Permit Ty
CITY TIGARD PLUMBING PERMIT
i, DEVELOPMENT SERVICES PERMIT #: PLM2002 -00234
' ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/19/02
SITE ADDRESS: 06707 SW PINE ST PARCEL: 1S136AD -04600
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 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 water heater and clothes washer.
FEES
• Owner:
Type By Date Amount Receipt
HETICK PRMT CTR 6/19/02 $72.50 27200200000
6707 SW PINE ST 5PCT CTR 6/19/02 $5.80 27200200000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
PARAMOUNT PLUMBING COMPANY
6019 SE 23RD AVE
PORTLAND, OR 97202 -0000 REQUIRED INSPECTIONS
Phone 1: 239 -7516 Rough -in Insp
Top -out Insp
Reg #: LIC 125438
PLM 26 -627P6 Final Inspection
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
Notificatio ter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952- 0001 -0080.
You ay obtain co '-s of these rules or direct questions to OUNC by calling (503) 246 -1987.
�►�s
ii i � �., / �
I sued By �_�� -�.� ; � / _, � Permittee Signature:
�
Call (5+ - . 9-4175 by 7:00 P.M. for an inspection needed the next business day
•
t Plumbing Permit Application , ,
Date received: . /I Q3— Permit no.. 1 ,,,,,, 40,.
' City of Tigard
r � Sewer permit no.: Building permit no.:
..4.91- Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Aill'ie date:
r
Fax: (503) 598 -1960 Date issued: t Receipt no.:
Land use approval: Case file no.: Payment type:
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family U Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: T t.99. S/J /' 're_ 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: Subdivision: SFR (2) bath
Project name: HP7,G SFR (3) bath
City /county: 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: 4172ATai,.. % i " i ' ' K. • Manholes
Address: C o f r_ . / ' Ih J Rain drain connector "
City: , 7/ State OK I ZIP:f, 24.11— Sanitary sewer (no. lin. ft.)
Phone:z.5- 1.S' /C I Fax: .2J /arnl'E -mail: Storm sewer (no. lin. ft.)
CCB no.: / $"yd Y I Plumb. bus. reg. no: 2C -G27. 4 Water service (no. lin. ft.)
��
Fixture or item:
City/ metro li no.: c/ ,r,/ Absorption valve
Contractor's r s repress entative e s ig nature: Back flow preventer
Print name: < 1i� '/ L4 C L .e- Date: -/i °L ' Backwater valve .
Basins/lavatory •
Name: ,.f' <,..t •c • .< J ,,. Clothes washer /
Dishwasher •
Address: Drinking fountain(s)
City: 'State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): Garbage disposal
Mailing address: Hose bibb
City: I State: ZIP: Ice maker
Phone: I Fax: 1E-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
EN( INFER Tubs/shower /shower pan -
Urinal
Name: Water closet
Address: Water heater /
City: 1 State: 'ZIP: Other.
Phone: 1 Fax: 1E-mail: Total
Not an jurisdictions accept credit cards, please call Jurisdiction for more information. Notice: This permit application Minimum fee $
0 Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / State surcharge (8 %) .... $ ,
Expires within 180 days aRer it has been TOTAL $ . Ifs' 30
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount • 440 -4616 (6A0/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 tea) 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 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 -
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 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 - 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.
** All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
i:ldsts\forms\plm- fees.doc 12/26/01
CIT ZLTIGARD Inspection Line: (503) 639 -4175 —
BUILDING /� MST
INSPECTION DIVISION Business Line: (503) 639 -4171 &N
4-/ � BUP
Received Date Requested 4° AM PM BUP
Location D p< -211 , .sue Suite //�� MEC 0 2 00 a
Contact Person _,A /.. . ' Ph ( ) .71?" y'' /D LD PLM - vv 2 -3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC ,� /' I
Footing I�
Foundation Access: ,.� ELC ,-
Ftg Drain O m ,6 ELR � �
Crawl Drain /J
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear I �ll LA, p, Q n a QA/V\ S wv a
Framing J i— �� �l/v
Insulation �•y , 4j _ � 6
Drywall Nailing ra/ � L v"
Firewall :71 � � � S -t' -P r .
Fire Sprinkler //
Fire Alarm "lk� \� f� �r \--_ ' Cr _ff
Susp'd Ceiling (� / ` f
Roof 3 ,l 4 V � 1 \, &t- ` 11 a-,1 Cam_ '� „V a-- -J 0 k l
F -t�� c 'z etiJ. '� cc_v\.. ../
PASS PART FAIL G
PLUMBING 4.1 ) ki v” fi 0,,,..,/ c\ ci L D
Post Beam
Undder r Slab Q6)6. l _CD 6 ®T ,0� U
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole , TIJt� t/._e_—JZ-- — A.A.. A.A.. " , AM
Storm Drain
Shower Pan
Other:
FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
ke Dampers
Fina
A O jgr FAIL
CTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line -V ��
ADA I
Approach/Sidewalk Date , `C b Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITI OF TIGARD 24 -Hour e• A
• Inspection Line: 503
�UIEDING P ( ) 639 -4175 I
INSPECTION DIVISION Business Line: (503) 639 -4171 MST 1
r � U P
s e
Received Date Requested 6O /o AM PM BUP
Location 67 07 � � l e Suite MEC A— 00 24
Contact Person f -i- Ph ( 3 cl C eS PLM — a3 4 /
Contractor Ph ( &J/ ' 0 ` / 43 SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: p- �/� e:)0O
Ftg Drain - � o a ' ELR
Crawl Drain
Slab Inspection Notes: e_ cli SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear 7 iyl
Int Sheath/Shear
Framing
Insulation , 1 3 10 (/ «4{
Drywall Nailing
Firewall ril‘7 4 tS' Fire Sprinkler "►
Fire Alarm
Susp'd Ceiling 4,2,-1 A 41--1----) Roof
Othe � �M�
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam 61k.
k �
Under Slab
Va er Service
— tSit-..
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
o p FAIL
M CHANICAL
Post & Beam
Rou -In
s Line
Smoke Dampers -
Final
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: 111 Unable to inspect - no access
Fire Supply Line
ADA j t
Approach/Sidewalk Date ` e 2'y70 �� Inspector \ C �� E x t 2 � L I
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL