Permit CITY OF TIGARD PLUMBING PERMIT
I r DEVELOPMENT SERVICES PERMIT #: P 05/16/2001
-00199
,.�� 13125 SW Hall Blvd., Tigard, OR 97223 (5 6 39 -4171 DATE ISSUED: 05/16/20
SITE ADDRESS: 11950 SW LINCOLN AVE 01 PARCEL: 2S102A6 -01001
SUBDIVISION: MONROE SQUARE APARTMENTS ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: SR3.3 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: 85 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of water service line.
FEES
Owner:
Type By Date Amount Receipt
LOCKWOOD, MICHAEL P TANYA PRMT CTR 05/16/2001 $72.50 27200100000
c/o SERES, JOEL L 5PCT CTR 05/16/2001 $5.80 27200100000
2610 SO SHORE BLVD
LAKE OSWEGO, OR 97034 Total $78.30
Phone 1:
Contractor:
DETEMPLE CO INC
1951 NW OVERTON ST
PORTLAND, OR 97209 REQUIRED INSPECTIONS
Phone 1: 503 - 227 -2641 Water Service Insp
Reg #: LIC 2510 Final Inspection
PLM 26 -25PB
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 co ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: " Permittee Signature: ? 11/d4 _ 7 Il'S
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
, .
1 _ . / .
Plumbing Permit Ap pit' i .
R Datereccived:6 110 0 f Permit no.: ( 11 .2.00/.-12/.2 A
n N= ` , . Sewer permit ao.: Building pernut no.:
Address: 13125 SW Hall Blvd. Tigar4.•OR 97223
City o�gard Phone: (503) 639 -4171 V\ `v4 � qi `��' �l�appl.no.: • Expire date:
0. Fax: (503) 598 -1960 `0,1,,'.", Datelined: By: Receipt no.:
• Land use approval: C� Case file no.: Payment type:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory Ai Conuw rcial/industrial 0 Multi - family 0 Tenant improvement
O New construction ) it %Additku /alteration/replacement 0 Food service 0 Other.
JOBS! TE INFORMATION FEE SCHEDULE (tor spccial inluruwlion use checklis()
lob address: a I / •S c r5"0 t f bin Descripdon Qty. Fee (ea.) Total
Bldg. no.: 1N Suite no.: New l- and 2- family dwellings only
Tax map/tax ]ot/a count no.{9 (t ndudesl000 . tor each udlityconnection)
SFR (1) bath
Lot: Block: I Subdivision: SFR (2) bath
Project name: nil ( cc , ot re SFR (3) bath
ZIP: Each addihon bath/kitchen
City/county!" r. - ��— .
Description d location of work on premises: • r. 1 A 0 S ite utilities:
I J r��C 0 t J , i4 , Catch basin/area drain
Est. data of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footln drain (no. lln. ft.)
Manufactured home utilities
Business name: AN , . ,_� • ,,, • Manholes
Address: r, . • 4 4 Rain drain connector
City: fi . �� State: A 4 2 1': PIN • " Sanitary sewer (no. lin. ft.)
Phone: 277 -2( y I Fax: 7L/ D v, E -mail: Storm sewer (no. lin. ft.)
CCB no.: o ?,c - / 6 I Plumb. bus. reg. no: 0 1( e J5-P.0 Water service (no. lin. ft.) 851 55
City/metro lic. no.: / Q V, Fixture or item:
Contractor's representative signature: ; k / � _ Absorption valve
Back flow preventer
Print name: _, a ' f4 SC � a ate: i O Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking
City: State: 21P: Ejectors/sump
Phone: Fax: E Expansion tank
OWNER Fixdtre/sewer cap •
Name (print): Floor drains/floor sinks/hub
Garbage disposal
Mailing address: Hose bibb
City: . I State: 123P: Ice maker
r Phone: 'Fax: I E -mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primes(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 £47. 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: 1'i P: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdidiuw accept actin cards. plows can p 1adiuice for mere hJumadoa Minimum fee $ 7.3 • . S�
N
Not Th is permit application Plan � within 180 days a fter it hsbun accepted as complete. 7 A', 3 Z)
Name at cardholder's shown on cudit and
S
` Cantholder slputom Amorll fAii. �,' MO 4616 (61004:061) RI r
,. lick -h i5Sl1iv
; 12/05/00 TUE 17:22 [TX NO
12/05/ '0 TUE 17:14 FAX 503 598 1960 CITY OF TIGARD f]003
, . '''' i . . ..
PLUMBING PERMIT FEES: •
.I L.. i �, . T � �%'IE r r ;Ld n, d :r ;r• : �c .�i; ,
i. ,
''I
Pitl :iOY
- � � L ':Gluiles all. , ltimb Y n � L " _�... i
J ,, fl,C ��UR '�$c;(i.�tl.I "i�dua]Y�,.,,�, . , :��.,. ... ;i;; .� � , .i , � + !
tye{i•ii in ' iari 4 'tMe;: bl ti: 'l ` •(ea).:; ,AMOM T'
Sink 1 , m �. I l :.'. d:
16. '`ifo!'�a��:�tl�l�'.Oh'Ei$C�I' Fr }'!�'.. :: ; . r - _..... :
Lavatory One (1) bath • $249.20
Tub or Tub/Shower Comb. 16.6) Two (2) bath $350.00
Shower Only - 16.6) Three (3) bath $399.00
Water Closet 16.6) _ SUBTOTAL ir' :`
Urinal 16.6) • 8% STATE SURCHARGE 1 :: `i.'' i;Hf !' 1, '
Dishwasher • 16.6) • PLAN REVIEW 25% OF SUBTOTAL 1' ! ; ; 1. : :f ; ! • : :.:;
'4'.0:0!!!..' l l � .• . • Garbage Disposal TOTAL 16.6) is .I
Laundry Tray 16.6) •
• Washing Machine 16.61 '
Floor Drain/Floor Sink 2" 16.6) • PLEASE COMPLETE:
3" . 16.6)
4" 18.6)
, ; ' ;:; r,; • 1!;; :i u�a'riti " 4iii.P' o tried!
i:`
a� iii :'��' '� :. : :� ;i :iii IiI;k1I'� is � ii
Water Heater 0 conversion 0 like kind 16.6) jll' ' ,; .., ;i -4 '= r i' ;' i ; �i F l ;11..,,,1, t . I! ib � _. I a , ,. , R „,•. ,e .::
Gas piping requires a separate mechanical �IXIVIr. TSrpe flp� l ,;�N r�_�y�v,J, I�_ veq p . • 4 , efl•iOvai
permit. _ .:.i I I,', .., .„ . ...rtlliii'i!:.tIi�' �.,I' 1 iiiI i !lgrI I1 1� ii hill 4MO ,' I C'alipQdri'is
MFG Home New Water Service . 46.4) Sink .
' MFG Home New San/Storm Sewer • 46.4) . Lavatory
Tub or Tub /Shower
Hose Bibs 16 Combination • ,
Roof Drains 1 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures (Specify) 16.6) Urinal
• Dishwasher
Garbage Disposal •
• . Laundry Room Tray
Washing Machine ,
. Floor Drain /Sink: 2"
Sewer- 1st 100' • 55.0) 3"
• Sewer - each additional 100' 46.43 4"
Water Service - 1st 100' S5 f 55.03 cK-� Water Heater
Water Service - each additional 200' !! . 46.40 JJ . 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/lir COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25 •
•
Grease Traps 16.60
•
• QUANTITY TOTAL ... 'g ; P;!
Isometric or riser diagram Is required if r::'' ^:r °' ! i , , :'�'f.l i
ii •
Quantity Total is > l j. . ,. M.: , u P= � :i 11 : ;; ,
•
`SUBTOTAL : : : :� 'Ail;j0 l'iir
8% STATE SURCHARGE ' k`!ii'i "r4 ;i.. a ` .•,! :`
*'PLAN REVIEW 25% OF SUBTOTAL ; : ::.':; j'
Required only If fixture qty. total Is > 9 I! ! Vii ' ::i! r'; ! +;i .' _
TOTAL 4:::?.:;::::-:.::;: :. • ;.; $
�i.ii•,, ::1;:11..
P.:,i:' Lira,;, -
Minimum permit fee Is $72.50 + 8% state surcharge, except Residerlial Backfiow
Prevention Device, which Is $38.25 + 8% state surcharge.
"AU New Commercial Buildings require plans with Isometric or riser diagram and •
plan review. •
•
is \dsts\forms\plm- fees.doc 10/10/00 ' •
12/05/00 TUE 17:22 [T% /R% NO 9573] IJ003
/7 Qs,
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
tt Date Requested L5- /, AM PM BLD
/Mar M O S cr/ Ara L t MEC
Contact Person (h1o'► re) * 5 Ph 2Z 7'ZG �� PLM tv/ - v l
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: dl'\ C2.; r,,, s - — `to - Conn c.co`Q FPS
Foundation (.0.C. *SS V Z �'�„� N ¢ �t 0
Ftg Drain (v\G-. -✓� SGN
Slab
Crawl Drain Inspection Notes: Le__ � � d w ) v /2_12, a �•
SIT
Post & Beam
Ext Sheath /Shear o / "' /17 Z - DA. 6 ..H P i .a L
Int Sheath /Shear f2 j c 1, , .•A
Framing
Insulation
Drywall Nailing
d i
Firewall /
Fire Sprinkler Q v. � -e / -Q C,' �n� �r p o� M . �v t �� t� K w� . 7 y
Fire Alarm 11
Susp'd Ceiling O V Re- � - o/ // t,.> a 1 _ J, L1- s; .
Roof v � S2 LvtrJV A' 11 '2 ' r -e S , L G
Misc: I
Final ,. j�•e{urc et c - // .
PASS PART FAIL
• 1 �
ost & Beam
Under Slab /
" u
ater Servi
Sanitary Sewer
Rain P • ins
el lerwr
PART FAIL
. "'ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
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
Approach /Sidewalk
Other Dat �' l7 - D l Inspector. �� 0111.., , E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.