Permit CITY TI CARD PLUMBING PERMIT
H °+1 I DEVELOPMENT SERVICES PERMIT #: PLM2002 -00411
���Ii 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/02
SITE ADDRESS: 07560 SW BONITA RD 034 PARCEL: 2S112BD -00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: OTR GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 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: 1 SEWER LINE: 0 ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Replace plumbing fixtures.
FEES
Owner:
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 10/28/02 $99.60
#200 -L, MS63 [PLUMB] Permit Fee 10/28/02 $0.00
HILLSBORO, OR 97124 - 3082 [TAX] 8% State Tax 10/28/02 $7.97
[TAX] 8% State Tax 10/28/02 $0.00
Phone 1: 503- 846 -4794
Total $107.57
Contractor:
ALBERTA PLUMBING
LEWIS TRANER
PO BOX 55031 REQUIRED INSPECTIONS
PORTLAND, OR 97238
Phone 1: 503 Rough -in Insp
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
Issue /� i/� Permittee Signature: ;
Call (503) 639 -4175 by 7:00 P.M. for an inspection need • the next business day
Building Fixtures
Plumbing Permit Application OFFICE USE ONLY
„. /; _ , Date received: /045 2 - Permit no. • , (�f'/ 1 / /
.4- te^lij'i City of Tigard4; j 1t W f 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 OCT 2 3 2002
Fax: ( 503) Date issued: ? By: ? Receipt no.:
Land use approval: 7—• r Y �u� l%�b 4 •'-- Case file no.: Payment type:
r rn�4
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)
Job address: /.,-7 ( 0 � ‘. ,0 ... t ,1 ` 1.. 4, . ? q Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: 1 / New 1- and 2- famil dwellin onl •
(includes 100 ft. for each utility connection)
Tax map /tax lot /account no.: S1;R (1) bath
Lot: (Block: I Subdivision: • / SFR (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: /e n,. li . .6 ! . .. / Manholes
Address: ,� Rain drain connector
City: Ajr'1 , e ZIP: 0 (, Sanitary sewer (no. lin. ft.)
Phone:*g Sgt 9 ' ax: - %d„(,c mail: Storm sewer (no. lin. ft.)
CCB no.: e j t ( , k t ? 1 5 - Z - Plumb. bus. reg. no: 2 6 . - 7 0 " 1 : - . n Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
� � Back flow preventer
Print name: ate: i ,. > O Z Backwater valve
CONTACT PERSON
Basin avato3 /
Name: —_ . _ /' Clothes washer
Address:
g 4, 5,, �' e t �� Dishwasher /
City: 74,..
is IAif StateOv' ZIP: 9� Drinking Ejectors /sum
ptains)
_p
Phone: ' lo 0 `� Fax: E -mail: Expansion tank
OWNER . • Fixture /sewer cap
Name (print): Floor drains /floor sinks/hub
Mailing address: Garbage disposal /
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 drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink), basin(s), lays(s)
Owner's signature: Date: Sump
• ENGINEER Tubs /shower /shower pan ./
Urinal
Name: Water closet /
Address: Water heater
City: I State: I ZIP: Other: •
Phone: I Fax: E -mail: Total
Minimum fee $ gq , 60
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
%) /o $
/ / days after if a permit is
been not obtained State surcharge (8 %) $
Credit card number: within 180 dft it has bn
Expires TOTAL $ 1 l0 7
Name of cardholder as shown on credit card accepted as complete. $
Cardholder signature Amount 440 -4616 (6 /00 /COM)
l04�
PLUMBING PERMIT FEES:
•
-
!FIXTURESAiticliVidualr;; • - QTY ; (ea). : AMOUNT TOTAL
Sink 16.60 tteind t V(' ='• , Q AMOUNT
7 • •
•
Lavatory 16.60
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 „•',,,7,„ -
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" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 1 6.60 ri,4",01.tantity: by Work Performed
Gas piping requires a separate mechanical Removed!
permit. „'"-..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 1,6.60 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
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 ';,Y
Quantity Total is >9 ° r
* S UBTOTAL
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL aitti 4-1,;.31.„,!tvi •
Required only if fixture qty. total is > 9 ;4:art .i
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. "
•
i:kIsts\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 7 Date Requested �✓ 1� AM PM BUP
/
Location 70 e Suite 3 MEC
Contact Person Ph ( ) 7 ` 7 1 6 - - 1 - c7p PLM ` c f '(
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain 1 ELR
Crawl Drain ''� 6*.
Slab Inspection Not& 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:
PART FAIL
MECHANICAL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA f
Approach/Sidewalk Date 6 a Inspector 9Y) 3 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL