Permit ~ CITY OF TIGARD PLUMBING PERMIT
A...4000 DEVELOPMENT SERVICES PERMIT #: PLM2000 -00383
! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/00
SITE ADDRESS: 14805 SW 103RD AVE PARCEL: 2S111CB -00500
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
MUNHALL, WALTER F JR AND PRMT CTR 10/16/00 $36.25 27200000000
JEAN B 5PCT CTR 10/16/00 $2.90 27200000000
14805 SW 103RD AVE
TIGARD, OR 97223 Total $39.15
Phone 1:
Contractor:
SUNSET LANDSCAPE & IRRIGATION
P.O. BOX 2337
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone 1: 503 - 547 -0082 RP /Backflow Preventer
Reg #: LIC 12621 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 callin• (503) 246 -1987.
Issued By: ` 1 Permittee Signature: 7// „” /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t e next business day
Plumbing Permit Application
Date received: 4// / Pertnit no.:AGy Z�o �3
ai,_l 'fill' City of and
• Ti g 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: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
Al 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: /L/gc,s S t ,,J / O 3 /}-1) 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: Mt/ /N',i ,.p ma's SFR (3) bath
City /county: 17 &ed (,t/I} I ZIP: , -7 Z z,1 Each additional bath/kitchen
f)
Description and location f work on premises: Site utilities:
S Pie, n)IC./.. INST .4-n Fit 04 i- ?D 8,4t4_ Catch basin/area drain
Est. date of completion/inspection: 10 f So DD Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: St,hsc.4 i aNdscu,pa- `wt L- .Tier.. Manholes
Address: "PO 30 x 2.. 3 / Rain drain connector
City: i1 1b loueo I State: 0 ,4 ZIP: c' 7 / 2_3 Sanitary sewer (no. lin. ft.)
Phone: 03-s-y7 .Fax: 7-00921E-mail: Storm sewer (no. lin. ft.)
CCB no.: t 2 t, 2 ■ I Plumb. bus. reg. no: Z Z 51 Water service (no. lin. ft.)
City /metro lic. no.: C 5 ? 14.4 14.4 3 Fixture or item:
Contractor's representative signature: 44.4 ;4 A bsorption valve
Back flow preventer I b 2 ?(. ,
Print name: • er2444tie, - • a ate: /o /b DO Backwater valve
CONTACT PERSON Basins/lavatory
Name: _ 1) A ea (D4 r C4 h 1 ems. ■A_ Clothes washer
Address: F 6 ox 2. 3 3-7 Dishwasher
City: I State:Ot. I ZIP: 7/Z 5 Drinking fountain(s) •
Y: /-t, //4 W e ° Ejectors/sump
Phone: S o - 5-y7 -o0 Pax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): W a,14- M. (,t,v,k a l Garbage disposal
Mailing address: 1 q $ O S 5 cJ /0 3 Ra m Hose bibb
City: 77 6.444.0 I State: 02 I ZIP: y' 2Z y 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
Name: Urinal
Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: E -mail: Total
Minimum fee $ 3 6 ZS
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Z 9�
Credit card number: / / within tate surcharge (8 %) $
Expires n 180 days after it has been TOTAL $ 3 9 a
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
16.60 for each utility connection)
Lavatory 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 b 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' 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
8% STATE SURCHARGE
* *PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
* * All 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
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
` BUP
/
Date Requested /0 / AM PM BLD fil
Location /11,65
L/' &) 5 r-✓ / 0_3 Pd AL) L Suite MEC
Contact Person Ph PLM 2-,i -6 D 313
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall 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
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
Post & Beam DG
Under Slab u 014'e
Top Out CAeK,
Water Service P- -Qv /V
Sanitary Sewer re"
Rain Drains 5pv^kIa -
Fi
AS PART FAIL
HANICAL
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA p�(1
Approach/Sidewalk /O / V v Inspector ' " 1 Ext
Other Date
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
Y' Inspection Description Date Passed By 4 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 -4 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
1,1 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 fmal Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
J Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final /Ulu q lc/ 7
Sprinkler supply lines -
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils 4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR, ELC ELR, MEC SIT PERMITS
, CITY OF TIGARD PLUMBING PERMIT
Azi l i t, DEVELOPMENT SERVICES PERMIT #: P /16/00 -00383
- - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/00
PARCEL: 2S 111 CB -00500
SITE ADDRESS: 14805 SW 103RD AVE
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
MUNHALL, WALTER F JR AND PRMT CTR 10/16/00 $36.25 27200000000
JEAN B 5PCT CTR 10/16/00 $2.90 27200000000
14805 SW 103RD AVE
TIGARD, OR 97223 Total $39.15
Phone 1:
Contractor:
SUNSET LANDSCAPE & IRRIGATION
P.O. BOX 2337
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 503 - 547 -0082
R Final Inspection
Reg #: LIC 12621
d X
Sb
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. 0
You may obtain copies of these rules or direct questions to OUNC by callin ; (503) 246 -1987. 0 Issued By:Z P ermittee Signature: ��/, i / ; Ai . 4
Ugh
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t e next business day
U4