Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00478
- 13125 SW Hall Blvd., DATE ISSUED: 12/10/02
Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 07540 SW BONITA RD 023 PARCEL: 2S112BD 00100
SUBDIVISION: TIFFANY COURT APT. ZONING: R -
BLOCK: LOT: 065 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Replacing fixtures: 1 lay, 1 dishwasher, 1 garbage disposal, 1 kit. sink, 1 water closet.
FEES
Owner:
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 12/10/02 $83.00
#200 -L, MS63 [PLMPLN] Plan Review 12/10/02 $6.64
HILLSBORO, OR 97124 - 3082 Total $89.64
Phone : 503- 846 -4794
Contractor:
ALBERTA PLUMBING
LEWIS TRANER
PO BOX 55031
PORTLAND, OR 97238 REQUIRED INSPECTIONS
Phone : 503- 331 -0657 Final Inspection
Reg #: LIC 96782
PLM 26 -707PB
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 questions to OUNC by calling (503) 246- 669•..
____ r —
Issued By: , ' � / � ��1 Permittee Signatur•.
Call (503) 639 -4175 by 7:00 P.M. for an inspection ne- red the next business day
' - Building Fixtures
Plumbing Permit Application OFFICE USE ONLY e Date received: t - , -0-- Permit no.: A ,,� 00 1 � � i � j � City of Tigard 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: ma Receipt no.:
Land use approval: Case file no.: Payment type:
,•TYPE OF .PERMIT ,' • . .
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
' JOB SITE INFORMATION ' , FEE SCHEDULE (for special information use checklist)
'l• Description Fee Job address: '7, ‘, ' + 23
N ew 1- and 2- family dwellings only: Qty. F Total
Bldg. no.: Suite no.:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: - Each additional bath/kitchen
Descri • • and to .a ione ion . ork • pr ,e• is- .: 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: 4., 1..,0' , t , Manholes •
Address: �1 4 O Rain drain connector
City: n ' Stat r- ZIP: 1-1„Z jg _Storm sewer (no. lin. ft.)
Phone: t 0047 Fax: E -mail: Storm sewer (no. lin. ft.)
CCB no.: i Plumb. bus. reg. no: r6 Z6 -•707 Water service (no. lin. ft.)
Fno-G
City /metro lic. no.: Fixture or item:
Absorption valve
Contractor's representative signature: Air- � Back flow preventer •
Print name: t �'• ,- / ll, i Backwater valve
- CONTACT PERSON Basins /lavatory
Name: Clothes washer
Address: Dishwasher l .
Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
. OWNER . - Fixture /sewer cap
Name (print): . Floor drains /floor sinks /hub
Mailing address: Garbage disposal I,
g Hose bibb
City: I State: • I ZIP: Ice maker
Phone: I 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 property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) , J
•
Owner's signature: Date: Sump
ENGINEER . Tubs /shower /shower pan
Urinal
Name: Water closet 1/
Address: Water heater
City: State: ZIP: Other: .
Phone: I Fax: E -mail: Total
Minimum fee $ g . O!)'
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ visa O Master Card Plan review (at %) $
expires if a permit is not obtained State surcharge (8 %) $ .�L . -I
Credit card number: / / within 180 days after it has been .�/
Expires TOTAL $ Z
Name of cardholder as shown on credit card accepted as complete.
Cardholder signature Amount 440 -4616 (6 /00 /COM)
•
.:
PLUMBING PERMIT FEES:
'` iiiirandiVamil d
"wellings°only:, , ',:_. ;:;, r =`
, PRICES -� T, - ` Ne
•�� � y� r . �.
' FIXTURES, (indivldual)'i- , , , .QTY (ea) ,AMOUNT'.' (incltades allplumirig£ ztur In, P RICE - TOT
Sink 16.60 tithe dwelling and the fi ft rst100 ; QTY (ea) . AMOUNT -
Lavatory 16.60 :,for.eachAutility connection) ,> fir, ' ° „..„ '-
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 k„; _k :-k " , `: .' - . .,
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 b' Work Performed ,
Gas piping requires a separate mechanical Fixture. New Moved' =. :� Replace ,Rem vedl
P P 9 T,
q P t, .. � _� , '' 4 g ' ' ; Capped
permit. . � �. .
Y
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer 4 6.40 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 ,
,v F loor 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 t" ' F ; ; >"
Isometric or riser diagram is required if � .r' �s,�s� � " ,k�'�`:�y; ✓ �.� ,
s t:
Quantity Total is > 9 '- -� ° __ �£ � h3= �°�t `�;» •
*SUBTOTAL Zrt>. ,' +:
8% STATE SURCHARGE . s' '.;°:
* *PLAN REVIEW 25% OF SUBTOTAL , . t,,, ,'
Required only if fixture qty. total is > 9 , -r "
,, ' .:•ii •
TOTAL ,' ' ;',.1 $
•
* 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.
i : \dsts \forms \plm- fees.doc 12/26/01 •