Permit y
C ITY OF TIGARD PLUMBING PERMIT
�i =` � DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2001 -00427
_.f l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/7/01
SITE ADDRESS: 13434 SW 122ND AVE PARCEL: 2S103CB -11600
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 074 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 back flow preventer.
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 9/7/01 $36.25 27200100000
4230 GALEWOOD ST. 100 SPOT CTR 9/7/01 $2.90 27200100000
LAKE OSWEGO, OR 97035
Total $39.15
Phone 1: 503 - 387 -7538
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 6136 Final Inspection
PLM 11558
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Permittee Signature: Issued By: � / t � ..� 9 �YJ ��/1 � �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit A plication
•
T
Date received: 0 ? o i Permit no.: L.Jh2D) _06,42_7
a . i City of and
- Ti
1 1 ' J g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, ' , OR 9'I$CEI
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 SEP 0 C 20 ,Pate issued: By: a I Receiptno.:
Land use approval: Case file no.: Payment type:
COMMUh1T' DfVELOPtnriT
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
z' ew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: '
JOB SITE INFORMATION FEE SCHEDULE (for special infor ation use checklist
Job address: / 3 L/ 3g St.) /.)-0 het_ A-cc 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.: l t/ ,T rf SFR (1) bath
Lot: '7'4 (Block: 1 Subdivision: C . i . L I� / /vi SFR (2) bath
Project name:(�,t,.(_a. Hz) (/ How '7 -f SFR (3) bath
City /county:7 ici ckAci ! U31Sr(1 I ZIP: 9 7 Aa `f Each additional bath/kitchen
Description and laicatipn of work on premises: Site utilities:
/? - Ma) D ice.) . Catch basin/area drain
Est. date of completion/inspection: ci 34) 01 Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: Pro 6rc& s Lll frisCL%& Zn C. _ Manholes
Address: Fq 5 R) k: �yyl R D Rain drain connector •
City: (0 j / VM u I I f G I Sta ZIP: 9 7 076 Sanitary sewer (no. lin. ft.)
Phone t - (o07( 1 Fax:6 a - q87(1 E -mail: - Storm sewer (no. lin. ft.)
CCB no.: &/3 ( I Plumb. bus. reg. no: _Water service (no. lin. ft.)
City/metro lic. no.: no3a/ Fixture or Item:
i Absorption valve
Contractor's representative signature: -_ ___„__, _ Back flow preventer / , 2 7- 55 , 5S
Print name: / /Gil , o i ,. , Date: q L( -
t . Backwater valve
CONTACT PERSON Basins/lavatory
Name: L eji ,,VDQ/'r(J-(,0 Clothes washer
Address: 9P'Q5 a0 / -WirM _Dishwasher
Drinking fountain(s) -
City: (nil ktrnu L. i le> I State: I ZIP. 97670 Ejectors/sump
Phone: , a - , 76' Fax: 6ra -yg7 y E -mail: Expansion tank '
OWNER Fixture/sewer cap
Name (print):t)Ql mprj SSP7 -} Floordrains/floorsinks/hub
Garbage disposal
Mailing address: ta3() SL.LL C 1t° w ooCC .S7 Hose bibb
City: [ltd, O I ra I State:C_I ZIPg' 703 Li Ice maker
Phone: ax: 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. Notice: This permit application Minimum fee $ v a S
❑ Visa CI MasterCard expires if a permit is not obtained Plan review (at — %) $
Credit card number. , / / within 180 days after it has been State surcharge (8 %) .... $ , ..2. 90
Expires TOTAL $ 39- /5
Name of cardholder as shown on credit card accepted as complete.
_$
Cardholder signature Amount 440 -4616 (6100 /COM)
PLUMBING PERMIT FEES:
t. }, } - c , PRICE ,, > TOTAL -' New 1 and 2 family dw eIIings,only:. 4 �4 4 t
A , includes all tumbin fi xtures in �rs PRIC m TAL
FIXTURES = (individual) � : ��. _ a � QTY � �:�(ea) - ,��, , AMOUNT�:� ( P 9 - � � ., - �;�
Sink 16.60 the dwelling and the firs t100 ft • QTY , (ea)' O t1NT
:for utility connection) w ...,
Lavatory 16.60 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
TOTAL
Garbage Disposal 16.60
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
-
4" 16.60
'- Quantity by Work Performed
Gas piping i ngt re 0 requires a conversion 0 like kc 16.60 Fixture Type New Moved $ Removed/
Gas piping requires a separate mechanical , _. , = Replaced pP ed
�_',,,, k . Ca
permit.
MFG Home New Water Service 46.40 Sink
Lavatory
MFG Home New San/Storm Sewer 46.40 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 a7 5 5
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 r
Isometric or riser diagram is required if / 0�7 ..SS a7 7
Quantity Total is > 9
*SUBTOTAL 0.&.P5
8% STATE SURCHARGE 90
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty total is > 9
TOTAL , $ 3c i5
* Minimum permit fee is $7 % state surcharge, except Residential Backflow
Prevention Device, whic is $36.25 + % state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms \pim- fees.doc 10 /10 /00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 t Business Line: 639 -4171 MST
BUP
Date Requested � AM PM BLD
Location / y MEC
Contact Person Ph 6 a:Z.46 7 C° PLM o O qa- 7
Contractor Ph L a' 1 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
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Alarm
Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS T FAIL
1-7
LUMBING
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
• ' gRT FAIL
'` CAL
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
Other oach /Sidewalk Date 1 / / Y Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
Inspection Description Date Passed By � 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 Ai 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
Structural observation Mechanical final
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
Ai Inspection Description Date Passed By
BUP — Fire Protection System Permit Plumbing underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer 91/ ,W r
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 9'/' ` "Up / �0
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
is \dsts \ forms \InspRecordBUP.doc 04 /17/01
C ITY OF TI GARS PLUMBING PERMIT
I ,� DEVELOPMENT SERVICES PERMIT
#: PLM2001 -00427
' I! DATE ISSUED: 9/7/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13434 SW 122ND AVE PARCEL: 2S103CB -11600
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 074 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 back flow preventer.
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 9/7/01 $36.25 27200100000
4230 GALEWOOD ST. 100 SPOT CTR 9/7/01 $2.90 27200100000
LAKE OSWEGO, OR 97035
Total $39.15
Phone 1: 503- 387 -7538
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Final Inspection
Reg #: LIC 6136
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 obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
^
Issued By: _ / , 4/ _ , ,_ :e Permittee Signature: //j . ,,,,,,4! ! d A . A
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day y