Permit CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PLUMBING
PLM2002 -00418
��, II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE- ISSUED: - 10/29/02
SITE ADDRESS: 13660 SW PACIFIC HWY PARCEL: 2S102CC -01000
W
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 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: 260 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 260 feet of water service.
FEES
Owner:
Description Date Amount
NORRIS & STEVENS
520 SW 6TH AVE #400 [PLUMB] Permit Fee 10/29/02 $101.40
PORTLAND, OR 97204 [PLUMB] Permit Fee 10/29/02 $0.00
[TAX] 8% State Tax 10/29/02 $8.11
[TAX] 8% State Tax 10/29/02 $0.00
Phone 1: 503- 225 -8483
Total $109.51
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
.BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone Water Service Insp
hone 1: 643 - 7619
Final Inspection
Reg #: MET 00001047
LIC 12889
PLM 34 -4PB
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
I sued By: ! ,'jiji� % 4 ' �� Permittee Signature: L � ,, /k6"-b
Call (503 .39-4175 by 7:00 P.M. for an inspection needed the next busi ess day
_ Building Fixtures
A Plumbing Permit Application OFFICE USE ONLY
City of Tigard received: /0 "If 0P Permit no. „ ,. 4,0ff
- 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
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial $Multi- family ❑ Tenant improvement
❑ New construction ¢l Addition/alteration /replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
/ Description Qty. Fee(ea.) Total
Job address: �3Y ( 0 sr� A C.�F ►L W �
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
Tax map /tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath . i
City /county: tO I ZIP: Each additional bath/kitchen ,
Description and location of work on premises: Site utilities:
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:
TKBAL TOIJ - ,p C-BC )f✓�- Manholes
Address: I35 St..) 7 14 / / J(7 Rain drain connector
City: 13 (,n),) I State &L I ZIP)(VS� Sanitary sewer (no. lin. ft.)
Phone: 6 7J _ I Fax: E -mail: Storm sewer (no. lin. ft.) ,
CCB no.: 0 f7 p I Plumb. bus. reg. no:7 S'-ypH Water service (no. lin. ft.) - ZO
City/metro lic. no.: Fixture or item:
Contractor's representative signature: 0 Absorption valve
Back flow preventer
name: , (, �+' j r ate: )0G, 02.--
Backwater valve aloe
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Address: Dishwasher
City: • I State: ZIP: Drinking fountain(s)
Ejectors /sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): (J( a,' S S AR/6S Floor drains /floor sinks/hub
Mailing address: Sap `� (.0 # goo Garbage
b bbisposal
City:TI I State:a� ZIPcf 7�p� Ice maker
Phone:2L( _ NO 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
Name: Urinal
Address: Water closet
Water heater
City: I State: I ZIP: Other:
Phone: Fax: E -mail: Total O 1
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
n
Notice: This permit application o
❑ Visa 0 MasterCard Plan review (at _ %) $
expires if a permit is not obtained a
Credit card number: / / within 180 days after it has been TOTAL charge (8%) .... $ / D9 s�
Expires
Name of cardholder as shown on credit card accepted as complete.
Cardholder signature Amount 440 -4616 (6/00/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
Lavatory 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 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
MFG Home New San /Storm Sewer 46.40 Lavatory
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
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 I I I I
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
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 fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** Ail 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
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 63 75
INSPECTION DIVISION . Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1 () "' 3 AM v PM BUP
Location /3 ' () Suite MEC
Contact Person / Ph ( ) CO-76/7 PLM i /S
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ft Drain Access: L-L-4? Crawl Drain io DU U V ( ELR
Slab Ins ection Noires: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm / / 1)41/ji
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
IIMRINCD
Post & Beam
Under Slab
Rough -In �✓
Wate[Servic
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
0th _
Fib
PART FAIL
' ANICAL
Post & Beam
Rough -In t
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 reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Y p
Inspector r Ext
Other:
Final 0 NOT REMOVE this inspection record from the Job site.
PASS PART FAIL