Permit CI TY OF TIGARD PLUMBING PERMIT
* *' DEVELO SERVICES PERMIT #: PLM2002 - 00291
'll DATE ISSUED: 7/25/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12835 SW FONNER POND PL PARCEL: 2S103AC -OFP07
SUBDIVISION: ON FONNER POND TOWNHOMES ZONING: R -4.5
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF ' WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install irrigation backflow preventer. Irrigation system for FONNER POND DEV.
FEES
Owner:
Type By Date Amount Receipt
PRMT CTR 7/25/02 $36.25 27200200000
5PCT CTR 7/25/02 $2.90 27200200000
Total $39.15
Phone 1:
Contractor:
SELBY PLUMBING INC.
20565 SW TV HWY #373
ALOHA, OR 97006 REQUIRED INSPECTIONS
Phone 1: 503 - 531 -3889 RP /Backflow Preventer
Final Inspection
Reg #: LIC 150252
PLM 34 -397PB
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: 624161, l ,t/i , Permittee Signature: O
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
�4 �
building Fixtures
Plumbing Permit Application ' . OFFICE USE ONLY •
Date received: Permit no.7(M -co i /
City of Tigard
�t,,.��f 1 Y 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: By: Receipt no.:
Land use approval: Case file no.: Payment type:
> a ,;, "r- ;.de' ; ', , -' •. , " 4 ' ? t ,. a s TYPE - OFPERMIT . • F , . •
1 & 2 family dwelling or accessory ❑ Commercial /industries ❑ Multi- family ❑ Tenant improvement
O New construction ❑ Additi• , 1 1tecation/r• .lacement ❑ Food service ❑ Other:
`" 4 ° JOB: SITE INFORMATION ' " ''- : ::::;:;.,',,,f, '• FEEjSCHEDULE (for special infor use checklist) ,
Job address: . 2, 36 16NfV 4110 64e-t- 4 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: ,A FOit< 4/ OAfi,J SFR (2) bath —
Project name: 0 C3 Ng QNV SFR (3) bath —
ity /county: _ _ ISE.. ZIP: Each additional bath /kitchen M
Description and locatioyp.,,of work on premises: Site utilities: 3ferturrargiy .0,A- CKFL Catch basin/area drain
Est date of completion /inspection: Drywells /leach line /trench drain _
, •0 ..
. , Footing drain (no. lin. ft.) _
t y , : PLUM BING C O NTRA C T O R . , :''?'•:; 4 ,'.-' , ? 'Y� '.. .
* r �• �� = -`'' Manufactured home utilities _
Business name: S L CIR't = i , 4 • Manholes MI
Address: Rain drain connector _
City: State: ZIP: Sanitary sewer (no. lin. ft.) —
Phone: Fax: E -mail: Storm sewer (no. lin. ft.) _
CCB no.: /, U2 5 Plumb. bus. reg. no: 3 _ - p Water service (no. lin. ft.)
City /metro lic. no.: , Fixture or item: ■ --
representative signature: '/�� �— Absorption valve
Contractor's re
p g �- / Back flow p r e v e n t e r
MI
P r i n t nam / /t r.3 A . ° Date: Backwater valve —
t ;;::' - : w , ,,CONTACT PERSON , : , Basins /lavatory
Name. ;, ' , .4 yt/d rieJ Clothes washer NM
Dishwasher _
Address: 07 db A i ii ; S ' S ,�Q /t/
Drinking fountain(s) —
Ess i State:e'e ZIP9 2 3/ Ejectors /sump _
Phone 5 Fax: E-mail: Expansion tank —
` ' . Oi , °.OWNER,; .,., r a. ' .. , ? „„, . ' l Fixture /sewer cap 11111
Floor drains /floor sinks /hub
Name (print): 4 % f : I a 0 A • Garbage disposal _
Mailing address: Hose bibb
City: State: ZIP: Ice maker —
Phone: aa) - /9Q 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 I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) —
Owner's signature: Date: Sump _
s ENGINEER • _ Tubs /shower /shower pan =
Urinal
Name: Water closet ME
Address: Water heater _
City: State: ZIP: Other: _
Phone: Fax: E -mail: Total _ — � �
// y
Not all junsdicu This ons accept credit cards, please call jurisdiction for more information Minimum fee $ �(/l �F
Notice: s permit application Plan review (at _ %) $
❑ Visa O MasterCard expires if a permit is not obtained o d
Credit card number: / / within 180 days after it has been State surcharge (8%) ....
Expires TOTAL $ l . / 5
Name of cardholder as shown on credit card accepted as complete. $
Cardholder signature Amount 440 -4616 (6 /00 /COM)
. VIINPF
PLUMBING PERMIT FEES:
°,yve. ,, " :. -` v ` 'TRICE . �.T.OTAL 'y. R Nevi't and =2=familya`dwellings�;only':. ,° { 2' - ''' ' , ", :,'= "i`
v "• - in all `Iumbin = ` ,,. =t ` .PRICE"~h .TOTALS "..
i �;� .ate .kQTY -u ,. ea ,:•,AMO,UNT,., °r( eludes „ a p. 9 r,.•• s ��.• �¢
,�EtXTURES„�(ind vidu ): ,. - .. <, �'�. �" r:..:. �:� )�°="' "� - � :,��.. s .. �
Sink 16 60 , the�duvelling , aril=the�first1,00ft'. : ?.,ry. • ,
QTY' " , -,> AMOUNTO
1 6.60 f ` . °eachu °._° .0
Lavatory One (1) bath $249.20
Tub or Tub /Shower Comb 16 60 Two (2) bath $350.00
Shower Only 16 60 Three (3) bath $399.00
Water Closet 16.60
SUBTOTAL ;MAW -_ [:
Urinal 16 60 8% STATE SURCHARGE ' :,-i, `'.,`` ":n. =Nh Z
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL t°'`="'' :': -'
,
Garbage Disposal 16.60 TOTAL " '
Laundry Tray 16.60 &i
Washing Machine 16.60
I
Floor Drain /Floor Sink 2" 16.60
3" 166.660 0 PLEASE COMPLETE:
4" 16.60
x.p 'N.-44 ,,' " " ' .=,'EP ''x4Y1 Quantity$by:Worl Peftormed :` -
Water Heater 0 conversion 0 like kind 16 60 , •2 "
6r` e Type :;::r 1iNew`';:t Moved 'RepIaced` l'Renioved / ".
Gas piping requires a separate mechanical Fiztu ;_, 6 '6. ,A I;6"..4,5 _' Capped�rl'
permit ,_ � � °`�� "'�� zw ° °� ", :,
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 ,
- Other Fixtures
Water Service - each additional 200' 46.40 (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 ..)..7_ 5 5
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 -� j
Quantity Total is > 9 = 5+�°` —` "-
*SUBTOTAL :::.-,' ° ;
,
8% STATE SURCHARGE ', '
' . „¢ -1"',
, -
* *PLAN REVIEW 25% OF SUBTOTAL -� ' ',.`' ;;' 1 ,
Required only if fixture qty total is > 9 '." '' ' . :�,
- ` , ", °s
TOTAL $ IJ
* 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.
is \dsts \forms \plm- fees.doc 12/26/01
CITY OF TIGARD 24 -Hour (e... it( A"
- ,BUILDING Inspection Line: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST,
BUP
Received Date Requested �' 3 O AM PM BUP
Location (1( 3) 5 w - ,' ..e^ l)e `"` Suite MEC
Contact Person Ph ( ) 57 f-3 G PLM Z '2iG v z /
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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
Fire Alarm , / it
Sus 'd Ceiling
/∎ = " - � l��l�i
Roof g r
Other:
Final
PASS PART FAIL �)
-
Under Slab ft#VC/
Rough -In ?,�
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Other: c f
Other: � - {
F
S T
HANICAPARL FAIL
Fr Post & Beam
Rough -In
- Gas Line •
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL � ' i��
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El 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 Inspector � Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL