Permit CITY TIGARD PLUMBING PERMIT
l� DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00390
� ' c= I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/02
SITE ADDRESS: 07540 SW BONITA RD PARCEL: 2S112BD - 00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: ALT GARBAGE DISPOSALS: 5 MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 5 URINALS: GREASE TRAPS:
LAVATORIES: 5 OTHER FIXTURES:
TUB /SHOWERS: 4 SEWER LINE: ft
WATER CLOSETS: 5 WATER LINE: ft
DISHWASHERS: 5 RAIN DRAIN: ft
Remarks: Replacing fixtures. Multiple addresses, multiple apartments. 7540 Bonita #13
7580 Bonita #'s 38 & 42, 14620 76th # 50 & 57
FEES
Owner:
Description Date Amount
BOROS, STEFAN A + FIVIA
PO BOX 1890 [PLUMB] Permit Fee 10/4/02 $478.90
GRESHAM, OR 97030 [PLUMB] Permit Fee 10/4/02 $0.00
[TAX] 8% State Tax 10/4/02 $38.31
[TAX] 8% State Tax 10/4/02 $0.00
Phone 1:
Total $517.21
Contractor:
LIBERTY PLUMBING
6107 SW MURRAY BLVD #135
BEAVERTON, OR 97008
REQUIRED INSPECTIONS
Phone 1: 503-888-8830 Rough - Insp
Top - out Insp
Reg #: LIC 142162 Final Inspection
PLM 34 -373PB
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 -6699.
Issued By: 7 T i -T� Permittee Signature: \ V ` L C'te.
Call (5039 -4175 by 7:00 P.M. for an inspection needed the next busine , day
. Building Fixtures
Plumbing Permit Application OFFICE USE ONLY
Date received: Permit no.:X/n, 02 ...1ra A b
t Ai City of Tigard
All- - i 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 /indust *Multi- family ❑ Tenant improvement
❑ New construction 7 c c . , Addition /alteratio replacement ❑ Food service ❑ Other:
•. JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: '� �, W i,„,.., ,L, 1 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: Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: 11 c & ZIP: Each additional bath/kitchen
Description aq to ation of work on premises: c. c Site utilities:
�/G1 v 1 I l c .+ I too./ t Kt 4 t-5 was pi- 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 ,_ t, . Manholes
Address: (' ? („ W I l A c. 6 . 9 # 32 Rain drain connector
City: \1,Jn5 ( State: 02 ZIP: Gj 1 0( Sanitary sewer (no. lin. ft.)
Phone: egg -6G Fax: ( E -mail: (win Storm sewer (no. lin. ft.)
CCB no.: IL( 2 1 tp Z Plumb. bus. reg. no: fit{ -3-73P0 Water service (no. lin. ft.) •
Fixture or item:
City /metro lic. no.: (De , Absorption valve
Contractor's representative signature: 4 , �a r
Print name: a vu c, r ate: 4 00 Z Ba flow p Backwater valve
• . CONTACT PERSON - Basins /lavatory
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: State: ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
' • OWNER . Fixture /sewer cap
Name (print): Floor drains /floor sinks/hub
Garbage disposal
Mailing address:. Hose bibb - - -
City: State: ZIP: Ice maker .
Phone: Fax: 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 1 own as per ORS Chapter 447. Sink(s), basin(s), lays(s) ' -
Owner's signature: Date: Sump
ENGINEER ' . • Tubs /shower /shower pan `i
Name: Urinal
Address: Water closet 5
Water heater
City: State: I ZIP: Other:
Phone: I Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application o
O Visa ❑ MasterCard Plan review (at %) $
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: ,., ...
''' - - •----"•.; - • ' 7r ---, - --., - ,'•. . "" '' ' = PRICE: 4 TOTAL 4NeWraiiir2ifaiiiilktlik011iiigs44::',.: ' ,
- ,.. ..= , ' ' ',t''' , '' - • - -: '- ", • • ' ': ' ' „, '4 , ', ' '.,::.,6, fi xtures ,„.1.-,1,-Z, - r 1 , ',,' P RICE. , ,
FIXTURE phdiodualy.„," 7 ' , : Q : ,':''; ' QTY " 1:(eay:::.: '4:AMOUNT ,4- (includesall I 49rpng,pin, f ..,, :. ,; RIp , TOTA ,j
Sink c 16.60 3R,50 AfteTclliieflthgTandlirieMigil0,04L'i.; , .C10',.: - --.4t e Y * - i' =,' AM° V Kr
, -.for:!eachlutilitylconnedtion) , ,. -'
Lavatory 7 16.60 egg „ c o
One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 go Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 5- 16.60 li?6,
SUBTOTAL :.::.:
Urinal 16.60 8% STATE SURCHARGE , ,, . • ,1, ., ,-
Dishwasher *' 16.60 ig ., 5 - 0 PLAN REVIEW 25% OF SUATOTAL ';''';',' -. •
5 Q
Garbage Disposal -- 16.60 54 . <0 t-P '4p
Laundry Tray 16.60
Washing Machine 16.60 LI G . , q .6111) os
•
Ir"
Floor Drain/Floor Sink 2" 16.60 • .40
3" 16.60 PLEASE COMPLETE:
0
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 - .Calafititje,bVINOfk Perfciriiieff,.'';
Gas piping requires a separate mechanical ',-'F' -4 6.4.4i : &7 y ;'. M;oy7,dif.: ;',R01014'6,q•,'' ,AReoVe:ei
permit. : ,.1, : ' ..:;•';.,,.. Id - 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 .
Other Fixtures (Specify) 16.60 Urinal
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
Othr
Water Service - each additional 200' 46.40 eFixtures
(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 --
, .g.:, , Se,: ...L''...,', ,' li'',.; , .Z ,- •
Isometric or riser diagram is required if ' -"'''','; 'z :,- ,,,,,,,;
Quantity Total is > 9 ?: '0' ' .•
*SUBTOTAL ':::
.
' - - - • :, ,..'. 17/. L i O .
, 13% STATE SURCHARGE ,:-' - .
,-,.." ,- -,. 7/ / i 3 (
**PLAN REVIEW 25% OF SUBTOTAL ._,7* ,..-: , . : Af : 1,,; , : .., : ,.:. •
Required only if fixture qty. total is > 9
TOTAL . ' , r:4.PEt:,&' / zi -7 g q o
3i 3
* Minimum permit feels $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 1 a-i
diagram for plan review. L c l •
i:\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 (— 7 AM PM BUP
Location 75 7
Suite 57 MEC
Contact Person Ph ( ) 8 W ' F 8.3 a PLM p � d f7 370
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation
Ftg Drain ACCess:JL D 5 ELR
Crawl Drain /v X 7-T
Slab rinspection Notes: - SIT
Post & Beam z C-C `T YI
Shear Anchors / '� w _ -
Ext Sheath/Shear `' �� �Wl J (7e- �i`'r2c./1
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
Shower
I 0*,
PART FAIL
ECHANICAL
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 LI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1 ' 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ( 2- - / 2 AM PM BUP
Location — i- i 0 - 44i rl c- /2-ef Suite 3 Y-5 )-4 MEC
Contact Person Ph ( ) g_.30 PLM ,&2-N 3? d
Contractor Ph ( ) SWR
BUILDING Tenant/Owner PA Ca" h r ? 4,4 ik C �^ /t, ELC
Footing /
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain •
Slab Inspection Notes: _ - SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler j �� -
''°°: Fire Alarm
Susp'd Ceiling ,, ' i _
Roof
-41110
11ij
Other: -
Final
PASS PART FAIL / �� `7 �� 7 2 y
Under Slab t / r <LC ()
Water [',
Water Service 7 .Z � v
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
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 LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA )
Approach /Sidewalk Date - Inspector Ext
Other:
Final R 0 NO REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 r LL ST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 7/ / AM PM BUP
Location 15 k) Suite 5 3 g a MEC
Contact Person 1 Div✓\ Ph ( ) 982' - 3 d PLM - 06 X39
Contractor h ( ) SWR
BUILDING Tenant/Owner ()-c- ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: / L � � ✓ �� P � SIT
Post & Beam
Shear Anchors L-1\4-1 x2 ' &
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing •
k/V1 LA kt'a_ �JJ „ , (< J C/ 6 C f' / C /) Fire Sprinkler y
Fire Alarm /��. P J
Susp'd Ceiling �� //
Roof
Other: V P _ n 1 G - 6 L � ,, /
Final r” (� V
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
f � I 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 EI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA I O Approach /Sidewalk Dat I Inspector Oct
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour A. — Am
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested M 4 3 AM PM BUP
Location 7S Suite ro 9 & t, q MEC
Contact Person Ph ( ) 5 i 3 Z PLM — 4 6 3 6
Contractor merit ' Ph ( ) 38?- ??30 SWR
BUILDING Tenant/Owner 4 ELC
Footing
Foundation ELC �i
oundation
Access:
Ftg Drain ELR , t
Crawl Drain �; '' Ll/
Slab Inspection Notes: // ±� SIT �t'/
Post & Beam � � t -
Shear Anchors —
Ext Sheath/Shear - , , --"°+
Int Sheath/Shear
Framing
Insulation L ' � ��
Drywall Nailing MEN' WA
Firewall
Fire Sprinkler
Fire Alarm ‘fj,
Susp'd Ceiling
Roof •
Fi �� ��
J ,
PASS PART FAIL
PLUMBING - ‘ (d C%
Post & Beam .
Under Slab Adel) _ (�
Rough -In ' 41r40- W 4r
Water Service - //� '1-`d
Sanitary Sewer /
Rain Drains .Ale — .
Catch Basin / Manhole
Storm Drain
Shower Pan / / / �A ` ���_ / L�
Oth - r: ror_ - ,_ r — � —
ie PART FAIL
■ CHANICAL
Post & Beam
IMF
Rough -In ��_
Gas Line Air
Smoke Dampers
Final Al Zraf- n ( • d / <<, '- �,
PASS PART FAIL W;—
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 El Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date - Inspector Ext
Other:
Final DO N '• T REMOVE this inspection record from the Job site.
PASS PART FAIL