Permit I ` f CITY OF TIGARD PLUMBING PERMIT
4 0 , 1Y, A1 DEVELOPMENT SERVICES PERMIT #: PLM2002 -00204
Ail 13125 SW Hall Blvd., Tigard, OR 9 7223 (503) 639 -4171 DATE ISSUED: 6/10/02
SITE ADDRESS: 08060 SW PFAFFLE ST PARCEL: 1S136CD-00600
SUBDIVISION: SPRINT PCS WIRELESS MONOPOLE ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B 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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of commercial back flow preventer.
FEES
Owner: •
Type By Date Amount Receipt
EEI SOLUTIONS PRMT CTR 6/10/02 $72.50 27200200000
5665 SW MEADOWS RD, SUITE 300 5PCT CTR 6/10/02 $5.80 27200200000
LAKE OSWEGO, OR 97035
Total $78.30
Phone 1: 503 - 294 -2150
Contractor:
CEDAR LANDSCAPE
14145 SW GALBREATH DRIVE
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 625 -3700 RP /Backflow Preventer
Reg #: LIC 75535 Final Inspection
PLM 5843 LANDSCAPE LIC.
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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: A. / . / ` Permittee Signature: t e
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1
P lumbing Permit Application
Date received: -"7 p y Permit no.: . ii _ ,,
� ,:. ,, City of Tigard E �
;•� � `J Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd
Cit y of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 JUN U Cl 2 02 Date issued: By: ( e)b I Receipt no.:
Land use approval: CITY OF TIGARD Case file no.: Payment type:
TY OF PERMIT
0 1 & 2 family dwelling or accessory X,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: go ‘o Sc , PFA -FFLC- sr TGsl e.17 9 -4 224 Description Qty. Fee(ea.) Total
Bldg. no.: Suite 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: I Block: I Subdivision: SFR (2) bath
Project name: CRM Etzp PI ALA, SFR (3) bath
City /county: r j r d AuASN. I ZIP: 94 Z Z_4 Each additional bath/kitchen
Description and locati6n of work on premises: Site utilities:
Le, vie./ sCQPe SPY`1'i C k l eS g/ S lH . 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_rirjr ( iA14 t P. PAC_ Manholes
Address: I V IyS SW G ..I I Di' Rain drain connector
City: S Lter w ood I State:pe_ I ZIP: 9 -}. ( ii Q Sanitary sewer (no. lin. ft.)
Phone: ( Z _ 31 pU I Fax: GZ•S -$6ZZI E - mail: — Storm sewer (no. lin. ft.)
CCB no.: '8 413 I Plumb. bus. reg. no: _Water service (no. lin. ft.)
City /metro lic. no.: / r Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer I •
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
(MINER Fixture/sewer cap
Name (print): Floor drains/floor sinks/hub
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)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
Tubs/shower /shower pan
Name: Urinal
ame:
Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total -7
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Z
Visa ❑ MasterC d 7 Notice: This permit application Plan review (at _ %) $
p b / 3 ex if a p ermit is not obtained a 25v
Credit card number: 30 . J c °?. 36 /03Rf Ddb 6 State surcharge (8 %) .... $ T w 180 da after it has been
r 1. Ghae l D - Grrac� Expires TOTAL $ 18+ 3 14
of cardbol. .. : , o .• on credit card
jL accepted as complete.
,. , ' �
—�� $ id p 3 O
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
Lavato 16.60 for each utility connection)
ry 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
Washing Machine 16.60
Floor Drain /Floor Sink 2"
16.60
166.660 0 PLEASE COMPLETE:
3 "
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
• 16.60 Urinal
Other Fixtures (Specify) 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
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 J
Residential Backflow Prevention Device" --- 2r55 -
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 fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which Is $36.25 + 8% state surcharge.
• ' e • - _ . .. .. - w some nc or riser diagram and
plan review.
is \dsts \forms \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 Reque to • 2 / / 8 AM PM BUP
Location : D Suite MEC
Contact Person Ph ( ) 9O 9 - PLM — 0
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: r
Ftg Drain
�. M / ELR 67) / (o
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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
�r PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
LECTRI • AL
S - mice
R• gh-
UG :b
Low oltage
Fi = • - rm
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 C/( ( � �i �/ v S Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL