Permit CITY TIGARD PLUMBING PERMIT
I'' DEVELOPMENT SERVICES PERMIT #: PLM2001 -00314
V 13125 SW Hall Blvd., Tigar OR 97223 (503) 639 -4171 DATE ISSUED: 07/23/2001
SITE ADDRESS: 13482 SW 122ND AVE PARCEL: 2S103CB 11400
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 072 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 device.
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 07/23/2001 $36.25 27200100000
4230 GALEWOOD STREET 5PCT CTR 07/23/2001 $2.90 27200100000
SUITE 100
LAKE OSWEGO, OR 97035 Total $39.15
Phone 1: 274 -5223
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: .-/ F�1(,2� LJb 1._ Permittee Signature: ) "14-1 1-r 7
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
_ Plumbing Permit App L ion r
Datereceived1 , J Permit z(90/ 1 4
, , , i . I
I :�t City of Tigard CF�ED Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 223
City of Tigard Phone: (503) 639 -4171 ,I! l 1 - Project/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval:
COMMUNITY UENELOPM Case file no.: Payment type: '
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
■ ew construction 0 Addition/alteration /replacement 0 Food service 0 Other: '
■
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: I 3 534.6 ( ). (4 ) c- Description Qty. Fee(ea.) Total
Bldg. no.: • I Suite no.: i New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map/tax lot/account no.: & (D S 5 6 S SFR (1) bath
Lot: ') (Block: I Subdivision .O.LL t i/OI..) SFR (2) bath
Project name: 1101.1) '7d-. SFR (3) bath
City /county: Tf l&&cL / t.0 4. I ZIP:'7 7D- )3 Each additional bath/kitchen
Description and ati n of work on premises: Site utilities:
8 ncix 1I ou_) DW I Ce,..) . Catch basin/area drain
Est. date of completion/inspection: O Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: P &rugs L ., ldr 'C Zni CG Manholes
Address: ,pc) eq $ fit.) kul fl1 CLA. R.D Rain drain connector •
City: w i I s - r) in t I G I State:0/2.I ZIP:97 Or? 6 Sanitary sewer (no. lin. ft.)
Phonetta - 1 0 0% I Fax: - WO E -mail: Storm sewer (no. lin. ft.)
CCB no.: 40/3 ( I Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: (103W Fixture or item:
Absorption valve
Contractor's representative signature: _ a
Back flow preventer j 2 7- 55 x.7.
Print name: / /G,7 , _i • t 11 , Date: Backwater valve
CONTACT PERSON Basins/lavatory -
Name: Ell e �ar -Lo Clothes washer
Address: 904S' SW Kul Sim a t Dishwasher
C ZIP: 97670 Drinking fountain(s) •
City: ni I idni U i ll ee I State: I Ejectors/sump
Phone: ,:a _ , 74, ' Fax: 6g c 1-9g7 y E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): ,00 Mari Ssef -c- Floor drains /floor sinks/hub
Garbage disposal
Mailing address: 1-M30 S-LL) 6a/e ..,u o0d- s7— Hose bibb
City: (like, Q () I State:qR_I ZIPyr?b3'/ Ice maker
Phone: I 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
jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Q...5 Not all
� p Notice: This permit application
0 Visa 0 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 $ 3 9- / 5
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 4404616 (6/00 /COM)
PLUMBING PERMIT FEES: ,
� hd..` f P ICE
l'' TOTAL New 1 and 2 family dlreling sonly t ,
FI �
XTURES ` (individual) � ... - - .:`° Q TY, Xr -•(eat AMOUNT : (lncluc�esail pramOing'ftxtures" n - PRICE OTAL
Sink
16.60 the dwein
� lg ' and fhe first10O ft '> ; QTY x �(ea) 4. f OU
; NT
for each utthty connection) . ,''
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 •
Water Heater 0 conversion 0 like kind 16.60
Quantity by Work Performed '
Gas piping requires a separate mechanical F ix t ure Type N Moved Rep laced a Removed/
K permit. .
� . .. _ _, � „ . . Pp
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
16.60 Water Closet
Drinking Fountain 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 ?7 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 rr��``^ ('�
Isometric or riser diagram is required if / -tiX* +5 k Ir
Quantity Total is > 9
*SUBTOTAL S ` m4 .
�. x,�
8% STATE SURCHARGE ;. _ 90
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL .. $ 39' /J
* Minimum permit fee is $7 % state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + % 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 l AM PM BLD
Location / ,3 Fz 1 2-2- -7l / I --cam Suite MEC
Contact Person � Q-v_ Ph 622._-- Ce o 7, PLM 06/ 60 3/
Contractor Ph )C )-1 ^ 7 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain Citl4 u; / I / f (a) (
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Drywall on
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final f C �¢
PASS PART FAIL
PLUMBING
Post & Beam h
Under Slab (J
Top Out
Water Service 4,F. ,
Sanitary Sewer
Rain Drains
PAS PART FAIL
' ANICAL
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 r ,>
Approach /Sidewalk Date � / d 0 Inspector / � t - 2 f q(/� Ext
Other
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 I 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 ■ 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 _
Welding Lab Final _ Mechanical roush-in
Concrete Lab Final Fire damper
I Bolting Lab Final Duct work
Structural observation Smoke detector
Mechanical final
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
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
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
CITY T I GA RD PLUMBING PERMIT
Ak , DEVELOPMENT SERVICES PERMIT #: PLM2001 -00314
A.��i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/23/2001
SITE ADDRESS: 13482 SW 122ND AVE PARCEL: 2S103CB -11400
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 072 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 device.
Owner: FEES
DON MORISSETTE HOMES Type By Date Amount Receipt
4230 GALEWOOD STREET PRMT CTR 07/23/2001 $36.25 27200100000
SUITE 100 5PCT CTR 07/23/2001 $2.90 27200100000
LAKE OSWEGO, OR 97035 Total $39.15
Phone 1: 274 -5223
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
gi,
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.
Aj
Issued By: `� 1 ' ` �_ . i Permittee Signature: a fjd,/�, -�4j 414Z.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day