Permit . CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2003 -00364
x�y DEVELOPMENT SERVICES DATE ISSUED: 7/25/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11825 SW LYNN ST PARCEL: 2S1036A -00143
SUBDIVISION: LERON HEIGHTS NO. 2 ZONING: R -4.5
BLOCK: LOT: 033 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 60 ft of water service
FEES
Owner:
Description Date Amount
BARKER
11825 SW LYNN STREET [PLUMB] Permit Fee 7/25/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 7/25/03 $5.80
Total $78.30
Phone :
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 - 5535 Final Inspection
Reg #: LIC 10967
MET 00003528
PLM 34 -42PB
•
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
Issued By: Permittee Signature: 11 _% I>> `=
Call (503) 639 -4175 by 7:00 P.M. for an inspection neede • the next business day
I
~ Plumbing Permit Appliccation
. Date received: - 7 a 03 Permit no.:pLvfl ab x ,, 36 y
t , if, City of Tigard and
,
.:)1' `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
„V--1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
U New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (forr special information use checklist)
Job address: / / ,2 .5 • SW X yhN 57' Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 R. 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: T 5n.41 1 4 I ZIP: 9) 2 2'1 Each additional bath/kitchen
Description and location or work on premises: Site utilities:
Q4_ /4 if.., , 1 S 4v/ei4 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: 4.4.44- Q / vii 4'+j Manholes
Address: / 3 9 05- f`„ i^ Rain drain connector
City: / de—Ad I State: ZIP: 9JC.„0,51 Sanitary sewer (no. lin. ft.)
Phone: a ; . 3 3S-I`Fax *- 66.33?.tE -mail: — Storni sewer (no. lin. ft.)
CCB no.: / 96 i I Plumb. bus. reg. no: 39 - y 2
Mater service (no. lin. ft.) 6
City /metro lic. no.: / 3,3 Fixture or item:
Absorption
Contractor's representative signature: Back flow flow valve
preventer
p 'Pi ,4
Print name: / (4 Date: _ Back
Backwater valve •
CONTACT PERSON Basins/lavatory
Name: eg, r?j ,g,ge_,¢' Clothes washer
Dishwasher
Address: 5 #11°- Drinking fountain(s) City: tate: I ZIP: Ejectors/sump
Phone: 6 .SS�3S Fax: 6f/j S "E Expansion tank ,
OWNER Fixture /sewer cap
Name (print): 420A...9 Floor drains/floor sinks/hub
Mailing address: a_6--- Garbage disposal —
Hose bibb _
City: S te: ZIP: Ice maker
_
Phone: 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
Urinal
Name:
Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total y,
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ Z' S
0 Visa 0 MasterCard Plan review (at _ %) $
expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $ 79 . O
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 410 -4616 (6N0/COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures In PRICE •'TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavat 16.60 for each utility connection)
°� 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 z 16.60 PLEASE COMPLETE:
3" 166.60 60
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical 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
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 Sg- 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 SS-.
Quantity Total is > 9
*SUBTOTAL •
8% STATE SURCHARGE . ,, . !- L / KD
"PLAN REVIEW 25% OF SUBTOTAL • • ' -
Required only if fixture qty. total is > 9 .
TOTAL $, , tie,
'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.
i:\dsts\forrns\plm- fees.doc 10/10/00
~-
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line! (503) 639 - 4171 MST
BUP
Received Date Reques ed -- 3° \ AM PM BUP
Location 1 a s Suite MEC
Contact Person Ph ( ) =S 3.5
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
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
ofr
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
r- i
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
C r PART FAIL
CHANICAL
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 reins s ection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector T % Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL