Permit t r t
CITY TIGARD PLUMBING PERMIT
� DE VELOPMENT SERVICES PE RMIT #: PLM2003 -00138
All DATE ISSUED: 4/15/03
-- 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171
SITE ADDRESS: 11015 SW 114TH PL PARCEL: 1S134DB -01200
SUBDIVISION: WINTERS ADDITION ZONING: R -4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: REP 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: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 50' of water service.
FEES
Owner:
Description Date Amount
THRASHER, HAROLD DEE AND
KOVAC, LISA THRASHER [PLUMB] Permit Fee 4/15/03 $72.50
11015 SW 114TH PL [TAX] 8% State Tax 4/15/03 $5.80
TIGARD, OR 97223 Total $78.30
Phone :
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 5535 Water Service Insp
Final Inspection
Reg #: LIC 10967
MET 00003528
PLM 34 -42PB
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
I By / I r -1 / I / i Permittee Signature: ir
If
Call (503) .39 -4175 by 7:00 P.M. for an inspection needed the next u siness day
f _ Plumbing Permit Application
1 Date received:// / .y, 1 ), Permit no.: J
,� '/ g ..6.0/ 3 0
m : I I. City of Tigard Sewer permit no.: Building permit no.:
- - " Address: 13125 SW Hall Blvd, Tigard, OR 97223 g
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: f Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
.(a'7 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SI ' E INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: \ t 015 5V0 1 1 .f1-- 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.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project namefac f k h j v ( SFR (3) bath
City /county: \ tc y tAxi ZIP: el7.). Each additional bath/kitchen
Description and ltation of work on premises: Site utilities:
! Phil' 2 j, 4 ;4 .Pv t. Catch basin/area drain
Est. date of completion inspection: is --D line/trench drain
3 Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: Ic nw1 I r 10 nq Manholes
Address: i3g85 51) ym■n}oW Rain drain connector
City: 6,�. I`State: 6 ✓ I ZIP: C 1 00 5 Sanitary sewer (no. lin. ft.)
Phone: 43 . 5 5 3 5 Fax: E -mail: Storm sewer (no. lin. ft.) � SE
DO
no.: 00 1 61 Plumb. bus. reg. no: 34 .-44 Z fa Water service (no. lin. ft.) 4, O()
City/metro lic. no.: 131 3 Fixture or item:
Contractor's representative signature: �}w 0-C,0 Back valve
e�� � Back flow preventer
Print name: cam° t r `e ' Date: 4\ .0 3 Backwater valve
('ON I ACT PERSON Basins/lavatory
Name: /•� 9 ∎`Q f (,Q., Clothes washer
Dishwasher
Address: cc a-O Drinking fountain(s)
City: c� , I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank ,
OWNER Fixture/sewer cap
Name (print): t too y ovac, -4 }- of l j v�ShP /' Floor drains/floor sinks/hub
Mailing address: I i 015 5 O 1 1 et- H disposal
Hoose se bi bb
City: c Ye, I State:6 f I ZIP: t aa3 Ice maker
Phone: 5e10 , b 5 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
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ °� • 5 l7
Notice: This permit application
Cl Visa ❑ MasterCard Plan review (at _ %) $
expires if a permit is not obtained g
Credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been TOTAL $ 7 ' <
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-4616 (6100/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 16.60
3" 16.60
PLEASE COMPLETE:
3"
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' 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
Re3idential 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 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
/ BUP
/ 7
Received / Date Requested ' — / AM PM BUP
/ Location / `C / ° t — Suite MEC
Contact Person Ph ( ) !D L/ 3 SAS PLM d d off
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ) l ELC
Ftg Drain ACCes y ELR
Crawl Drain T
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
F
(a
inal
P ASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough-In
`e ry
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin
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 El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for rei pection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO OT REMOVE this inspection record from the job site.
PASS PART FAIL