Permit Lay OF TIGARD PLUMBING PERMIT
l °a' IA DEVELOPMENT SERVICES PERMIT #: PLM2003 -00304
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/26/03
SITE ADDRESS: 13465 SW HOWARD DR PARCEL: 2S103CA 00601
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: 30 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 30' of sewer line and reversal of plumbing under the house to connect to newly installed sewer lateral.
Septic tank is to be pumped, filled and inspected. Reimbursement District #22 paid.
FEES
Owner:
Description Date Amount
WEEKS, JACK A ELIZABETH E
13465 SW HOWARD DR [PLUMB] Permit Fee 6/26/03 $109.50
TIGARD, OR 97223 [TAX] 8% State Tax 6/26/03 $8.00
Total $117.50
Phone :
Contractor:
•
MCKEE PLUMBING
PO BOX 801
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone : 503 Sewer Inspection
Misc. Inspection
Reg #: LIC 116965
PLM 3 -340PB
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
i
Issued By: I � . , / / Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures •
+ OFFICE USE ONLY
05mbingPermit Application •
Date received - -03 h Permit no. ! .) F'' ...0a 60 A
City of Tigard MJJI City 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 ,
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
,, 0 New construction 0 Addition /alteration/replacement 0 Food service 0 Other:
, . ' , ` JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: I Z 4'66 S r1 U 1471 F () Ul3" 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: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: -77 la ,A, e I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
a ,J.e _ — _ 1 4 / .L_ - Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
• - PLUMBING CONTRACTOR Footing drain (no. tin. ft.)
Manufactured home utilities
Business nam : if . ,e(. urfri 3 I ;( _C, Manholes II S
Address: 0 , 1 C'/ f Rain drain connector
City: e 'U State: Qj ZIP: 9 / s _Sanitary sewer (no. lin. ft.) .:W s O a
Phone: r/, - 7d f Fax o<ax'U7gx E -mail: Storm sewer (no. lin. ft.)
CCB no.: /ES'" Plumb. bus. reg. no: __ gcic, A.6 Water service (no. lin. ft.)
City /metro lic. no.: l 3q S-' Fixture or item:
Absorption valve
Contractor's representative signature: *� 6 Ma
. - _ Back flow preventer —,I /M1
Print name: ! ! ',(; I I' � �
1 3 Backwater valve lMi a�
", CONTACT PERSON : . . Basins /lavatory MEMI AIIIIIIVAWNI •
Name: m) )ot m (1"ki j Clothes washer —, r _AI r `.
1
Dishwasher ��fl�W_R
Address: g fountain(s) —.1W_l 1 0
Drinkin fountains
City: I State: ZIP: Ejectors /sump - �� v '
Phone: � 5, -� Fax: Email: p �- -� A , .
Ex ansion tank
{ ; OWNER 1 , . Fixture /sewer cap alli, \�n 7
Name (print) ` j t qc (4) ( * " ,c Floor drains /floor sinks � . b
Mailing address: Ga bibb isposal / _�__�
,I _i1►11M
City: State: ZIP: Ice maker I • t .
Phone: Fax: E -mail: Interceptor /grease trip msrkgral yrA - u
Owner installation/residential maintenance only: The actual installation Primer(s) I/11M5147/ 4 ' i
will be made by me or the maintenance and repair made by my regular Roof drain (commerc �rA�i�:A /j
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays - -,Zr,_-
Owner's signature: Date: Sump `_-
ENGINEER Tubs /shower /shower pan ■1%
Urinal
Name: Water closet
Address: Water heate i , ' y a 1 • nit l —
City: State: ZIP: 40ther:.. -" _ iffiffINMEIMI
Phone: 1 Fax: E -mail: Totals °
jurisdictions accept credit cards, lease call jurisdiction for more information.
Minimum fee $ ...SD
Not all
� a P � Notice: T his permit application o
0 Visa 0 MasterCard Plan review (at _ /o) �,./�
/ / expires if a permit is not obtained o ) .... •.I , "7
Credit card number within 180 days after it has been State surcharge (8 /o $ tt•3�
Expires i �
Name of cardholder as shown on credit card P accepted as complete. TOTAL $ G D
S ` • •
Cardholder signature Amount \ 440 -4616 ( 0 /
ems ... ; .
. 4
PLUMBING PERMIT FEES:
PRICE - -v
:‘FIXTURE (individual) ,',.',.• : . ... r::::'(ea) •:: ,:tAMOUNT 1 409910P-aPiplIiIr4419,fixtuTs:lin !=p13ICE, - TOTAL •
Sink 16.60 Iiikeliiiiti•iid .s, 'i,QTYii ,' (4) ' '-=' ''':AMOUNT
Lavatory 16.60 •*;torteachAitility.lconnecticitil ::•. • '; ;:':, -, tI:a. '-'1 '..'. :- ,
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 :;:••'::J.:.-1? :.:4;' • .. -.,...
Urinal 16.60 8% STATE SURCHARGE :f.,;2,;9X; v.,,,::::::: .,, .
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL ;•;:: ";,-,,,;:.! .' , ]'=',.
•,' - ;°,,S..7,'.i.„:.;: , " - "I .
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 16.60 ''
.,,,1•:,„:;7; ,,e-' ,. '
=-- , 31 - V . :* , ' , '4 ,,,, : :7 . - - • --. .
Gas piping requires a separate mechanical .Fiktued Tyjie;', :,, •::• TNeW,'::: - ‘VICIVed..4! 126 a •Reltroved/
permit. e,.., ;04,:,".4 '' , - ." - ' `: i,''-',"k4 'f '',:'-- '- : :''g C/Carped.
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
1 • - , -
Laundry Room Tray •
Washing Machine . .
FloorDrain/Sink: 2"
Sewer - 1st 100' i 55.00 5:c00 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 ' : , :',.;-,
Quantity Total Total is >9
*SUBTOTAL
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL '
..
Required only if fixture qty. total is > 9 .,.:`, .:'V
TOTAL ::';, ;' :.,, !'' • , c'.:.-2 $ •
..- .
... • . --,. -., ---k
-- .... - : •
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
"Air New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts\forms\plm-fees.doc 12/26/01
M-i -
A AFFORDAIE
00304 f. SEPTIC SERV3CE
P.O.BOX 1130
WILSONVILLE, OR 97070
. (503) 5824929 FAX (503'1 570.0719
CUSTOMER'S NO. PHONE pw2 DATE
(
NAME
A D S ifr,... 3
/7a-t .
7e)
SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
QTY. DESCRIPTION PRICE AMOUNT
,7;
- 9
TAX 7
RECEIVED BY
TOTAL
All claims and me o MUST be accompanied by this bill. Rnee
C11-2:7Fi'll..7; or nabs-coin THANK YOU--
CITY OF TIGARD 24 -Hour .
BUILDING , .. .. Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested (' °Z AM PM SUP
Location _ • Ar '' uittee C -� MEC
Contact Person , _d Ph ( ) / l �� PLM 3 d 0 3 d L(
Contractor Ph ( )
BUILDING Tenant/Owner (26-e-10, C AJ .2-2) 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 i — ���
Fire Alarm 1 �'�
Aidlilligl Susp'd Ceiling j �� /
Roof � �'�
Other:
Final rt
PASS PART FAIL
g i--- /
PLUMBING
Post & Beam
Under Slab
Rough In
Water Service
sitar ewe
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan ,
Other:
V F'
A h 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 El 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 , Dat -2 , Inspector � / Ext
Other:
Final DO • OT REMOVE this inspection record from the job site.
PASS PART FAIL