Permit C ITY OF TIGARD PLUMBING PERMIT
It DEVELOPMENT ELOPMENT SER VICES PERMIT #: PLM2002 -00164
. I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/19/02
SITE ADDRESS: 08015 SW HUNZIKER ST PARCEL: 2S101BD 00300
SUBDIVISION: ZONING: I -L
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: 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: Add bathrooms on 1st and 2nd floor.
FEES
Owner:
Type By Date Amount Receipt
PERFORMANCE CONTRACTING INC PRMT CTR 6/19/02 $398.40 27200200000
8015 SW HUNZIKER ST PLCK CTR 6/19/02 $99.60 27200200000
TIGARD, OR 97223 5PCT CTR 6/19/02 $31.87 27200200000
Phone 1: 503 - 684 -5533 Total $529.87
Contractor:
FULLMAN SERVICE CO LLC
5221 SW CORBETT
PORTLAND, OR 97201 -3716 REQUIRED INSPECTIONS
Phone 1: 224 -5221 Underfloor /Underslab
Reg #: LIC 122310 Top -out Insp
PLM 26 -443PB 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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: .1� Permittee Signature: "�A 6 -4^4—_- eeff/k
Call (503) 639 -4175 by 7:00 P.M. for an inspection need d the next business day
. �' -° /
P lu r Application
Date received: ,r if, Permit no.: PyNA.qd /CS
.,-, :0
b , ) City of Tigard
�� ` Sewer permit no.: - - Building permit -no..
- --. Address: 13125 SW Hall Blvd, Tigard, OR '972?3
City of Tigard Phone: (503) 639 4171 ' �,%,. Projecdappl. no.: ate: t
M ,•
Fax: (503) 598-1960 � < i , `J Date issued: 13 Receipt no.:
M
Land use approval: ,` y ',- �; Case file no.: Payment type:
\, . iens ficS° .
TYPE OF PERMIT
-r u�
❑ 1 & 2 family dwelling or accessory �l Commerc ► n d ist ❑ Multi - family El Tenant improvement
❑ New construction ❑ Additiofl ,alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 8015 SW Hun iker Rd . Description Qty. Fee(ea.) Total
Bldg. no.: I 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: IBlock: I Subdivision: SFR (2) bath
Projectname: Performance Contracting, Inc. TI SFR(3)bath
City /county: T i g a r d/ Wa s h. I ZIP: 9 7 2 2 3 Each additional bath/kitchen
Description and location of work on premises Site utilities: _
Ail ' /bpmi on 1-51 ;PIA Flo f f Catch basin/area drain
Est. date of completion/inspection: A - . ,r04� Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
t
Manufactured home utilities .
Business name: FULLMAN /KINETICS SERVICE Manholes
Address: 5221 SW Corbett - Rain drain connector
City: Portland I State: OR I ZIP: 97201 Sanitary sewer (no. lin. ft.)
Phone: 224 -5221 I Fax:4 1 7-0 3 2 8 E -mail: ., - Storm sewer (no. lin. ft.)
CCB no.: 32357 ( i / j /o IPlumb. bus.\reg. no: 26 -443PB Water service (no. lin. ft.) _ F
City /metro lic. no.: 161/9 � Fixture or item:
Contractor's representative signature: I5 ,,, i , Absorption valve
Back flow preventer
Print name: la D b !_ Date: D 0 Z Backwater valve
CONTACT PERSON Basins/lavatory , , t
Name: Clothes washer
Dishwasher
Address:
Drinking fountain(s)
City: I State: . I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank .
OWNER Fixture /sewer cap
22 Floor drains/floor sinks/hub
Name (print): fer6 iree Con -,.e i%I
G
4:
arbage disposal
Mailing address: Some. - vo fs Hose bibb
City: State: I ZIP: Ice maker
Phone: 4- SS3 3 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 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 _
ENGINEER Tubs/shower /shower pan i
Name: Urinal 3 .
Water closet 17
Address: Water heater
City: I State: I ZIP: Other: -
Phone: Fax: I E -mail: • Total 2:3
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at %) $
❑ Visa ❑MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $(
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
modup
PLUMBING PERMIT -FEES:
„ ; `. ' 'PRICE t ..'TQTAL #New:1"and only: . "
- FIXTURES3 ( individual). s'- - _ - '= 4 ,. QTY ,y- (ea) ---;; :,,,AMO T- „„ ¢(includes all plu big fxtur in , PRI TOTAL. , _
Sink g 16.60 iy'z . t p he dwelling and the firstlOO ft. QTY 3(ea) AMOUNT
16.60 , for ?each - utilitytconnection). '" . •
Lavatory One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 // Two (2) bath $350.00
Shower Only I 16 / � ✓ Three (3) bath $399.00
Water Closet 7, ' 16.60 i/ /_, Zv ✓/ SUBTOTAL - '_ . .. -
Urinal 3 16.60 49 P' J 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" Y 16.60 66. yo PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion like kind 16.60 ' . .Quantity by Work'Performed
Gas piping requires a separate chanical � / 0 , Fixture Type: New Moved .. ,' Replaced Removed/ ,
permit. & _ .. 'Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer - 46.40 Lavatory 3
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet 4
Urinal 'm
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
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 2 - Y
Quantity Total is > 9 `
*SUBTOTAL ,.
8% STATE SURCHARGE ' '' '1":', '; �'a >,,;i b
**PLAN REVIEW 25% OF SUBTOTAL �d
Required only if fixture qty. total is > 9 ,
TOTAL - ` $. 9 84 7
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backfiow
Prevention Device, which is $36.25 + 8% state surcharge. ,
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms \plm- fees.doc 10/10/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busines's.L'ne:" (503) 639 -4171 MST
BUP
Received II • - ' e. ested AM PM BUP
Location / 6 7- 5 �. Suite MEC
Contact Person Ph ( ) PLM 2-0 b/
Contractor C 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
Ale
Firewall
Fire Sprinkler •
Fire Alarm 4C 41.4111
Susp'd Ceiling
Roof
Other:
Final
PAS 1aF FAIL
P BIN
earn
Under Slab
Rough -In
- Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Sho er Pan
O er
in -.
S 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 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 o
ADA ( d )4 ' � � / 2 L_^
Approach /Sidewalk Date Inspector J Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL