Permit A- CITY OF TIGARD PLUMBING PERMIT
44 VIA DEVELOPMENT SERVICES PERMIT #: PLM2000 -00407
..� � ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/1/00
SITE ADDRESS: 12174 SW QUAIL CREEK LN PARCEL: 2S103CB -10600
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 064 JURISDICTION: TIG
CLASS OF WORK: OTR 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 residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 11/1/00 $36.25 27200000000
4230 GALEWOOD STREET 5PCT CTR 11/1/00 $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 Final Inspection
PLM 11558
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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 ma .. -'n copies of these rules or direct questions to OUNC by ca,; (503) 246 -1987.
Issue. By: '� _ ' / �� / Permittee Signature: , � A A L .0(%
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Date received: g... /- pc.) Permit no.: L/-J -� 7
A�fi t ,, i City of Tigard
� b Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl.no.. Ex ire date:
Fax: (503) 598 -1960 Date issued: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
1S1,1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi - family O Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
a CP - e - L0�
Job address: / at 7 � � L�i-n � (o y Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
Tax map /tax lot/account no.: Co SS /3 $ (includes 10011. for each utility connection)
SFR (1) bath
Lot: (Block: I Subdivision AltD/1OZ0 SFR (2) bath
Project name:CALA_Ct _L. /4-0 ((OZ,t &,,D.._., SFR (3) bath
City /county: etAf /w I ZIP: 9 '7 4,0 Each additional bath/kitchen
Description an ocatio premises: work on remises: Site utilities:
e picirifkno d) /C& Catch basin/area drain
Est. date of completion/inspection: OUQ1/ f()`/-71 Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: Pm („ S L d$CC -p e- Manholes
Address:ag g qs Cu./ kJ, )g_nna+L. /ao Rain drain connector
City: LC) j Urn u i /JL I Stater .., I ZIP: 97o70 Sanitary sewer (no. lin. ft.)
Phone: a_4,a94, (w)I Fax:t >74 E -mail: Storm sewer (no. lin. ft.)
CCB no.: (D (3. (p I Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lic. no.: 003/ Fixture or item:
Absorption valve
Contractor's representative signature 1.2.0. ] _ Pt..6 p / a'7. .7. 5
Back flow preventer
Print name:a I • S at'I-6 W Date: ID 31 00 Backwater valve
CONTACT PERSON Basins/lavatory
Name: C I r)-t,v Clothes washe
Addressaq Q 9 5 a 16 rcr YLJ\- (-D
Dishwasher
City :t) t 1 bY1 u I l VP� I State Ol( I ZIP:97076 Ejectors/sump
ump tain(s)
Ejectors/sump
Phone: b Ea- ( .1t1 Faxioga- 9 e E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): • can I Y)0Y/ SS ei-k I- /cal -r e,S. Garbage disposal
Mailing address:L30 at.) (,Ct /e.wDOL Lane., Hose bibb
City: Lceicc. 0 c 1U I StateOiZ I ZIP: 97035 Ice maker
Phone: r7 90 - loy.S(a 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
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 3� . S
Notice: This permit application Plan review (at _ %) $
I7 Visa D MasterCard expires if a permit is not obtained
Credit card number / / within 180 days after it has been State surcharge (8%) .... $ a , 90
Expires TOTAL $ 39. / 5
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6100/COM)
PLUMBING PERMIT FEES:
- r'
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 16.60
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
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00 RACtficrOdanie I
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' i 27.55 0...7, ss
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 / aPz 55 22 s
Quantity Total is > 9
*SUBTOTAL 34) *a5-
8% STATE SURCHARGE . q®
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL /S ' $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which i 962t + 8% state surcharge. '
** Ail New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
is \dsts \forms \plm- fees.doc 10/10/00
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•.CITY'OF TIGARD BUILDING INSPECTION DIVISION Mss
•
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
p BUP
Date Requested /� -- D AM PM BLD
Location b2,/ ' Y 5 ‘-z/ Qu 4 (7 a Suite MEC
Contact Person Ph 267 2I'3 f PLM . -GO 407
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
Post & Beam
Under Slab
Top Out
Water Service 01.0'
Sanitary Sewer
Rain Drains
Fi
'• PART FAIL
` HANICAL
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA Approach /Sidewalk Date N L (jb Ins 010 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.