'uh!ohower/shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name_ Water closet _ 16.60
-- --- --- -- -- Water heater 16.60
Address: _ other:
City/State/Zip: Other:
Phone: ax: /z ?r D, Plumbing Permit Fees*
Subtotal S
CCB Lic. #: / U%1 Plumb. Lic.#: -ea Minimum Permit Fee 572.50 S
AuthorizedResidential Backflow Minimum Fee$36.25
Signature: -_ =_-T Date` Plan Review 25%of Permit Fee) S
State Surcharge 81,10 of Permit Fee S B
-- (Please print name) - _- TOTAL PERMIT FEE I�_ f, 3I
Notice: This permit application expires if a permit Is not obtained within All nevi commercial bu;dings require 2 sets of plans with Isometric or
190 days after It has been accepted as complete. riser diagram r'or plan review.
`Fec methodology.et ny Tri-County Building Industry Service Board.
1:\Dsts\Permit Forrns\PlmPermitApp.doc 01/03
pitillill3kaU Per_ _Ul#tion -City of"I'ig;:11
Page 2-Supplemental Information
Fee Schedule: Residential Fire Su ) )r,ssion Systems: _
Site Utilities Qiy. Fec(c+) Total S uare Footage: Permit Fee:
0102,000 $115.00 _
Footing drain-1"100' -- 55.011 2,001 to 3,000 .6160.00
Footing drain-each additional 100' 46.40 3,601 to 7 2u0 +220.00 _
Sewer- I st 100' 55.00 7,201 and a.reatcr $309.00
Sewer-each adui ional I oG 46.40
Wetcr Service-1st 10t)' 55.00 Medical Ga S Stems:
46.40 Permit Fee:
Waver Service each addn,unal 100' Valuation: _ —
Storm&Rain Drain-Ist 1004 55.0(1 $1.00 to$5,000.00 Minimum fee$72.50
$5,001.00 to$10,000.00 $72.50 flit the first$5,000.00 and$1.52 for each
Storm&Rain uraitt-tach—additional 1011' 46.40 I additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(ea) Total includin $10,000.00.
C,mmercial Buck Flaw Prevention Device 40.40 $10,001.00 to$25,000.00 $I48.5u ti r the first$10,000.00 and$1.54 for
each additional$100.00 or fraction thereof,to
Residcutial Backflow Prevention De,,ice and including$25,000.00.
minimwn permit Ice$36.25 27.55
65.25 $25,001.00 to$50,000.00 $379.511 for the first$25,006,00 and$1.45 for
Rain Drain,single family dwelling each additional$100.00 or fraction thereof,to
Inspection ol'cxisting plumbing or and including$50,000.00. _
s�cciell re nested ins cctions- er hour 72.50 _ $50,001.00 and up $742.00 for the first$50,000.'10 and$1.20 for
SubtntaL _� each additional$10(1.00 or t}eition thereof.
Fixture Work:
Are you capping,moving or replacing;existing fixtures? If
"yes",please indicate wot k performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. ('onpnlents regarding fixture work:
— uantit b Fixture Work Performed
Flzture Type: Replace
New Moved Extxtln Ca ted
Ba tistt /font ---- --
Bath =fuh/Slu•ver
-Jacuzzi/Whirl ool
Car Wk,sh Mach Stall
Drive 7'bru
Cus idor+'Watex As irator
Dishwasher -Commercial
Domestic — —— ----- —-- ——
_j2Ejnkja Fountain
1s ye Wash _
Floor Drain/sink .2" _
Car Wash Drain *Note: If the fixture work upder this permit results in an
(larbage -Domestic Increase of sewer EDUs,a sewer permit will be issued and
Disposal -romn,crciul — fees assessed for the sewer Increase must be paid before the
-Industrial
plumbing permit run he issued.
Ice Mach./Betel .urains
Oil 5c orator (les Station
Rec.Vehicle DUm Stenion —
Shower -Gang _—..
-Stall
Sink -Bar/I avatory
-Bradley
-Commercial —
-Servic.
S% mtnin pool Filter
Weshcr-clothes —
Water I;xtractor
Water t'Ioset-Toilet
Urinal
Other Fixtures: —
i,�usts\Permit Form9\PlmPermitAppPR2.doc 01103
TTY OF TIGARD 2.f-Hour
BUILDING Inspection Line: (503)639-4175
MAST ---
INSPECTION DIVISION Business Line: (503)639-4171
BUP ----- -- --
Received ___ __ _Date Requested. Z Z' — AM_ PM _- BUP
Location _-____ '� Suite G� _ MEC
Contact Person _ -- v -- Ph(—) PLM 2023 1
Contractor _ Ph(—) _ SWR __.._.
BUILDING Tenant/Owner _ _ - ELC
Footing ELC
Foundation Access: ' r7 S, N - �—
Ftg Drain / �/ ELR
Crawl Drain
Slab Inspe o Notes: SIT
Post&Beam � fl
Shear Anchors I
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _-
Firewall
Fire Sprinkler - - --
Fire Alarm
Sut;p'd Ceiling
Roof i
Other. -
Final J�'
PASS PART FAIL
PLUMBING
Post& Beam -�
Under Slab - _--_
Rough-In
V�Vater y.� - -- - --- -- •
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain
Shower Fat
Other: __ -'-- --- --- -
Fi
_ i PART FALL -- - -- -'-
M HANICA L _-
ost&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 Hall, 13125 SW Hall Blvd
PASS PART FAIL
SITE Please call for reinspection RE:- �. - Unable to inspect-no access
Fire Supply LineADA
Approach/Sidewalk Date Inspector /�- -Ext-----
Other: _ _ � �
Final — DO NOT REMOVE thle Insp�ectior► record from the Jour site.
PASS PART FAIL