Permit , >h
CITY OF TIGARD
PLUMBING PERMIT
1'�I� DEVELOPMENT SERVICES PERMIT #: PLM2001 -00283
r - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/3/01
SITE ADDRESS: 08260 SW HUNZIKER ST PARCEL: 2S101 BC -02100
SUBDIVISION: ZONING: I -P
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: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 40 ft. of sanitary sewer.
=,r: FEES
Owner:.:
Type By Date Amount Receipt
ANNAND, JOHN D II + EDNA N PRMT CTR 7/3/01 $72.50 27200100000
8260 SW HUNZIKER RD 5PCT CTR 7/3/01 $5.80 27200100000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
CR WOODS TRUCKING INC.
P.O. BOX 1488
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 503 - 625 -5242 Sewer Inspection
Reg #: LIC 123973 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 "permitwill 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
Not fcation Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You,.rnay obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued. By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
A, City of Ti Date received: Permit no.PUln V (21)) - 0/72.0
.�, , ; i ' and
,,� �� `J 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
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: , v
2_( 0 ',,J k V Z 1 K_ E_ 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: I Block: I Subdivision: SFR (2) bath .
Project name: SFR (3) bath '
City /county: -- r" i Cl" T1/4 I ZIP: 9 —1 2, 'a- . Each additional bath/kitchen
Description and location of work on premises: Site utilities:
4-Q rz Z-; �1✓� � L.,, 1 , ,7 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: Cr r WC, 0 t> Manholes
Address: 7. LD . ( " ( I 4- 8? Rain drain connector
City: ��- 1-1 C'1L�wco ®j? I S e I ZIP:q� l 4 — O XSanitary sewer (no. lin. ft.) 4-0 Phone: 3 s l - 057 4Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: 1 a3ct' - 7'3 I Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
•
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
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
Name (print): 4 ®14 tN) r›... /\.1,3 t� / ..1,11:::. . Mailing Floor drains /floor sinks/hub
address: Garbage disposal
g ciC W - Z7 Pc Hose bibb
Ci °-r /0 �� t( a� ZIP: --122, '� Ice maker
Phone: ( ac - I S
,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)
Sink(s), basin(s), lays(s)
employee on the :ig y I o m .. s per ORS Chap ' fir 7.
Owner's signatur ;_ M=r . 4, ` , i' + ' e: ' 0 Sump
I Tubs/shower /shower pan
U n
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: 1 E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 2„2 • SO
Notice: This permit application Plan review (at _ %) $
0 Visa ❑ MasterCard expires if a permit is not obtained f
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $ -7e 0
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount - 440-4616 (6/00/COM)
PLUMBING PERMIT FEES:
- , ...„ ,,i e 4p RICE4 -,'2,„!..tailijIyAWAIFtid_sOillitv,. ‘,,,,,,,,,,„' t,„%i;:e.,
j: ' ' i -,...-4 , ,-, - .:',:,'< A MOUNT -- 4(rrialudital(plimibliidfiiiturfes,iin.,--7 °,' , *BRICE - - -
- - - fIXTORESAiiii0idifal) „:7,77Trt.7: -,* .7 7..:I;11Y 7 lea)„ ,A , i6.,
Sink 16.60 e irrici,Ad,i147fiiifidbIft;:::: .:'=7,(ii01':
•forteadh'utility.,donnection), :( , :,:-
Lavatory 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 .
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 - - -• - ' '-' - ' - ' -- ",:Qu'aiititilby'WorkRetfcirmed - ... '
Gas piping requires a separate mechanical Fixture Type : 4 ' ' ' tleN M0ed Replaced
permit.
-.• .., :,„"- : .' : , - •r • '• '• - tapPed
MFG Home New Water Service 46.40 % Sink .- . , , .---- -
j
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
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 li.v;,;•, ''''';'-• -
,...
Isometric or riser diagram is required if
Quantity Total is >9
*SUBTOTAL ':),(7 „7•''''''',.i.'4,-,
8% STATE SURCHARGE :-- :.,-,..-'-',:-:
: ' _ • ,- . "';',.:7 ; '
"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 plans with isometric or riser diagram and
plan review.
iAdsts\forms\plm-fees.doc 10/10/00
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 /
BUP
Date Requested 1' Z > AM PM BLD
Location O ' Z ad Suite MEC
Contact Person //4 k -ey Ph %U y 053 7 PLM 2,3
Contractor Ph SWR
BUILDING =‘ ' Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm Susp'd /
'd Ceili l "/
Roof / ��
Misc: •
Final
PASS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
• ains
11p. PART FAIL
ANICALys ra r , . _ ..
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final -
PASS PART FAIL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITEti..s ".a.
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 7 ( Ins ecto r Ext
Other - p
Final
PASS PART FAIL DO. NOT REMOVE this inspection record from the job site.