Permit ilk CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2000 -00420
-411 I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/16/00
SITE ADDRESS: 15065 SW 103RD AVE PARCEL: 2S111CB 03700
SUBDIVISION: MARION ESTATES ZONING: R -3.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: OTR 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
DRAPER, DOUG AND KAREN M PRMT CTR 11/16/00 $36.25 27200000000
15065 SW 103RD AVE 5PCT CTR 11/16/00 $2.90 27200000000
TIGARD, OR 97224
Total $39.15
Phone 1:
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 6136 Final Inspection
PLM 11558
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 ebtairt copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issue By: /_ 41q p oL4M Permittee Signature: __44 „eel;a —6 •
Call (50 39 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
REcEIV F Date received: j/- /b- DU Permit no.: t _ti MIENIMiMillllII
°�
City o f Tigard
.. g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR _9722(10(
City of Tigard Phone: (503) 639 -4171 tIO\ Projecdappl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
CU1h1AU!' ���
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
.11 & 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 infori ation use checklist)
Job address: I SO In t tip / C r el ! ' c~C'., Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
��. (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: ,)_) /b j,„ SFR (1) bath
Lot: (Block: Subdivision: SFR (2) bath
Project name: Kq, r1 b_i- a.p ez SFR (3) bath
City/countrnq ttttt tt) /3 j� I ZIP: C17 �• Li Each add bath /kitch en
D cription An location of work on premises: Site utilities:
1r`}t 1 Liu) /Gf G( e-t) / C € Catch basin/area drain
Est. date of completion/inspection: 1 / • _ C? Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: P(r &/ tSS L IL LS Cap e 7n G Manholes
Address: _9 gq S' Si() KJ,r)S- rvietiL /Q./O Rain drain connector
Ci tU /VSfn'1uiIi IState:6d ZIP:g76 70 Sanitary sewer (no. lin. ft.)
Phone:(,g - (,,Cy7(, " Fax 4 2 - VE.')4,E -mail: Storm sewer (no. lin. ft.)
CCB no.: Is / 3 Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lic. no.: d.1 Fixture or item:
C�
Contractor's representative signature�' 1�4 0-e. Absorption valve
Back flow preventer - S
Print name: — S r12ru.) Date: / -/3 -00 Backwater valve
Basins/lavatory
Name: E P CP rrt^u) Clothes washer
Addresser(8?5 t() Kf Cam. R-- D iinkin ihwn gfo
Drinking fountain(s)
City: 1.6 t J FtSn vI I if I State:( . ,ZIP:9 7O '7CJ Ejectors/sump
Phone: C c�, - ( 0 1 ax:(A car? ... -mail: Expansion tank
OWNER Fixture/sewer cap
N. - (pn • KCIy /) br( ,. G Floor drains/floor sinks/hub
M. ing address. U to S 1o? -r - ' Hose bibb
disposal
Hose bibb
Ci : ri � td I State: 0 . I' :97 2 2 L/ Ice maker
Phone: (2�a Li- gY) Fax: I E -mail: Interceptor /grease trap
Owner installation/resident : maint nance only: The actu.. installation Primer(s)
will be made by me or the m.' ten. ce and repair made by m ,regular Roof drain (commercial) _
employee on the property I own ..: 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 ! x'7, 5 5 c z 5
all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ [ro .
Notice: This permit application Plan review (at %) $
Li Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $ Q Q. ��
Expires within 180 days after it has been
TOTAL $ 31. /5
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 I Quantity by Work Performed
Gas piping requires a separate mechanical I Fixture Type: ( New I Moved ( Replaced I 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 iSA e.e/.1 &J
Commercial Back Flow Prevention Device 46.40 a-tbit.-e.
Residential Backflow Prevention Device* i 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 3 ,
8% STATE SURCHARGE
C qU
"PLAN REVIEW 25% OF SUBTOTAL `'
Required only if fixture qty. total is > 9
TOTAL 39 /5 $
*Mifimum permit fee is $72.50 + 8% state surchar ems, except Residential Backflow
p revention Device, which is $36.25 + 8% state surcharge
" 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 y- .•
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 ST
/ /� BUP
l
Date Requested /Z - Z / AM a PM BLD
Location / 5 £' j s' w /03rd Suite ME
Contact Person Ph 54Y Cya 6076 PL z. e/ — 6 y Z v
Contractor Ph < Z/ 7 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 /� �/� - I J� �1 ( \
—
F aminath /Shear l > L1 A00 V V 2i l � C v - 1 s _ , ' (� ) ✓�Q.e_s s
g ' \ � �1.�1
Drywall on l U 0 ('� \_ E \. t ' n
Drywall Nailing �/J C \f) k 3 ` �-O�.x
Fire wall � ��
Fire Sprinkler .� I`
Fire Alarm
Susp'd Ceiling I I
Roof
ma A.,4_41._ s11:� ∎Z..
Final • _ II I
PASS PART FAIL ' ■
LU M
s Beam
Under Slab
Top Out
Water Se ' e 6;c /( r'"
Sanitary ewer (JA, t,
Rain Drain
ma
PASS PAR FAIL
MECHA L
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
,
PASS PART FAIL
ELECTRICAL - 6
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
Approach /Sidewalk ` �
Other Date � 2 / 2/ Inspector Ext - J 19
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.