Permit ¢- CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00134
4-' ea �� DATE ISSUED: 4/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO PARCEL: 1S136DC -04500
SUBDIVISION: PP1995 -013 ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
• TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Add (1) sink, (2) move sinks, (1) hand sink relocated, (1) dishwasher capped, and add 1(1) trench drain.
FEES
Owner:
Description Date Amount
WAREMART INC
BY BURKE + NICKEL [PLUMB] Permit Fee 4/10/03 $83.00
3336 E 32ND ST #217 [TAX] 8% State Tax 4/10/03 $6.64
TULSA, OK 74135 Total $89.64
Phone :
Contractor:
GRIDLINE PLUMBING + HEATING
4343 SE 37TH AVE
PORTLAND, OR 97202
REQUIRED INSPECTIONS
Phone : 771 8790 Rough -in Insp
Top -out Insp
Reg #: LIC 00074105 Final Inspection
PLM 26 -449PB
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
Issued By: . _ �f / , �� Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
'wR •400 -0v /.
r " Plumbing•Permit Application .
'Pe:). t
Date received - 4 -0 .0___ I Permit no. / O3 / r
j; City of 04 Citf Tigard. Sewer no.: ermit Building permit no.:
" Address: 13125 SW Hall Blvd, Tigard, OR 97223 p g p
City ofTigard 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 r 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: Description n Qty. Fee(ea.) Total
Bldg. no.: ( Suite no.: 4 / 00 New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no:: .
SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath .
Project name: W t l' CO t - (Doi5 SFR (3) bath
City /county: W ZIP: Each additional bath/kitchen
Description and location of work on premises: _RG /OC11 t 5cr� Site utilities:
V 1 MT ADD - r a2 Neil I kg i M64 g✓n, i- 3 �C54•4 � /43 A.vP 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: QlR►-1AJ 2 i i / 0 vn1c411) 2.. )vnx.4 N 1 N e. i Manholes
Address: 43 T 3 ' .3 7 1W Rain drain connector
City: ? o RA - I State:6 R I ZIP: q r ZQ . Sanitary sewer (no. lin. ft.)
Phonej5 77 / —Cb 79 Fax: 5ig I E -mail: Storm sewer (no. lin. ft.)
CCB no.: �`f'¢/D5 ! I Plumb. bus. reg. no:242-y 9 * ?/ 7 ' Water service (no. lin. ft.)
City /metro lie. no.: / 5 2 Q Fixture or item:
Contractor's representative signature: ; " Absorption valve
/ ����s. •
Print name: Date: Back flow p
Backwater valve alve er
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Address:
Dishwasher / /(o 4t
Drinking fountain(s)
City: J State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
. OWNER Fixture /sewer cap
Name (print): Floor drains/floor sinks/hub 3" t I 1,9 (pQ
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 Rqof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) 1-/9 K)
Owner's signature: Date: Sump '
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: State: I ZIP: Other:
Phone: Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee information.
Notice: This permit application
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 %) .... $ & •6 - q
Expires TOTAL $ 'g . VJ
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
_
PLUMBING PERMIT FEES: •
. I ?Tv:4m"
FIXTURES (individual) QTY (a) : '-iAMOUNT 4 - - 0,010E°C TOTAL
Sink LI 16.60 +ipco I QTY , AMOUNT(
Lavatory H„,,Atat_ 5 /g/(
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
,
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
37- TAN 1 4. Mk I 16.60 fto , kr1 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 „
. Quantitij,bY'WorkPerfoillie
Gas piping requires a separate mechanical Fixttre Type New ''Re'en'OV'edr,
permit. , •
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory HAN() zo
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 P •
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer - 1st 100 55.00 'rehiCti-1 DA1/4)
Sewer - each additional 100' 46.40
•
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 72.50
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
8% STATE SURCHARGE •
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9 •
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.
hcists\forms\plm-fees.doc 08/29/01
CITY OF TIGARD 24 -Hour .
BUILDING Inspection Line: (503)639 -4175
MST
INSPECTION DIVISION " Business Line: (503) 639 -4171 •
BUP
Received Date Req sted .J — '7 AM PM BUP
Location 0 1 1 414.! - - /.■ Suite 7 6,-- b MEC
Contact Person Ph ( ) PLM .3-06 /3q
Contractor Ph ( ) `7 - 7 (-8790 SWR
BUILDING Tenant/Owner �L-e_47 ( 2' ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab - Inspection Notes: 1 SIT
Post & Beam
Shear Anchors _ /
Ext Sheath/Shear '��
Int Sheath/Shear °�
Framing P
Insulation
Drywall Nailing J Firewall �'�j ,�G�' /�
Fire Sprinkler y 1�' L
Fire Alarm Oi i 4 /.� -
Susp'd Ceiling
Roof
•
Other:
Final - � , i - r '-
PASS PART FAIL
PLUMBING ! it %'s , ` '1r _ _ - �r ,
sr" — - .s - - - -
Post & Beam
Under Slab 1
Rough -In
Water Service /
Sanitary Sewer i ;- -Z1-
Rain Drains j '
Catch Basin / Manhole
Storm Drain
Shower Pan
O I -. :
cir PART FAIL �
CHANICAL / ' (.d °
Post & Beam
Rough-In - ,' `
Gas Line r(/ ,
Smoke Dampers •
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE I Please call for reinspection RE: I Unable to inspect - no access
Fire Supply Line
ADA D Vo) Inspector )3 '7 1 , Ext
Approach /Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL