Permit CITY OF TIGARD
PLUMBING PERMIT
" DEVELOPMENT SERVICES PERMIT #: PLM2001 -00426
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/7/01
SITE ADDRESS: 12213 SW QUAIL CREEK LN PARCEL: 2S103CB -11300
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 071 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 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 back flow preventer device.
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 9/7/01 $36.25 27200100000
4230 GALEWOOD ST. #100 SPOT CTR 9/7/01 $2.90 27200100000
LAKE OSWEGO, OR 97035
Total $39.15
Phone 1: 503 - 387 -7538
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
•
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 6136 Final Inspection
PLM 11558
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: Ar, , _ Permittee Signature: 0
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit A 1 plication
Datereceived: -7 ( 1 / Permit no.: -Ct2 4 lb
4.:r,.;;, `J g i , City of 'Tigard
J J Sewer petmit no.: Building permit no.:
` Address: 13125 SW Hall BI tgard, OAIVED .
City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Expire date:
' Fax: (503) 598 -1960 0 c 2001 Date issued: ' By: Ise I Receipt no.: •
S EP
Land use approval: Case file no.: Payment type: '
i , I DEVELOPMEN .
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial • 0 Multi- family • 0 Tenant improvement •
N ew construction 0 Addition/alteration /replacement 0 Food service 0 Other: '
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: / j 3 5, atukut, Crcedt T Description Qty. Fee(ea.) Total - -
Bldg. no.: I Suite no.: New 1 -and 2- family dwellings only:
(includes 100 ft. foreach utility connection)
Tax map /tax lot/account no.: id, 51 xr7 SFR (1) bath -
Lot: r] 1' I Block: I Subdivision: ISILt L:e_ t4o1 l ou` SFR (2) bath
Project name: Q.!-t r' 1 2. II (31.0 '71 SFR (3) bath
7�P: 97 4 Each add itional bath/kitchen
City /county: rlyu,r4 / wr�M I
- Description and locatip n of work on premises: Siteutilities: _ . _
8/4L'4C't70' D.2 I Gf) Catch basin/area drain •
•
Est. date of completion/inspection: q .30 01 Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.) -
Manufactured home utilities _
Business name: P &I a SS Liinds civic Zn C� Manholes
Address: 6915 ALL) kip i611 0 IQ.D Rain drain connector • .
City: U) % I SOYI U [ I I G I State:0721 ZIP: g (1 7(' Sanitary sewer (no. lin. ft.) .
Phone. - /0076 I Fax:6,8A - q'(0l E -mail: - Storm sewer (no: lin. ft.) -
CCB no.: �/ / Water service (no. lin. ft.) . t`013 /p C6-", ■ 'o11 Plumb. bus. reg. no: vn /1 v Fixture or item: F ixt - -
. City/metro lic. no.: 603a /
Contractor's representative signature: Absorption valve
�-«-� .. G • Back flow.preventer / .27-5 29. SS
Print name: ewe") ,_• • ti■ , - Date:'] - -01 Backwater valve
CONTACT PERSON - Basins/lavatory '
Name: l C /. 1 f f- —J) _ Clothes washer .
Dishwasher •
Address:
9 S'45 ) /4"S -knwt:Rm. Drinking fountain(s) -
City: (A kyyjoi lier I State:UK ZIP: 97070 Ejectors/sump .
Phone: ,:a - , 96 ' Fax: 6K2-9g7 , E -mail: Expansion tank - '
OWNER Fixture/sewer cap . •
• Name (print):,00 h'iDr; S,sef -e- Floor drains /floor sinks/hub
address: 3() ..LL e..w oocL S — Garbage disposal
Mailing �a ' Hose bibb
City: [((.fie, Q U I State:OR...1 ZIP9703 4' Ice maker
Phone: iax: 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 .
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ oZ s
1 p � N otice: This permit application (8% Plan review (at _ %) $
ci Visa 0 MasterCard expires if a permit is not obtained surcharge
Credit card number: / / within 180 days after it has been State eview (8%) "" $ Q. 90 3r(. /5'
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (600/COM)
•
• PLUMBING PERMIT FEES: "
.� :mot, • . :,I •:; •. - :•: i ,� ~ > L? S ,too and 2,faitill owellirignl ;Qt'.a- {; ' ': , y" ( ,
_: �; �� .N� � •` _ P, ICE � :, �, � �. w" `��� i t_' eC: e i ` y , �.� •:::� ; t, : . ,. F ^r. .3, r •,8'3..act eo " y_.i, -*.E e
�r '�:<s 4,:.._ , ' � u,xs.ir�> �., 4. �. : ' r R *s�-� y �' ;: 7V - . OTAI: .
fixTURE$ (lndividualp ,.:tt4`'5 :ai•a x;.f1TY:m ,.�m(ea : ;.A ,,(includes_ all.Ranbirirfiixt resin -=; .., , ,�; . IC „ ;
a nd Wirt irst100 tt '.: ¢ ;iQTYr : (ea) 4 AA O
Sink 16.60 ;the dwelling ;
Joi, each: utility .connection }'.�:'c:_i'. " >:.'' • -� `•sri,' =Y. � ?� =:4'-2.
Lavatory 16.60 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 A'-•;T -; =.;
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL .
' TOTAL
Garbage Disposal • 16.60 .
Laundry Tray 16.60
Washing Machine 16.60 • ,
Flaor Drair,/FloorSink 2" 16.60 P LEASE COMPLETE: :
3" • 1660 COMPLETE:
•
4^ - 16.60 4..
. . ::r; - r.Y:. ai 1 1, i ' _� y ; , .:,1 QLiaritity.by.Work .Perforrifed ? =A: .
Water Heater 0 conversion 0 like kind 16.60 F ixtue . T . . ' e ' =7 r ew ; "od °� ' °Replaced •) �Renio
Gas piping requires a separate mechanical • yp•r •.4 ,� �? ve =' t . °'ti"" 'r ;1 � ved/
= =
:rYF• r*� x NM :r ... PP • permit. ..:'= - tie.: .x. , ,.r r .� >b-.. 7s i >> C a ed
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 • s
. • • • 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 -
Residential Backflow Prevention Device' / 27.55 � '7 5 5
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 : 'f" `' `"' 5 ''" <•• ' ` `-
Isometric or riser diagram is required if - . 1., 5 S p� / - :.7
• Quantity Total is > 9 ` '
*SUBTOTAL ' ',"".'.c '4 ' •` Y
8% STATE SURCHARGE � 90 Is
'PLAN REVIEW 25% OF SUBTOTAL :. :. ' "'= -
' Required only If fixture qty. total is > 9
• TOTAL : :. ; .: � .- $ 39 /5 •
* Minimum permit fee is $7 % state surcharge, except Residential Backflow
Prevention Device, whit % state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:1dstslforms\pim- fees.doc 10/10/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
9' BUP
Date Requested l 'l / AM PM BLD
Location 1 ZZ 1 Cpl -,,. .Q 2 4 '„uite MEC
Contact Person �Q���„� Ph &goZ d PLM (9 y
Contractor Ph K's-- / 7 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain 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
T FAIL
PLUMBING
Under Slab
Top Out
Water Service 6 `
Sanitary Sewer
Rain Drains
_.;y PART FAIL
NICAL
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
BackfilUGrading
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
Other Date T//4-//& / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.