Permit CITY TIGARD PLUMBING PERMIT
4 DEVELOPMENT SERVICES PERMIT #: PLM2001 -00523
- `4' DATE ISSUED: 10/17/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12965 SW PACIFIC HWY PARCEL: 2S1026D -02600
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: C -G
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 0 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 0
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocate 1 toilet and add 1 new lay.
FEES
Owner:
Type By Date Amount Receipt
KIM, ROBERT + HAE LIM PRMT CTR 10/17/01 $72.50 27200100000
1360 SW WOODWARD WAY SPOT CTR 10/17/01 $5.80 27200100000
PORTLAND, OR 97225
Total $78.30
Phone 1:
Contractor:
SONSHINE PRODUCTS, INC.
8596 SW DAKOTA
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503 - 885 -0997 Top-out Insp
Reg #: LIC 110240 Final Inspection
PLM 37 -382PB
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 -! : ;0.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -19:�i
Issued By: Permittee Signature: / 44A, ii,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1 co 013q _5316-o o? acrd ► 003 \ k_ _
1/4 fob] Plumbing Permit Application .
Datereceived: l 1(0/01 Permit no. ja)/ -005 , 3
. City of Tigard
:4 I Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Ti:. :;ro •97223
City of Tigard Phone: (503) 639 -4171 T l C Project/appl.no.: Expire date:
Fax: (503) 598 -1960 1 Date issued: By: j�j I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other: •
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: /,,,1 4. 1, • 4 c ` ` " Description Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: ,a, I Suite o.:
Tax map /tax lot/ac7rount no.: (includes 100 R. [or each utility connection)
SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: A i i q /-e,SS' SFR (3) bath
7• f�'/.1� ZI P: 9
City /county: ' Each additional bath/kitchen
�Lz _
Description and location of work onremises: Site utilities:
44a ✓ 4''�: LET f $ t k to o B 4 - i,�,4 Catch basin/area drain
Est. date of completion/inspection: Drywalls/ leach line/trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: 5 l . ? , e , ,,e,, wA / ,, i¢llManholes
Address: j^t s( D4 (di A Y ,A., i Rain drain connector
City: — AzA ,f_ e I State: err I ZIP: ? z _ anitary sewer (no. lin. ft.)
Phone 3-- -Ogf #ax: I E -mail: form sewer (no. lin. ft.)
CCB no.: '/,247) I Plumb. bus. reg. n. • Water service (no. lin. ft.)
City/metro lic. no.: • CCX2 &.7 Fixture or item:
Contractor's representative signature: / ' Absorption valve
Back flow preventer
Print name: NM E , _ Da e: /0 S / Backwater valve •
CONTACT PERSON Basins/lavatory
Name: 'Rid, VJ A ul eV' cl Clothes washer
Address: 574 SW /19 Lc) 2,-
Dishwasher •
City: - I k State:� Z Drinking fountain(s)
Ejectors/sump
Phone E -mail: Expansion tank .
Fixture/sewer cap 7 I L
Name
(print): Floor drains/floor sinks/hub
(p
Mailing address: Garbage disposal
Hose bibb
City: I State: I 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) c
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) / Y � e / Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan �0 6-0 Urinal fit / 4 J `f - /0
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total -3 •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ -- 7.?- • S U
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
credit card number / w 180 days after it has been State surcharge (8 %) .... $ .S• W Expires TOTAL $ - 7 $ ?,U
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount • 440 -4616 (6100/COM)
tfrii
PLUMBING PERMIT FEES: -
..t - - PRICE • TOTAL Netilr.1 and 2- family dwellings only:
FIXTURES (Individual) • QTY , ' (ea) AMOUNT (Includes all plumbing fuctures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory k
16.60 / V ti 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
Urinal 16.60 i& o SUBTOTAL
8 /o 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 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 I -.'e
O
MFG Home New San/Storm Sewer 46.40 Lavatory W
Hose Bibs 16.60 Tub or Tub /Shower
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures (Specify) 16.60 • Urinal }fji (� / /
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
Isometric or riser diagram Is required if ":
Quantity Total is > 9
*SUBTOTAL .
8% STATE SURCHARGE •
*"PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* Minimum permit e is $72.50 + state surcharge, except Residential Backflow
Prevention Devi wh is $38.25 + 8% state surcharge.
** MI 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
(,7.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /e �- AM PM BLD
Location 1 (,S Pc' --�. e. • Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner - A _ � - ELC
Retaining Wall ELR
Footing
Foundation S ✓ p FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing All
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof -
Misc:
Final 1—Mr
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
i faitpART 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 Date h/ / / Inspector � V� Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
d BUP
Date Requested /6 — /c1 AM PM BLD
Location ,/( w/ Suite MEC
Contact Person Ph 3 jam' g /A-- PLM 0 /
Contractor Ph SWR OS-2-3
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation PC.
FPS
L BOX T
Ftg Drain /� J 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 Ceiling
Roof
Misc:
Final
P:RT FAIL
Pos
1
Water Service
Sanitary Sewer
Rain Drains
Fin
PART FAIL
MECHANICAL
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
AApproach/Sidewalk Date ' '1/ 9/0/ Inspector v E xt
Final
PAS PART FAIL DO NOT REMOVE this inspection record from the job site. .