Permit CITY OF TIGARD PLUMBING PERMIT
4.4,000, DEVELOPMENT SERVICES PERMIT #: PLM2001 -00180
Ajj- - II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/2/01
SITE ADDRESS: 11190 SW 82ND AVE PARCEL: 1S136CB -02300
SUBDIVISION: RANCH VALLEY ZONING: R -4.5
BLOCK: LOT: 004 JURISDICTION : - TIG •
CLASS OF WORK: ALT GARBAGE DISPOSALS: , MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW 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:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 30 ft
DISHWASHERS: RAIN DRAIN: ft
• Remarks: Installation of 30' of water service line.
FEES
Owner:
Type By Date Amount Receipt
DORIS ALVAREZ PRMT CTR 5/2/01 $72.50 27200100000
11190 SW 82ND AVE 5PCT CTR 5/2/01 $5.80 27200100000
TIGARD, OR 97223
Total $78.30
Phone 1: 503- 624 -6088
Contractor:
AMERICAN STAR DRAIN & PLUMBING •
CHARLES ANDREW BUXTON
, PO BOX 66183 REQUIRED INSPECTIONS -
PORTLAND, OR 97290 -
Phone 1: 238 -1919 Water Line Insp
Reg #: LIC 131403
PLM 26 -652PB
•
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 requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued B Permittee Signature: �'
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day •
1, - ~ Plumbing Permit Application
Date received: ..5/2/0/ Permit no.:P�i� / -DO /�
6.<<t}, 1 g City of Tigard
`J Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By2 > 9 Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
L1.1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
❑ New construction )[ Additio alteration/re!, acement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special iuforu ation use checklist)
Job address: //i le, 6 62 �-d�3 Description Qty. Fee(ea.) Total
Bldg. no.: S uite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath .
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: A A 4 ,' £� ,0A./ sr Ax ) � J - Manholes
Address: Rain drain connector
City: I State: I ZIP: Sanitary sewer (no. lin. ft )
Phone: r> y c/ _ Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: / coo y I Plumb. bus. reg. no: 2d - -4,2R5 Water service (no. lib. ft.) ;4/, City/metro lic. no.: d0 �� cf- ?Noy 9/3/p A o i
Contractor's representative signature: Absorption valve
• --1- — _Back•flow preventer
Print name: y -s - , Date: ,$- - -00 Backwater valve
CONTACT PERSON Basins/lavatory
i_ Clothes washer
Name:
42 7 75 5 7 T n /V Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Name (print): DO A l 4' Z
G S Floor dratns/floor disposal sinks/hub
arbage
Mailing address: ) f i q' .T w ¢ 2 R /2—
Hose bibb
City: 77T G-4- �� State: p ZIP: Ice maker
Phone: G 2y..., Az Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total n
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Pl nl evi fee $ / s
CI Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number / / within 180 days after it has been State surcharge (8 %) .... $ S . (e()
Expires TOTAL $ " • 3 0
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00/COM)
PLUMBING PERMIT FEES:
I PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' . 3d 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device" 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL 7.2 56
8% STATE SURCHARGE
eY'U
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $-7e, 30
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $38.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:\dsts\formskplm- fees.doc 10/10/00
• CITY,. OF TIGARD BUILDING INSPECTION DIVISION (4o 7',
24 -our Inspection Line: 639 -4175 Business Line: 639 -4171 MST
H
BUP 4I'
Date Requested 5 ----3 AM PM v BLD WINV
Location ` I ff / 5 w o Suite MEC
Contact Person Ph PLM v/ - 0 /1 6)
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing
Foundation Access: PP K FPS
Ftg Drain SGN •
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
•
Int Sheath/Shear — —
Framing .
Insulation
. Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof C a 5 C
Misc:
Final
- PASS PART FAIL
Post & Beam
Under Slab
Top Out
Sanitary Sewer
' ! rains
- • S •ART FAIL
NIt ANICAL
Post & Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab .
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: . [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date / 3 lb ( Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.