Permit CITY TIGARD PLUMBING PERMIT
4 s DEVELOPMENT SERVICES PERMIT #: PLM2001 -00055
DATE ISSUED: 02/26/2001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134AC-05600
SITE ADDRESS: 10998 SW 109TH AVE
SUBDIVISION: HART'S LANDING ZONING: R -4.5
BLOCK: LOT: 027 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: 0
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install backflow prevention device for irrigation system.
FEES
Owner:
Type By Date Amount Receipt
BERKHOEL, PHILIP J 5PCT CTR 02/26/2001 $2.90 27200100000
10998 SW 109TH AVE PRMT CTR 02/26/2001 $36.55 27200100000
TIGARD, OR 97223
Total $39.45
Phone 1:
Contractor:
TAN MAI LANDSCAPING
2514 SE 67 AVE
PORTLAND, OR 97206 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 503-775-3202
Final Inspection
Reg #: LIC 12431
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: '
111 �� _ . , 1 Permittee Signature:
,Call ( 13 .39-4175 by 7:00 P.M. for an inspection needed the next business day
.r
.
Plumbing Permit Application
Date received _ j ` i �" 1 Permit no.: t UR .0 1 --• SS
.4 , City Ci of Tigard
{
b ' P Sewer permit no.: Building permit no.:
- Address: 13125 SW Hall Blvd, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 F 001 Date issued: By: I Receipt no.:
Land use approval: tMrAUli1TY DEVFt_UPMUII Case file no.: Payment type:
TYPE OF PERMIT
Pk & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ • w construction t= Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: I pal C I p 001, A-ft . 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: ( a, "Dior -01 SFR (2) bath
Project name: SFR (3) bath
City /county: 'jl A I ZIP: Each additional bath/kitchen I
Description and location of work on premises: Site utilities:
c tI V v SyS1'E'* . 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: i ' 11Pt t...A4DSt. .IN f 1 NI Gl • Manholes
Address: lam} �^E, j "rte. I J' Rain drain connector
City: QrQ I State: 0'04 ZIP: al , 1, . Sanitary sewer (no. lin. ft.)
Phone: sA =115 - Fax: I E -mail: Storm sewer (no. lin. ft.)
Plumb. bus. re no: Water service (no. lin. ft.) MN L k 12 } g' Fixtur_c_or -item: �� [
City /metro lic. no.: �j ^ t h5 fi • 'sorption valve ' ■ IIII` ; I- 'tir_ , -
Contractor's representative signature: 4/ 111, 'c L Back flow prevent �"'IEW ..r : 2
Print name: ; ate t Date: — - 0 :. ckwater valve II v '
CONTACT PERSON Bass • 6 •
Name: rt'( -'tJ Mprk Clothes washer I
Address: di ! ( 17c.‘ Ne Dishwasher
Drinking fountain(s) ■ Mt
City: Pp41j State: ZIP: 2(5-10 E
Phone: 1 S- 3 2.../.)9._ Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap _N ION
Name (print): VIA . p (t \\_ $£mil! 06.6.>- . Floor drains/floor sinks/hub IIII i
Mailing address: 0 ' , ‘0 , .c H bi disposal
Hoo se se bibb IMII`M.
EEIIIBMILMIIIIIIIIIIIIM State: ZIP: Ice maker
Phone: Fax: 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:
Ill
City: State: ZIP: : ter:
Phone: Fax: E -mail: . Total _ _L r
Not all jurisdictions accept credit call Notice: •. rm application s, please call jurisdiction for more information. tion Minimum f $ _ �to ��
-
O Visa 0 MasterCard expires if a permit is no o.tained • review (at _ %) $
Credit card number / / within 180 days after it has been State surcharge (8 %) $ '- E b ,
Expires
-1 ), accepted as complete. TOTAL L\ S -
Name of cardholder as shown on credit card ,
$
Cardholder signature Amount - d4t9•4616 (6100ICOM)
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 1 6.60 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 .�echa ;cal Fixture Type: New I Moved I 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 _
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 p is 72.50 + 8% state surcharge, except Residential Backflow
Prevention Device. which is $36.25 + 8% state surcharge,
* New Commerciat rutidln require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm- fees.doc 10/10/00
QT. ( OF TIGARD BUILDING INSPECTION DIVISION 6/MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 34 AM PM BLD
Location /6 f ff 5 / G f 4 Ad! Suite M
Contact Person Ph o - GoS.S
Contractor Ph 7 7) ZG Z.1 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
1043 5:171. C I
Post & Bea
Under Slab
Top Out
Water Servic
Sanitary Sewer
Rain Drains
Fin
S PART FAIL
CHANICAL
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 T
Otheoach /Sidewalk Date ��(v Inspector �\ v C Ext3
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
h + e
BUP - Building Permit ELC - Electrical Permit
4 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
4 Inspection Description Date Passed By
Drywall nailing 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
4 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
Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final 3 /Ll%1) ✓ 6
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 TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2001 -00055
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/26/2001
PARCEL: 1 S134AC -05600
SITE ADDRESS: 10998 SW 109TH AVE
SUBDIVISION: HARTS LANDING ZONING: R -4.5
BLOCK: LOT: 027 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: 0
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install backflow prevention device for irrigation system.
FEES
Owner:
Type By Date Amount Receipt
BERKHOEL, PHILIP J 5PCT CTR 02/26/2001 $2.90 27200100000
10998 SW 109TH AVE PRMT CTR 02/26/2001 $36.55 27200100000
TIGARD, OR 97223
Total $39.45
Phone 1:
Contractor:
TAN MAI LANDSCAPING
2514 SE 67 AVE
PORTLAND, OR 97206 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 503-775-3202
R Final Inspection
Reg #: LIC 12431
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: kb �� , ,�_,� Jib Permittee Signature:
Call ( 13 .39-4175 by 7:00 P.M. for an inspection needed the next business day