Permit CITY TIGARD PLUMBING PERMIT
l DEVELOPMENT SERVICES PERMIT PLM2002 -00152
DEV
• ELOPMENT
SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/7/02
SITE ADDRESS: 08485 SW HUNZIKER ST PARCEL: 2S101 BC -01000
SUBDIVISION: KNOLL ACRES ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement. Capping (1) lay, installing (1) lay at new location.
FEES
Owner:
Type By Date Amount Receipt
CLICKENER, ROBERT R + PATRICIA PRMT CTR 5/7/02 $72.50 27200200000
13855 SW PACIFIC HWY 5PCT CTR 5/7/02 $5.80 27200200000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: Rough -in Insp
Final Inspection
Reg #: •
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You .y obtain c•pj s of these rules or direct questions to OUNC by calling (503) 246 -1987.
I .sued By: ` .k"), rit -a _ , : Permittee Signature:
Call (503) 63• -• 75 by 7:00 P.M. for an inspection needed the next business day
elllumbing Permit Application
Date received: 5 ? 4 — Permit no.: PaY04 1.
/5
°; ^• City ' of Tigard _
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard; OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: / B . iridd te:
Fax: (503) 598 -1960 Date issued: ( .B1 / Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 1il Commercial/industrial ❑ Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: ta -- 5 s ti u„N z_, L Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2 -family dwellings only:
Tax map/tax lot/account no.: Zs' (0 ($G ®1 f7O0 ( include bath .foreachutilityconnection)
SFR (1) bath
Lot: (Block: I Subdivision: Kr (ALL gC.R SFR (2) bath
Project name:' j x-. fit, LEP;12-nlvvcr EP44/ 5c#00/... SFR (3) bath
City /county: ` 1 - Z - C-Pr(Z4) I ZIP: 9 '7 2,23 Each additional bath/kitchen
Description and location of work on premises: .rt.-3S Site utilities:
.),.r K. rofL ;Flyayr /7 - ur,A(C AIWA' , it Catch basin /area drain
Est. date of completion/inspection: .S o'g -- 0 '� Drywells / leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: A/ 14/ f Q-e/Y Z- '1(l(IYIFj/ G Manholes
Address: 7, o. 'Bo 2--....?3 S _ Rain drain connector
City: t-p.R , State:&(L ZIP: ;' 77...8 Sanitary sewer (no. lin. ft.)
Phone:53 CZ4 ;,$ax53 (,7y o ,,: r -mail: Storm sewer (no. lin. ft.)
CCB no.: / 3 S . I Plumb. bus. reg. no: 39 _3128 Water service (no. lin. ft.)
Fixture or item:
City /metro lic. no.: e' y ,: „ / 06 / - D r Absorption valve
Contractor's representative signature: -• %` �'-�. - -
1 Back flow preventer •
Print name: , , / G - 4 .,/` Date: .s 2 Backwater valve
CONTACT PERSON Basins/lavatory
Name:,p 6 07?-11 L.!— ��1«)JeL- Clothes washer
A'
Address: I i-1�I �• S O .) 17 ,974- (/t<' Dishwasher
City: Ts Drinking fountain(s)
y -- T - 76-ft - g--17 7 I State: �r I ZIP: g 7Z� y Ejectors/sump
Phone: G13 5`G( -06 - Fax 5 . E -mailQ i. kex,a - ( ®ad + tpansion tank .
OWNER Fixture/sewer cap
Name (print) p c g 7” C, - K Ater _
Floor drains/floor sinks/hub
Mailing address: I ' ° 5't,) % Ave-, Garbage Hosse e bibb
disposal
bb
City: - G,.pre tj ('State: 0((2-I ZIP:g'7zz y Ice maker
Phone: 5 5 1 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) A
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan - -
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ - 7,,g rm
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
3.e0
Credit card number: / / State surcharge (8 %) $
Expires wi 180 days after it has been .... 7 t 36
Name of cardholder as shown on credit card accepted as complete. TOTAL $
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
PLUMBING PERMIT FEES: "'
° 't -. 4 '�` '.. APRICE`e�: ,. . , ;TOTAL - New Ti and 2 family °dweliings ,, ;:; . : __ " d d a l QT n ., (e a) . . A� ( s aIlT tu bi n g fi , I PRICE � § � ;TOT
Sink 16.60 �theidwellingtand,the first100'ft y 44* ;(ea) , AMO.UNT:
Lavatory 16.60 ,for= eachutitifyrconnection)` a -. ; z .,:= 6:. , . -,. ;.w-,.
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350'.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60
SUBTOTAL ° ',<r -_ -
Urinal 16.60 8% STATE SURCHARGE ' ,; . --, 7:
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL ' ' ':$ ` '
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 by Work Performed a -
Gas piping requires a separate mechanical f.Fixture type - ' New Moved , Replaced `Removed/
;•>> . • , ,.Capped
permit. ,_�,.: " : " .1 �`a, , ' . . . < . =� - . � _ _
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
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 .: i ., !V . T 7,
Isometric or riser diagram is required if,r
Quantity Total is > 9 �' � ",, ' n g` °'
*SUBTOTAL °_ -' ° ��, r -' ,
8% STATE SURCHARGE g "' : "
t `' t-!: 1; 4
**PLAN REVIEW 25% OF SUBTOTAL '�'
Required only if fixture qty. total is > 9 , `= ° l' p ,
TOTAL ... ; '' e, .:443
* 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 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts \forms\plm - fees.doc 12/26/01 • •
��' p _ Accumulative Sewer Tally '1//-
Tenant Name: � � ioni (� ' `c . /� . This SWR#
Address: g / �� ) Ne ,- �4 - -/ J This PLM #: pt,Nao4a - /s'o,
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
Baptistry /Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirl.00l 4
Car Wash - Each Stall 6
- Drive Through 16 .
Cuspidor/Water Aspirator 1 .
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 -
Eye Wash 1 .
Floor Drain /sink - 2 inch 2 -
- 3inch 5
- 4 inch 6 _
- Car Wash Drn 6 .
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 42
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
' Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink -Bar /Lavatory
2 / 2`
- Bradley 5
- Commercial 3
- Service 3
Swimming Pool Filter 1 _ .
Washer - Clothes 6 .
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
TOTALS /(
; /0
Total fixture values: / 6 divided by 16 = / 'EDU Ai
ca t_ ...
HISTORY
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# / EDU# SWR#
is \dsts\swttaly.doc/1 \i'e /; J c-
•
CITY OF TIGARD 24 -Hour
ti•
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
•
Location • •i it . , �y . Suite MEC
Contact Person 4 L - Ph ( ) 8 'V PLM — 00
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 AIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
S PART FAIL
ME ICAL
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 fl Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA r
Approach /Sidewalk Date �� ®f ®Z-- Inspector f /Aa-fi • Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL