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CITY OF TI GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00378
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/31/03
PARCEL: 2 S 103CA-00305
SITE ADDRESS: 11720 SVJ FONNER ST
SUhDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: B-,CKFiOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES_ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS. URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE' 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Water service replacement.
FEES
Owner: __
—•--- Descrlptior Date Amount
CAUDILL, KIRK
11720 SW FGNNER ST Ni Pci,nit I rr 7131103 $72.50
TIGA i7D, OR 97223 1 f,1 X 1 ``° titan'I ax 7/31/03 $'5.80
Total $78.30
Phone : 503-521-1634
Contractor:
TRI COUNTY PLUMBING CO
1 C' SE 242ND AVE
GRESHAM, OR 97080 REQUIRED INSPECTION'i
Water Line Insp
Phone : 503-658-7773 Final Inspection
Reg#: NIFT 0000 1660
I,IC 000601779
:'LM 26-423ph
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Fpecialty Codes and all other applicable laws. All work will be done in aci:ordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if viork is suspended
for more than 180 days. ATTENTION: Orcyon law requires you to follow rules adt)pted by the Oregon
i
Permittee Signature:
Issued By: g - -1—= - --
Call 503) 639-4175 by 7:00 P.M. for an inspection needed the next busi ess day
Building Fixtures
Plumbing Permit Applievition Rrceived_ � „!, 11
Nte/B : 7 I'cmut No.: CSC
City of Tigard Planning Apprdval Sewer
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-596-1960 ;, Post-Review land Use
Internet: www.ci.tigaid.or.m% Date/lly: Case No.: _
Contact Jw;s.: Scc Page 2 for i
24-hour Inspection Request: 503-639A 175 Name/Mcthod: /i snpl lemental Information.
TYPE OF WORK FEE*SCHEDULE for special inrormation use checklist
N•w construction _ I)cmolition Description I Qty. I Fce(ca.) Total
ddition/alteration/replacement New 1-&2-family dwellings
i CATEGORY OF CONSTRUCTION Includes 100 ft.for each u 111tv connection
1 & 2-Family dwelling Commercial/Industrial SIT(t bath 249.20
SFR 2 bath _ 350.00
Accessory Building - Multi-Famil _ SFR 3 bath 399.00
LJ Master Builder _ Other: Each additional bath/kitchen 45.00
JOB SITE INFORM TION d LOCATIO Firesprinkler-sq. 11.: Pae 2
Job site address: 1A;; site Utilities
Shite#: $ld ./A to Catch basin/arca drain 16.60
Dr well/leach line/trench drain 16.60
Pro�ect Name: Footing drain no,linear fl. Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
(h Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no. linear R.) Paw 2
Subdivision: - Lot#: Storm sewer no. linear ft.) aimm 2
Tax map/parcel Water service no. linear R.1 ) Pae 2
DESCRIPTION OFWORK Fixture or Item
~ (I Absorption valve 16.60
_ Backflow preventer Page 2
Backwater valve 16.60 _
Clothes washer 16.60
---- -.---.__- -.._.--�_ Dishwasher 16.60
DU2kin fountain 16.60
PROPERTY OWNER .F.NANT Ejectors/sure 16.60
_Name: ' --
h ' (X Expansion tank 16.611
Address: 72-L)SlJ G PI S' Fixture/sewet cap 16.60
City/State/Zi rt X77 4? Floor drain/floor sinkAub 16.60 -
Garbage disposal 16.60
Phone: - ro Fax: Hose bib 16.60
Ll APPLICANT CONTACT PERSON_ Ice maker 16.60
Name:- _ Intcrce tor/ rease trap 16.60
Address: Medical gas-value: S Pae 2
City/State/Zip: Primer _16.60
Roof drain(commercial) 16.60
Phone: -� �X: -_-�� Sink/basin/lavatory 16.60
E-mail: _ Tub/shower/shower pan _ 16.60
CONMACTOR - Urinal16.60
1, Water closet _ 16.60
Business Name: a ,t' t<t f C'
�j -� Water heater 16.60
Address:
vim- Other:
City -4/State/Zi . �71J _� Other:
Phone: ' -?0 ' Plumbing Permit Fees*
Subtotal S
CCB Lic. #: lumb. Ir.#: -----
Minimum Permit Fee$72.50 5
Authorized 1/ /� c. .y Residential Backflow Minimum Fee
✓ �-- t - $36.25SiHn4ure:
--
Plan Review(25%of Pcnnit Fee) S
._' ,charge(8%of Permit Fee) S
(I ,:ase print nantcl TOTAL.PERMIT FEE S
Nance: This Itcrrttlt application expires If a permit Is not obtained within All nett commercial buildings require 2 sets of plans with Isometric or
100 days after It has been accepted as complete, r her diagram for plan revirm.
Pre mvilmdology set by Tri-County Building Industry kertice Board.
i:\I)sts\Permit FomuTlmPermitApp.doc 01103
Pluinbing Permit A_pnlication - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ca) Total_ Square Footage: Permit Fee:
Fooling drain I" 1001 -- 55.( 0 to 2,000 $11500X) . v�
Footing drain-each additional !00' 46.40 32 600 $160.041
601 to 3
601 to 7,200 $22004)
Sewer-I At 100' 55-00 7,2_0_1 and greater $309.00_ _
Sewer-each additional 100' 46.40
Water Service-Ist 100' 55.00 Medical Gas S stems:
Water Service-each additional 100' 46.40 Valuation: Permit Fee:_ _
Storm&Rain Drain-I st 100' 55.00 51.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(ea) Total ;:.eluding$10,000.00.
Commercial(jack Flow Prevention licvice 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thea of,to
minimum Pei nut f'ce$36.25 27.55 and including$25,000.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
each additional$100 00 or fraction thereof,to
Inspection of existing plumbing(it —
and including$50,000.00. _
specially i i.• uesled inspections- r hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurately or( fixtures could result in increased sewer fees*.
uantit b Fixture Work Performed Comments regarding fixture work:
Fixture Types Replace
New Moved Exbtin Capped
ed
9e ►isl /Punt _ —
Bath -Tub/Shower _
-Jacuzzi/Whirlpool _
('at Wash -Each Stall _ -
-Drive Thru _
Cus idor/Water As irotor
Dishwasher -Commercial -
-Domestic
Drinking Fountain
Eye Wash
Floor Diain/sink -2"
4„ —
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage -Domestic in;rease of sewer Ehtis,a sewer permit will be issued and
Disposul -Commercial
-Industrial fens assessed for the sewer increase must be paid before the
Ice Much./Refs .Drains plinabing permit can be issued.
Oil Sc arator Gas Station
Rcc.Vehicle Dump Station _-
Shower -Clang
-Bu II
;ir.x ?nri'Avatory
-nraii,ey
-Commercial
-Service _
Swinimin Pool miller
Wasi er-Clothes _—
Wate Extractor
Water Closet-'toilet
Unna;
Other Fixtures;
i Dsls\Pcmiii Fiirnis\I11inl'ennitAppPg2.doc 01'01