Permit CITY OF TIGARD
PLUMBING PERMIT
11 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00537
c ''l l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/1/2004
SITE ADDRESS: 13332 SW BENCHVIEW TERR PARCEL: 2S104DC -00200
SUBDIVISION: BENCHVIEW ESTATES ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 45 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 451f. Water service replacement.
FEES
Owner:
Description Date Amount
CAUSLEY, GARY
13332 SW BENCHVIEW TERRACE [PLUMB] Permit Fee 12/1/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 12/1/2004 $5.80
Total $78.30
Phone : 503 329 - 0477
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD #344 REQUIRED INSPECTIONS
MILWAUKIE, OR 97267
Phone : 503 Water Line Insp
Water Service Insp
Reg #: LTC 138941 Final Inspection
PLM 3 -434PB
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 -0100. You may obtain copies of these rules or direct questi o • • ' • calling (503)
246 -6699.
11,
Issued By: 4 - Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the le t business day
►c 1--S t
' r.'—* A S Plumbing Permit Application
A Date received: . / /a V Permit no.: (,�} a D 5 _
�7
Ci of T igard
i , "���( g 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 •
m 1 & 2 family dwelling or accessory U Commercial/industrial U Multi- family U Tenant improvement
U New construction U Addition/alteration /replacement U Food service U Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: ) - v3 b(,v.,K. I60/ Toy, / 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: (Block: I Subdivision: SFR (2) bath
Project name: v_)1 t--t) SFR (3) bath
City /county: Tt ( j) I ZIP: G -17,-7.-3 Each additional bath/kitchen
Descrip 'on an911 location of work on premises: Site utilities:
'�. Si 2 J 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: I, 0 0 O iL I Manholes
Address: )'- j 01,Air ' P ( p ' 3 Rain drain connector
City: L . - !,, I ■ i State ZIP: �f '7 Sanitary sewer (no. lin. ft.)
Phone: ,r03- 53 5'r0l Fax 53 5370 E -mail: Storm sewer (no. lin. ft.)
Water service (no. lin. ft.) r " s l'
CCB no.: . ' I Plumb. bus. reg. no: P�
t City /metro lic. no.: 10t7 _ Fixture or item:
Contractor's representative signature:
S.
Iv -b s �� . ` Absorption valve
Back flow preventer
Print name: Li at t i - b) - Date: / / J Backwater valve •
CONTACT PERSON Basins/lavatory
Name: O .- , ,t Clothes washer
Dishwasher
Address: 6. 1 1 5A , Drinking fountain(s)
City: .,. _ I State: I ZIP: Ejectors/sump
Phone: E bi .— ., Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap •
Name (print): &km wk Floor drains/floor sinks/hub
Mailing address: I )31 5 iA) l�'fi(t/ t) re a disposal
Hose bibb
City: 1- \ ` 1 I State:DP_ I ZIP: 111/1' Ice maker
Phone: 'SO VFax: 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: Sum.
ENGINEER Tubs/shower /shower pan- -
Urinal
Name: , Water closet
Address: Water heater
City: I State: (ZIP: Other: •
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ r ?�
Notice: This permit application Plan review (at %) $
ID Visa ❑MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days State surcharge (8 %) .... $ . h
Expires ays after it has been TOTAL $ '7
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount J 440-4616 (6/00 /COM)
PLUMBING PERMIT FEES: "..._,
>y -� • - , -°3 ti New 1ranii 2=famil dwellin s : 43t1l" 'u" °', 'v ",, � `�
':;�� ° ,�. �° `-r. - - ` �� ;� �. , � PRICE `�u . TO TAL � ,..�, ,,..Y g Y�.` ., . � '.
"°FIXTURES ;(individual)' ` ,4 s,s} i.,;,,QTY . ?,- J,(ea) ` AMOUNT (includessall plumbing` ixtures in • ,. , PRICE TOTAL, -
Sink 16.60 1the;dwelling acid the first1.00 ft 1 ;'1 . QT g ,(ea)'' ' >AM OU I` -
Lavatory 16.60 iforeach'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 ° il
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" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 •'<; < = '� >`~ mss �, � :: " aQuantity Work Performed'
Gas piping requires a separate mechanical Fixture,Type # N e w Moved- _Replaced: :.Removed/
permit. ,• ' ,, ,a . r : " _ :;,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
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 ''" 7,!.:4 a
*SUBTOTAL '
8% STATE SURCHARGE '`' *A' =r
* *PLAN REVIEW 25% OF SUBTOTAL '` ,4 ° 7 ;'i
b
Required only if fixture qty. total is > 9 °. . - '.',ewa v 'fi r,"
TOTAL : ,� $
* 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 2 sets of plans with isometric or riser
diagram for plan review.
is \dsts \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 / 2 3 AM PM BUP
Location / D 8J/'V-P. l - reAk Suite MEC
Contact Person Ph ( ) c9 37)73 PLM 6 - 6653
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: 0 2 `6, SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
/ 11°"1"'
Roof
Other: / /�� ,
Final
PASS PART FAIL
PLUMBING: _ „ : _
Post & Beam
Under Slab
Rough -In
e ervir;
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi
AS 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: LI Unable to inspect — no access
Fire Supply Line
ADA /G `:!�
Approach/Sidewalk � Date fr�9 Inspector � Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL