Loading...
Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM200000405 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/1/00 SITE ADDRESS: 14530 SW 100TH AVE PARCEL: 2S111BD-00301 SUBDIVISION: PEMBROOK HEIGHTS ZONING: R -3.5 BLOCK: LOT: 001 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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: 180 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of 180' sanitary sewer line. FEES Owner: Type By Date Amount Receipt QUINN, DONALD R JR PRMT CTR 11/1/00 $100.40 27200000000 SHIRLEY A 5PCT CTR 11/1/00 $8.03 27200000000 14530 SW 100TH TIGARD, OR 97224 Total $108.43 Phone 1: Contractor: MIKE MOORE & SONS EXCAVATING 2500 SW 178TH ALOHA, OR 97006 REQUIRED INSPECTIONS Sewer Inspection Phone 1: 692-3150 Reg #: LIC 110863 Final Inspection 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 By: � _' Permittee Signature: X Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day .I/ .- Plumbing Permit Application Date received: / /// Permit no.: fi Za oo 619 Vas' ' 41k Rr .. , � . City of Tigard ( � ' `J b 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: By: Receiptno.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist) Job address: Description Qty. Fee (ea.) Total Bldg. no.: I Suite 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: IBlock: 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: /y9� �J, re' s,,,,; s �X( Manholes Address: p S c.,.) / Rain drain connector City: . 4,� ,i I State: o,el ZIP: 9740 . Sanitary sewer (no. lin. ft.) /go / Phone: 5jf_fjsig I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: //p sl I Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: Fixture or item: Absorption valve Contractor's representative signature: j�. ' >- o Back flow preventer Print name: , /,: . / /.. ,,,ems Date: / / -/ e5 Backwater valve • CONTACT PERSON Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E-mail: Expansion tank OWNER Fixture/sewer cap Name (print): r N Floor drains/floor sinks/hub Q Garbage disposal Mailing address: /5/, j 30 ,5 /Q d T-0 Hose bibb City: r, f �� n / I State:a2l ZIP: 9 7�7.,,7 3 Ice maker Phone: I 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 c� Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ l/� O • / v Notice: This permit application Plan review (at %) $ ❑ Visa 0 MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ . 0 3 Expires TOTAL $ /0k. y3 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/00 /COM) PLUMBING PERMIT FEES: • 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 PLEASE COMPLETE: 3" 16.60 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 .55; ffe 3" Sewer - each additional 100' 46.40 Z / y4 4" Water Service - 1st 100' 55.00 Water Heater Other Fixtures Water Service - each additional 200' 46.40 (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 /DO' w 8% STATE SURCHARGE fr * *PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ /De yj * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. * * AII New Commercial Buildings require plans with isometric or riser diagram and plan review. is \dsts \forms \plm- fees.doc 10/10/00 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24aHour'inspection Line: 639 -4175 Business Line: 639 1 / BUP Date Requested it AM PM BLp Location /13 .3 0 S 441 / G ' 42 &`r Suite MEC Contact Person '1 / /( Ph 5 f - fl L PLM v -G O YU 5 Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall / 3 , fY�^ « ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation • Drywall Nailing _ Firewall I © /c( ��� jlC �-t � �!� C� ✓ —P 0 Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMB! ost & Beam Under Slab Top Out Water Service Drains tft■ ( S' ART FAIL ICAL 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 2 0 0 y Approach/Sidewalk Other Date I !I 7' v Inspector L i Ext O Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. BUP - Building Permit ELC - Electrical Permit 4 Inspection Description Date Passed By I Inspection Description Date Passed By Footing /Setback Underground cover Foundation walls Wall cover Footing drain Ceiling cover Waterproof bsmt walls Electrical rough -in Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing 4 Inspection Description Date Passed By Firewall Low voltage Tilt -up panel Electrical final Masonry /Reinforcement Framing MFG - Structure set -up MEC - Mechanical Permit Insulation Drywall nailing - NI Inspection Description Date Passed By Post/beam mechanical Suspended ceiling Gas line • Engineered soils Mechanical rough -in Welding Lab Final Fire damper _ Concrete Lab Final Duct work Bolting Lab Final Smoke detector Fireproofing Lab Final Mechanical final Structural observation Final inspection PLM - Plumbing Permit Inspection Description Date Passed By BUP — Fire Protection System Permit Plumbing underslab 4 Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP /backflow preventer • Fire alarm final Rain drain Storm drain Water service SIT - Site Permit Sanitary sewer 4 Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final // — 1— pc- Sprinkler supply lines S'c�,p� /� / f� . Sprinkler underfloor /slab (� Catch basin/Manhole _ SWR - Sewer Permit Engineered soils 4 Inspection Description Date Passed Engineering acceptance Sanitary sewer /1 ? Final inspection Final inspection INSPECTION RECORD - BUP, PLM SWR, ELC, ELR, MEC SIT PERMITS A CI TY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES DATE ISSUED: P LM20%00 -00405 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14530 SW 100TH AVE PARCEL: 2S111 BD 00301 SUBDIVISION: PEMBROOK HEIGHTS ZONING: R -3.5 BLOCK: LOT: 001 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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: 180 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of 180' sanitary sewer line. FEES Owner: Type By Date Amount Receipt QUINN, DONALD R JR PRMT CTR 11/1/00 $100.40 27200000000 SHIRLEYA 5PCT CTR 11/1/00 $8.03 27200000000 14530 SW 100TH TIGARD, OR 97224 Total $108.43 Phone 1: Contractor: MIKE MOORE & SONS EXCAVATING 2500 SW 178TH ALOHA, OR 97006 REQUIRED INSPECTIONS Phone 1: 692 -3150 Sewer Inspection Final Inspection Reg #: LIC 110863 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 By: By: &�i.ir,;,. Permittee Signature: � Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day