Permit '_CITY OF TIGARD
PLUMBING PERMIT
�m l DEVELOPMENT SERVICES PERMIT #: PLM2002 -00048
` { n��,�., < 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/2/02
SITE ADDRESS: 17005 SW 92ND AVENUE PARCEL: 2S114A0 -01500
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: S2 FLOOR DRAINS; 2 TRAPS:
STORIES: 1 WATER HEATERS: CATCH BASINS: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS: 1
LAVATORIES: 1 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Maintenance Building - Phase II of Cook Park Master Plan expansion. The (2) floor drains are 2" aand the
other fixtures are (3) hose bibs.
FEES
Owner:
Type By Date Amount Receipt
TIGARD, CITY OF
13125 SW HALL
TIGARD, OR 97223 Total
Phone 1:
Contractor:
COLUMBIA MECHANICAL INC
1702 DIKE RD
WOODLAND, WA 98674 ::.• = - ..:.�
REQUIRED
Phone 1: 360 -225 -5761 Water Line Insp
Re #: LIC 151122 Rough -in Insp
Reg Top -out Insp
PLM 37 -451 PB
Rain Drain Insp
Misc. Inspection
Final Inspection
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.
-
Issu • By: IL _Al.': c� �t. !_.� Permittee Signature: u r !rll/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
r illi ' H A- 1 NT 06 60-__ Pa-L-b 4a - co ?o
'Yumbin Application
Date received: g 7. DA Permit no..111,fijgoev,/_;y0 /$
*'- �1}.x. ,' City of Tigard,
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: Eck Receipt no.:
Land use approval: CUP, r 0 ( Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
X New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 9it2 escription Qty. Fee(ea.) Total
�� S Ave. New 1- and 2- family dwellings only:
no
Bldg. no.: I Suite no.:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: IBlock: � Subdivision: f SFR (2) bath
Project name: 4' t- li- n.yrE l.I } t J �. � t 1.. -D 1(�)fo' I SFR (3) bath
City /county: � y D J „ I ZIP: 9 7 , /) Each additional bath/kitchen
Description and location off 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
Columbia Mechanical Inc Manholes
1702 Dike Rd Rain drain connector
\ 1 Sanitary sewer (no. lin. ft.)
A/7-j/ Woodland WA 98674 i Storm sewer (no. lin. ft.)
/ \ 1- 360- 225 -5761 1 Water service (no. lin. ft.)
CCB #: 15122 PLM #:37 -451PB J Fixture or item:
Contractor's representative signature: Back valve
Absorption
Bk fl flowow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): L '� o f: 'A-� Floor drains/floor sinks/hub .9n
Garbage disposal
Mailing address: j 3 ( a Sk) A/j /4' Hose bibb ,3
City: ri /b I StateO� Z IP: q7 g,2..3 Ice maker
Phone: 6 34._41, 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 prop- . I ow as per ORS Chapter 447. Sink(s), basin(s), lays(s) I
Owner's signature: A - _, _. Date: " — 0'2. 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
t Not all jurisdictions accept credit cards, please call jurisdiction for more information Notice: This permit application Minimum fee $ //& °
Plan review (at _ %) $ of F 6
expires L1 MasterCard expires if a permitis not obtained
Credit card number: / / State surcharge (8 %) .... $ 9. 3O
Expires within 180 days after it has been TOTAL $ 454/. 55
Name of cardholder as shown on credit card accepted as complete.
Cardholder signature Amount , 440 -4616 (6/00/COM)
PLUMBING PERMIT FEES: . ,, 2...,
---!, AIIIII1141
:7,PRICE '..:010TAp'!.0 mo:*fija:n:CL,iZfa
FIkTURES,(ihdiYidtial) : •..,:' , " OT.*: - : '',( ,',' 4;;*iit!tiNT,ir :11000des;a1 .701 Ombiiigliiftfckik;,- ' '..;,'„-: f:)RUE 1' -.:10,1"*L
Sink 16.60 l'theliffWaktigiWridi6;00166;ii - ' , Qty; :
Lavato 1660 forleadi utility connection) ',, °7..
/
ry .
One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
'
Water Closet
/ 16.60 SUBTOTAL c' -' '--;'''-‘.
- Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
' Garbage Disposal 16.60 TOTAL
. Laundry Tray 16.60
Washing Machine 16.60 . .
'
Floor Drain/Floor Sink 2" 16.60
3" 3 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 ; - ; . - ,;ii';•': 1 . . . - :' ': =: ' . .0 by Work",PetfOline ,,
Gas piping requires a separate mechanical •'Fiiitt.iie Type: ! " , Moved ,' 4, ',' :Removed! permit. :, 7 .. ,. . ,. ' • 4 ' •' - -,:. • ' ..-,. , -- :Capped
MFG Home New Water Service 46.40 Sink . _
MEG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs . 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) ,. • \0 -5 16.60
Dishwasher
cv, t) \II\ Garbage Disposal
Laundry Room Tray
, \ Washing Machine
Floor'Drain/Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures (Specify)
Storm & Rain Drain - 1st 100' 55.00 .
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially - . 62.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25 •
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is >9
*SUBTOTAL 71: - ;-:-;-',M ;$:.;:', , / / , ,,
// to d
8% STATE SURCHARGE :' 1
9/ 30 _
**PLAN REVIEW 25% OF SUBTOTAL AtV 74-:Vili 7 L 409 „
Required only if fixture qty. total is > 9 ::'::.= 7 -',:: :::',„<4.-•.4 ,:,: , 4-- 7 , c/...)
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 2 sets of plans with isometric or riser
diagram for plan review.
. hdsts\forms\plm-fees.doc 12/26/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested - -5 - AM PM BUP
Location / / 6 Q �"1� q /I'14 Suite MEC
Contact Person /4 Ph ( ) — 16 7_5 PL o —00 D ►
Contractor Ph ( ) _ e 9, —pc: D 5
BUILDING Tenant/Owner /74 . . o o eS1
Footing
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ae p - 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:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
r PART FAIL
HANICAL
Post• & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection.fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line �� / /°
ADA Op/ Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL