Permit CITY F T I GA R® PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 -00405
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/25/02
SITE ADDRESS: 12575 SW GRANT AVE PARCEL: 2S102BB 01900
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: NEW 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: 3.100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 3100 feet of private water service and 9 -3/4 meters.
FEES
Owner:
Description Date Amount
CASA TERRA LLC
0/0 ALPHA ENGINEERING [PLUMB] Permit Fee 10/25/02 $778.55
9600 SW OAK SUITE 230 [PLUMB] Permit Fee 10/25/02 $0.00
PORTLAND, OR 97223 [PLMPLN] Plan Review 10/25/02 $194.64
[PLMPLN] Plan Review 10/25/02 $0.00
Phone 1: 503- 452 -8003 [TAX] 8% State Tax 10/25/02 $62.28
Contractor: [TAX] 8% State Tax 10/25/02 $0.00
HARMONY PLUMBING Total $1,035.47
PO BOX 1007
TUALATIN, OR 97062
REQUIRED INSPECTIONS
Phone 1: 503-692-5986 Water Line Insp
Water Line Insp
Reg #: LIC 85021 RP /Backflow Preventer
PLM 34 -306PB Final Inspection
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.
Yo . ay ob a _ opies of these rules or direct questions to OUNC by calling (503) 246 -6699.
/ ,
/ ��
Is
.ued By: L � I � / Permittee Signature:��
Call (503) 63' , 175 by 7:00 P.M. for an inspection needed the next business day
,
`0/2 2 _—
! 4 • ! ~ Plumbing Permit Application
f ►y Date received: /D /�� O. Permit no.: Gr/,lopA -Co 65
? , � City of Tigard
y -Sewer permit no.: Building permit no:: C3
' ._ Address: 13125 SW Hall Blvd, Tigard, O 2 ` .�i
City of Tigard Phone: (503) 639 -4171 . . - A Project/appl. no.: xpt date:
Fax: (503) 598 - 1960 6L,IbAo0i( - DCO ,� �� Date issued: Byx Receipt no.:
Land use approval 00 /0/ O C Case file no.: Payment type:
ii • u n tt t blf 11 /..lit-. • ., x
TYPE OF PERMIT
,s✓ iJ....v� -
CI 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
New construction ❑ Addition /alteration/replacement Li Food service ❑Other:
1 . ,JORSITE:INFORMATION 4 r >� X...SCHf DI IE:(for special information use cf k1Zlist) ': :'
Job address: /A g.575 'aW 6p4,gtJT chi! Description Qty. Fee(,a.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only: C
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: 25 I (. Z 1313 SFR (1) bath
Lot: I Block: Subdivision: N1 o b12 se D- SFR (2) bath
Project name: f ri_ S N as • SFR (3) bath
City /county: • j , A2 I ZIP: 91Z2 Each additional bath/kitchen
Description and location of work on pr mises: Site utilities:
{J r,u S pv
l . ,,g,� 1...- "OR %VSTrtJ .tJ tl -rrvti Catch basin/area drain
Est. date of completion/inspection: / / Drywells /leach line /trench drain t.
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
• - Manufactured home utilities
Business name 4,-. , VIA:). - 0 y er, -.. Pc, L ' C r Manholes
Address: 7O p o pL 1 Rain drain connector
City: - p .L q . -, ) State: 04-4-ZIP: et To' t.� Sanitary sewer (no. lin. ft.)
Phone: C c _ _ 8. G I Fax: C..y ` - -Lj I E -mail: Storm sewer (no. lin. ft.)
CCB no.: $ 1 . 4, bus. reg. no: 7 306 1'!5 Water service (no. lin. ft.) 00
City /metro lic. no.: 27 4- >4 0, Fixture or item:
Contractor's representative signat re: Absorption valve
Back flow preventer
Print name: e ,}...1,.) r toe R.. - auk ‘ ' Date: Backwater valve, , •
CONTACT PERSON .'`" .Basins/lavatory
Name: 5 '/ )C_- 4 KS Clothes washer
Address: c/ C. o o S p v r -
Dishwasher n igfo
Drinking fountain(s)
City: / „�(( State: c7�I ZIP: ¶ 7 2 L3 Ejectors /sump • .
Phone: q-s'2- S e. ° 3 Fax: 1sl. -8 E -mail: Expansion tank
t `• OWNER Fixture /sewer cap
Name (print): A S A. '"rr�12a / Lt., c__ � ' Floor drains /floor sinks hub
G
Garbage disposal
Mailing address: c..70 4 y0/4A . (f-Wlo • c/ 5 w o a, Hose bibb
City: f /LT, State: o2 -1 ZIP: 77 Z Z- 3 Ice maker
Phone: 451. 0.3 I Fax: + & fj I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
i will be made by me or the maintenance and repair made by, mv'regtilar Roof drain (commercial)
I employee on the property I own as per ORS Chapter 447. ! Sink(s), basin(s), iays(s)
Owner's signature: •Dater . ', • Sump
ENGINEER Tubs/shower /shower pan -
' Urinal
Name:
49. A cpc , ica;,,,v.+cis,`c_ Water closet
Address: Water heater
City: State: I ZIP: Other:
Phone: Fax: I E -mail: Total _
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ 7 7 ° 5-5
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at i %) $ / 9 `1/ • (P
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ 5 2 ..x
Expires TOTAL $ /e 35". V 7
Name of cardholder as shown on credit card accepted as complete. $
Cardholder signature Amount 440-4616 (6/0O /COM)
PLUMBING PERMIT FEES: , `,'- ' ►
,'. ° , New ' ° 1 L and 2=fami dwellin sWbnl '� : Y' d: ?C,' - '
}
" � Fes, ' ., s.. ". ° , �.PRICE� r ° T OTAL � "s' Y" , ,9,�. Y�� ;"". ; , � . '
1. " ":includes all° lumbin fixturesin �. = ,PRICE . 3TOTAL
FIXTURES (individual) _� � -, � ": � = � �� QTY : =(ea) ;��: �^ �AMOUNT�� _(� .., �� p 9" � � ,PRICE,
Sink 16 60 'the, dwelling ;and the first�100 ft: • , QTY.'' ,- ;(ea)•-7 'AMOUNT
Lavatory 16.60 for :each utility; connection)`- ',`'.. • . _ ..r.. -
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" 1660 PLEASE COMPLETE:
3" 16.60
4" 16.60 '
Water Heater 0 conversion 0 like kind 16.60 `': =° 1 "'' x,. „-a. - ` ",” ' Quantitya.tiy; Work' Performed
fl
Gas i in requires a separate mechanical >FixtureiType ,, - . ` . , , -Moved - :. - `;Replaced ,, „`Re`moved /,'
p P 9 q p . a=, 3 , • '' - ° `'Capped
permit. ° . ;t.
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" .
I
X Water Heater
Water Service - 1st 100' / 55 00 dC Other Fixtures
Water Service - each additional 200' /6 - 46.40 494 (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 4P755- ^
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 ''''; ; `'. f _ ; ':'_{
Isometric or riser diagram is required if E_ .. , �� µ * , ' _ , v, ; ",.
Quantity Total is > 9 ' .3 .4k k°' -- , �j 7p
X' *SUBTOTAL 7 -_,. P' ; ' *-' ' "�> /,/ • Ss
V 8% STATE SURCHARGE " ,a - ., - g ,:
' * *PLAN REVIEW 25% OF SUBTOTAL `; ': i ' , " :'
_ ' ' /9440
T� Required only if fixture qty total is > 9 ' a' -,- , m , - ��-
TOTAL ., ° , ;,!' *` '/
it,. ,�, . .�__– /
* 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 BUILDING __
INSPECTION DIVISION Business Line: ( , , MST
BUP
Received Date Requeste l U " - ? AM PM BUP
Location / ZS 7 , sw C , Suite MEC
Contact Person Ph ( ) , S J c`2 5 ' PLM 0 go 5--
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
Susp'd Ceiling
Roof
Other: (
Final
PASS PART FAIL 41 Va Fr / / or
:116 Beam
Under Slab
Rough -In
Sanitary Sewer Lc / ��
Rain Drains / f —
Catch Basin / Manhole / /
Storm Drain
Shower Pan
Other:
Fi• =�:�
' 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line ! � )
ADA
Approach /Sidewalk Date 16 f ` ?( In spector s Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL