Permit 09./2E,2001 07:53 15032973381 THE SCOTTS PAGE 01
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�` C1TY OF TIGARD
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412$ s W Hall � A NT $ �� ARTI 60,
3fR �- • Tig$nr OR . --.c� I. uM ®JNG PL
swam, • 9 6485 SW KING CFA ) 639-11 RAg /T
7 ?3 ( 9n3 7 1 I' F
BLOCK; ARLE0 AVE BATE ISSUED; 11- 4 LIL12001 -00446
CL ASS S OF WO
LOT: F4RcEL: 2311 ssB437500
TyPE R K: ALT ZONING, OF 8e: SF OARa1tGE pfS .1UI21SDlQTI 23
ANC1' G Rp: R3 . WASHING MACH: FLOOR D ACH: MOEILF NOME SA K
URB$ FLOOR
H;I DR A WS • BACICFLOyW P aces:
FEE VNTRS
SINKS
RIES LAUNDRY TRAYS; caTCH TRAPS:
LAVATORIES
URINALS: s RAIN DRAINS,
rua �sHOweRs; OT I:IxruREs:
WATER CLOSETS:
DISHWASHERS:
ft
DISHWASHERS: SEWER LINE: LINE: ft
• Remarks: Rerrkwe bathtub and replace wEtr fibergfas�heDRAIN: c. ft
�
Owner _ -. PEES HELEN DALY Type g Y Dete _ Amount Receipt
16485 SW KING CHARLES AVE PRMT DLH 9/21/01
KING CITY, OR 97224 SKI' DLI-I 9121/01 $ 7250 KING CITY
$5.80 KING CirY
Tvtai $76.30
Phone 1: 603 - 620.0407
Contractor:
KEN THE PLUMSER
9210 SW JAMIErSON RD
BEAVERTON, OIL 97005 REQUIRED INSPECTIONS
Inapt
n i
RouInapt Phons 1> 503 - 297 -3313 f=inal inspection -n n9
Reg #: LAC 134678
PLM 34 -341 PB
vi,;0 p It ittued subject t o th regulations oontairied in t h e done in Municipal Code
with h a State o plans.
Specialty Codes and all other applicable laws. A ll work wilt be
This permit will expire if work
Oregon ! ew r eq:,ires o u a fa low t rines adopted by the A Utility
C more
than 180 days. ATTENTION:
Notificatian Center. er. Those rules are t d rest q es 9 s to O 1-O by hro g (503)2, 952 OQ1 -0080.
You may obtain copies of these u s
•
Perrr►Ittee Signature: j ±1 IM:. _ _de
Issued 0y: noses day - - -- ------- - - - - --
can (503) 639 -4170 by 7:00 P.M. for an inspection needed the next
71 e ..___,Cu 7t/----
- Plumbing Permit A P f 1 ' '
; on
Date received: 9/e� e/ Permit no.: �0�i2 jO O 4 yy
�> City of Tigard � _ � � Sewer permit no.: Building permit no.:
Address: 13125 SW Ha11 Blvd, Tigard 41 : ' _
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: Ity2yel Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION s FEE SCHEDULE (for special inforn ation use checklist)
Job address: /6 c/ S S� //✓G CGT� �/ZL,ES Description Qty. Fee(ea.) Total
Bldg. no.: ite 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: [Block: [ Subdivision: _ SFR (2) bath .
Project name: 2 { / L7 SFR (3) bath
City /county: [ ZIP: Each additional bath/kitchen
Description and location of work on premises: j ' /°L.4 -CE 7716' Site utilities:
1 07/ A /R t ;PG-t4 5 <go40 E!2_ t('` 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: ,' E/V fie" ,"ZJitf4 E?€ Manholes
Address: 9 ,A/0 JLJ 7,9/1/ /82s, Rain drain connector
City: / - (/g27d [ State: ® /L,[ ZIP: 97DQ.� Sanitary sewer (no. lin. ft.)
Phone: A9-7- 338/ [ Fax: [ E- mail:, Storm sewer (no. lin. ft.)
CCB no.: 42 76 7 c [ Plumb. bus. reg. no: 3y-3 y/ PQ Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signature: ,OA/ �//y Back flow / 7— Absorption valve
Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory '
Name: u/,� �ffjS'�/2 Clothes washer
Dishwasher
Address: •
Drinking fountain(s)
City: [ State: [ ZIP: Ejectors/sump
Phone: 3/ ? -, S_5, Fax: s( - _ , E - mail: Expansion tank .
OWNER Fixture /sewer cap
Name (print): /7 , Floor drains/floor sinks/hub
Garbage disposal
Mailing address: e6 Jes a'p.) /c. //✓G GEs Hose bibb
City: / Cr ry [ State:OA_ Z IP: 97a a y Ice maker
Phone: (p ZQ - D /0 7 [ Fax: [ 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
Urinal
Name: Water closet
Address: Water heater
City: State: ZIP: Other:
Phone: [ Fax: [ E -mail: Total ,
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ oZ SO
.0 visa O MasterCard expires if- -a- permit is -not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 5, e D
Expires TOTAL $ 7e, • 3 O
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6 /00 /COM)
PLUMBING PERMIT FEES:
FIXTURES (individual) 'CITY Z AMOUNT- (includes all plumbing fixtures in PRI toiAL, -
Sink 16.60 the,dveIlingand the firsti Obt. :QTY ;(ea): -
•
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 , Quarititji:bNi Work Performed
Gas piping requires a separate mechanical Fuxture Type - New Moved RelaceJ Removedl
permit. - Capped
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
Other Fixtures (Specify) 16.60 Urinal
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 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25 •
Grease Traps 16.60
QUANTITY TOTAL r! ;
Isometric or riser diagram is required if 1 ., ,- W
Quantity Total is > 9 .
*SUBTOTAL
8% STATE SURCHARGE
**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 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts\forms\plm-fees.doc 08/29/01
CITY OF TIGARD BUJ! DING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 63, 175 Business Line: 639 -4 -
BUP
D ate Requested Z /, AM PM BLS
Location l Cc� R� 1� ( ? �1X.P i) Suite MEC
Contact Person -lam/ Ph -3l (?‘ PLM 02{-9/ Go %
Contractor Ph SWR
BUILDING Tenant/Owner 2d -Q d ft) ELC
Retaining Wall _ (S L/ R 5r/3 W) ELR
Footing - r�
c - ess
Foundation _ FIPt
Ftg Drain �''l `'
Crawl Drain Inspection Notes: /� /�
Slab �rXe -1� SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
_ Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof c 1`
7C)�L. �� J 7 / /
Misc: /6,2,-2/ Cam{
Final
PAS3„ FAIL
MBIN
POSE Beam
Under Slab
op O
"a er ervice
Sanitary Sewer
Rain Drains
Fi f
(iMale," FAIL
Post & Beam
Rough In
Gas
Smoke e Dampers
Final
PASS PART FAIL
AMV
ELECTRICAL,
Service
Rough In
UG /Slab
Low Voltage
..Fire Alarm
Final
PASS PART FAIL
SITE,
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 /1 /
Approach /Sidewalk e L G r
Other Dat Inspecto ( Ext
Final
PASS PART FAIL DC `(OT REMOVE this inspection rF rd from the job site.