Permit - 4 CITY OF TIGARD
PLUMBING PERMIT
�;* DEVELOPMENT SERVICES PERMIT #: PLM2000 -00414
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 12436 SW QUAIL CREEK LN PARCEL: 2S103CB -09100
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 049 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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 preventor
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 11/7/00 $36.25 27200000000
4230 GALEWOOD STREET 5PCT CTR 11/7/00 $2.90 27200000000
SUITE 100
LAKE OSWEGO, OR 97035 Total $39.15
Phone 1: 274 -5223
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 6136
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: � aL. Permittee Signature:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
REGENED Datereceived: Permit no.A424 i
.a.:+► . 1 1 ;, City f Tigard t
i g Sewer permit no.: Building permit no.:
- -" Address: 13125 SW Hall Blvd, Tigari4 ` i 97Ft000
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: • Expire date:
Fax: (503) 598 4960 COMMUNITY DEVELOPMENT Date issued: (t`11(rb 1l , Receiptno.:
Land use approval: Case file no.: Payment type: .
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory O Commercial/industrial O Multi- family O Tenant improvement
O New construction O Addition/alteration /replacement O Food service O Other.
JOB SITE INFORMATION FEE SCHEDULE (for special infor ation use checklist)
Job address: /aL/3(, Sw �uL -t_ CSC ut/7v Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SS pS' SFR (1) bath
Lot: Liq IBlock: Subdivision:OLLe HD (l6U) SFR (2) bath
Project name:CQLQ, I l(W L/' 9 SFR (3) bath
City /county:? LtlGl. I v1lch l ZIP: 97,)-D.3 Each additional bath/kitchen
De npptio��n�an location o work on premises: Site utilities:
I�IC/C et..WiCP . Catch basin/area drain
Est. date of completion/inspection: -= De G 51-7-1 Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. tin. ft.)
Manufactured home utilities
Business name: Prc rags Landsat -e- Manholes
Address: ,;2989 s SW kcTnm6(-.t, Rain drain connector •
Sanitary sewer (no. lin. ft.)
City: (,V i ) S[JY)t)l /1 2 I StatelOf� I ZIP:g90`I d �Y
F ax: (o r,�- 9�7 -mail: Storm sewer (no. lin. ft.)
Phon {i, (o8a- ho7(cI - Water service (no. lin. ft.)
CCB no.: (p /34, I Plumb. bus. reg. no:
City/metro lic. no.: Co3_/ � Fixture or item:
Absorption valve
Contractor's representative signature: �(_ � it crcci Back flow preventer / a7 S s .7
Print name: E exl S' A-r • Date: /-CID__. Backwater valve
CONTACT PERSON Basins/lavatory _
Name: 5(j r� Sp are- r Clothes washe _
Dishwasher
Address: aglr Sup K(I) krn ail � Drinking fountain(s) •
City: (,13i (Baru) f lje. I State:O I ZIP:gip? Ejectors/sump
Phone: t - 607 . Fax:( - g ,, -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print):1)6Y1 ri p- SS e' �m e Floor drains /floor sinks/hub
Garbage disposal
Mailing address:‘-/a30 St.0 6ale.GUOoc T t-wi -e " /0 Hose bibb
CRY: L_C,c)C -L OS - () State:t7� ZIP:
y � I e 703 y Ice maker
Phone: I ax: 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
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
• Minimum fee $ 36 ,
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: within 180 days after it has been State surcharge (8 %) .... $ 37. • 70
Expires s
c AS
Name of cardholder as shown on credit card p accepted as complete. TOTAL $
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
for each utility connection)
16.60
Lavatory 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 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
Quantity by Work Performed
Water Heater 0 conversion 0 like kind 16.60 Fixture Type: New Moved Replaced Removed/
Gas piping requires a separate mechanical Capped
permit. Sink
MFG Home New Water Service 46.40
MFG Home New San/Storm Lavatory
Sewer Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
16.60 Water Closet
Drinking Fountain • Urinal
' Other Fixtures (Specify) 16.60 Dishwasher
• Garbage Disposal
Laundry RDom Tray
Washing Machine
• Floor Drain /Sink: 2"
Sewer- 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4 "
Water Heater
Water Service - 1st 100' 55.00 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 B el mo I
Commercial Back Flow Prevention Device 46.40
OVA) fCl
Residential Backflow Prevention Device* 27.55 ?. 5S
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 3(4,-QS
8% STATE SURCHARGE .2 ` yG
*`PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL . rS $
•
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which Is $38.25 + 8% state surcharge. • -
** Ali New Commercial Buildings require plans with Isometric or riser diagram and
plan review. .
is \dsts \forms\plm- fees.doc 10/10/00
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
i BUP
Date Requested / 2 - - 1 AM PM BLD
Location l 2 `r' 3 S w Qo 4 4 Suite MEC
Contact Person Ph PLM Zi — GU '(l Y
Contractor Ph 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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
d7 ASS /frt..,
ART FAIL
CAL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk D ate
Other / Inspector , Ext
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 ' • • 9-4171
BUP
Date Requested /2— /i PM BLD
Location l? L/3b ) at Zig Suite MEC 'l
Contact Person Ph PLM al POO — dO `"/ 7'
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR POrO* — o‘ 2 D.-- by
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGT
/1'I /Sy � Q?'t` 1 /z//z.._
Slab SIT
Post & Beam t
Ext Sheath /Shear IVv �� /e —24-,
N Vv �•
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler k: -r--r----‘0
Fire Alarm
Rop'd Ceiling C R000f
Misc:
Final
PASS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains h _4a
PA S>PART FAIL
HANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
G`TRICAI ?
Service
Rough In
UG /SI
. %w Volt. . -
Fire Alarm 2 ( 14
AS ART FAIL
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: I [ able to inspect - no access
ADA
Approach /Sidewalk A �
Other Date �� Ins Ext _
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.