Permit CITY T I G A R D PLUMBING PERMIT
wur DEVELOPMENT SERVICES PERMIT #: PLM2001 -00 1 52
�'�" fl � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/13/01
SITE ADDRESS: 13308 SW 129TH AVE PARCEL: 2S104DA -02900
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Backflow preventor
FEES
Owner:
Type By Date Amount Receipt
KORNERSTONE CONSTRUCTION PRMT CTR 4/13/01 $36.25 27200100000
14247 NW SPRUCERIDGE LN
5PCT CTR 4/13/01 $2.90 27200100000
PORTLAND, OR 97229
Total $39.15
Phone 1: 260 - 8918
Contractor:
DMS PLUMBING INC
12602 NE 28TH STREET
VANCOUVER, WA 98682 REQUIRED INSPECTIONS
Phone 1: 360-254-4539 RP /Backflow Preventer
Reg #: LIC 80744
PLM 37-271PB
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: A—e/yyl .1<_ J Permittee Signatur :
Call (50S) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• Plumbing Permit Application
Date received: Y_/ 3— 9 f Perm t 4I2.eyo / —Gi/SL
11 1 ; �� City of Tigard
1 b Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
•
TYPE OF PERMIT
❑ 1/& 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family 0 Tenant improvement
L INew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: •
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: r.4%c) 5 ,s(...3 oco.{,.\ 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: S' IBlock: I Subdivision:Ou of E{4(04.0 (, tR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
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: DtS p(U -(� Manholes
Address: ( 6.„ R ...I' 41.. S .- Rain drain connector
City: kicI�Co(j,t1e►.-__ State: ()N ZIP: C(& e .. Sanitary sewer (no. lin. ft.)
Phone:3C,)asC E -mail: Storm sewer (no. lin. ft.)
CCB no.: t "Z CFA I Plumb. bus. reg. no: 3 (e�
Water service (no. lin. ft.)
lic. no.: C� 1 Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer •/ 1
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory .
Name: Clothes washer
Dishwasher •
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER - Fixture /sewer cap
Name (print): lCa1...0. t p'1. Lo c V.' Floor drains/floor sinks/hub
address: Garbage disposal
Mailing ( —�.7 �( S Kxr "7' -� Hose bibb
City: l r, p �l 0.� State�j� �ZIP:C, - i Z1 Ice maker
Phone: 6 C � ` I Fax: I E-mail: Interceptor /grease trap
Owner installation/restdential 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 wn as per O S Chapter 447. Sink(s), basin(s), lays(s)
Owner's signatur : Date: 4.4-^ — fz: Sump
• • t Tubs/shower /shower pan •
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other: _
Phone: Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount • 440 -4616 (6/00 /COM)
PLUMBING PERMIT FEES: ,,
i.! ,. •'PRICEy; n TOTAL',' ., New1; ,and:2=faamilydwellings: -
FIXTURES .(individual), ; ,f ,,> ,.QT,Y ; . (e A MOUNT. "(includes all piumbing fixtures in PRICE ,t - ;TOTAL
_
Sink 16.60 the dwelling and the first100 ft. fi liQTY ;(ea).;' ` •AMOU .
Lavato 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
TOTAL
Garbage Disposal 16.60
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 ' ' ,, . ¢. r , . . Quantity by;Work
Gas piping requires a separate mechanical Fixture Type: - . ''. °New ''.. - 'Moyed • .Replaced Removed/ • permit. . . L ,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 - .:4 " : '
' 3
Co,a
8% STATE SURCHARGE .. o _
a .10 •
**PLAN REVIEW 25% OF SUBTOTAL `
Required only if fixture qty. total is > 9 " ' .
TOTAL ' / I S
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow_
Prevention Device, which is $36.25 + 8% state surcharge.
* * AII New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm- fees.doc 10/10/00
CITY OE TIGARD BUILDING INSPECTION DIVISION
MST t. <�
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 4 1 AM PM BLD
Location 1 3 3 o Suite MEC
Contact Person Ph 411iir ?ea I 60)S
Contractor Ph 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
(A 1/4„ (1 ) : () " ..i,
• PASS PART FAIL •
Post & Beam
• Under Slab �• Top Out
Water Service
Sanitary Sewer ( \L. )/ J
Fig
s PART FAIL
E HANICAL '
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 /
Approach /Sidewalk Date 4( ;2/ / nS O k Inspector Ex f
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
2-397
",t _CITY .
OF TIG BUILDING INSPECTION DIVISION MS S >1v 51( . 24 Hour Inspection Line: 639 -4175 Business Line: 639 4171
'/ UP
U
Date Requested 2 7 AM PM BLD
Location / 33 G Y Jw /27 e Ad, Suite MEC r7„.u...,),
Contact Person Ph - 8 9 /7 PL ' ®Q/ c2--
Contractor Ph t irip A t 0-0d ZW
BUILDING Tenant/Owner ELC
Retaining Wall ELR / 2/) 210 u filYI
Footing Access:
Foundation FPS
Ftg Drain SGN
04--Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear j
Int Sheath /Shear i /� / C/ \ .
Framing ` �( / �
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final L ,- ?_.60 \ , d 0 2_.-- .
PASS PART FAIL
0. LUMBI1 ,, 5 c��
Post & Beam
op Out 4(27/6. 1 )
Water Service
Pt Sanitary Sewer
Rain Drains
4 J ,_ 11 '�
6 1/41 .. CPASS PART /
MECHANICAL
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 I
3
Approach /Sidewalk Date 4( L
- 2:7/0\ Inspector l;/ . � .' E]:
x t
Other
Final
PASS PART FAIL . DO NOT' REMOVE this inspection record from the job site.
l
-.ITY OF TK AP, D BUILDING INSPECTION DIVISION ; - G — a ' 3 ' 1
24 -Hour Inspection Line: 639 -4175 Business Line: 639 171
BUP 11
Date Requested ei -L`r AM I PM _ BLD
Location /336r54.-) z y A-t Suite MEC
Contact Person Ph 24D -- sry /r tgr, ;_460 1 -- 06 j S
Contractor Ph -&.' �•"�a2 4 j
BUILDING Tenant/Owner ELC 6 / 0/9
Retaining Wall ELR eA
Footing Access:
Foundation FPS
Ftg Drain
MI/Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear '
Framing , n W L✓1 SIA ' k/6 6-e ( 1
Insulation 0 LA./1"4 I _ C w . Lt �/' '
Drywall Nailing ► � i � �-�t ��G�.� -• � ✓bra, ��.��
Firewall `
Fire Sprinkler _ `�
Fire Alarm 1 Mi r��C
Susp'd Ceiling r ■ •
Roof f ,,
�_�"`Ci'C,� N� • �•
v SV�
Misc:
Final k � I ( e _
PASS PART FAIL
o ► -31 ∎ rs. &t(/ , 5 - � r/ V -
fr i 'ost & Beam
osik Top Out ftie �'?
OA- Water Service A kf �9 _ ii _ f , i '
S. Sanitary Sewer
LR rains L vtn \j- x'.,2.4.›� It
Fin Ali •
PASS PART Al _
MECHANICAL L .
Post & Beam "' `°
Rough In
Gas Line — —
Smoke Dampers I 0----et �� _
Final
PASS PART FAIL
ELECTRICAL . •
Service �. _
Rough
UG /Slab ) 9-4-
- \M ( ■-1 Q✓►
Low Voltage
Fire Alarm
Final I I AI 12 - 1)
PASS PART FAIL 1 11
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 c
Approach /Sidewalk 4 i ' b) " f I( 7 Z -7 Other Date Inspector Ex t
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 1 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 J 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
Fireproofing Lab Final Mechanical final
Structural observation
Final inspection
PLM - Plumbing Permit
BUP - Fire Protection System Permit 4 Inspection Description Date Passed By
3' Plumbing underslab
Ai Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer 477:74 1 4)6
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
J Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls , Plumbing final 4( 17 / U
Sprinkler supply lines C-tt Ge �1-
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils AI Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM SWR, ELC, ELR, MEC SIT PERMITS
J
•
CITY TIGARD PLUMBING PERMIT
,,o�� DEVELOPMENT SERVICES DATEESSU 4/13/01 1 -00152
^-`�' 13125 SW Hall Blv Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13308 SW 129TH AVE PARCEL: 2S104DA 02900
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Backflow preventor
FEES
Owner:
Type By Date Amount Receipt
KORNERSTONE CONSTRUCTION PRMT CTR 4/13/01 $36.25 27200100000
14247 NW SPRUCERIDGE LN
5PCT CTR 4/13/01 $2.90 27200100000
PORTLAND, OR 97229
Total $39.15
Phone 1: 260 -8918
Contractor:
DMS PLUMBING INC
12602 NE 28TH STREET
VANCOUVER, WA 98682 REQUIRED INSPECTIONS
Phone 1: 360 - 254 -4539 RP /Backflow Preventer
Reg #: LIC 80744
PLM 37 -271 PB
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. I
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. gtO
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: T<- -e i! Permittee Signatur :
Call (503) 639 -4175 by 7:00 P.M. for an inspection neede the next business day