Loading...
Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2000 -00404 x ,1,1 1 DATE ISSUED: 11/1/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12192 SW QUAIL CREEK LN PARCEL: 2S103CB -10400 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5 BLOCK: LOT: 062 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 for irrigation system. 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 $39.15 Phone 1: 274 -5223 Contractor: PROGRASS LANDSCAPE SERVICES 29895 SW KINSMAN RD WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone 1: 682 -6076 RP /Backflow Preventer Reg #: LIC 6136 Final Inspection PLM 11558 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. Yo ay obtain c•pies of these rules or direct questions to OUNC by calling (503) 246 -1987. Is ed By: ,( � 1 Permittee Signature: � 2.4 Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi ess day Plumbing Permit Application qq Date received: /B .$ -# Permit no.:/ h , P000 - ao Vogl a,w� ,> ''s City of Tigard AP- `J t� Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement tit New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCI1 EDULE (for special inforn ation use checklist) lob address: /dIq aLLCf._LL Crr crt (_e.tri e, Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (40 !3 (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: 'Block: I Subdivision: ( l- tea-G. /-/ / /(Zc) SFR (2) bath Project name: ( 0z, /-/p / /Uw & .2- SFR (3) bath City /county: 77 yandl LUA.H I ZIP: 9 7 ,2, U/ Each additional bath/kitchen Description and location of work on premises: 6 A- .1C.i7tfa) Site utilities: At-vie e, Catch basin/area drain Est. date of completion/inspection: m 3-1'6 Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: P(2 f 'S, L/ ,lSC IIIC' Manholes Address: aq c s , -9 S Sly ,t L',7 fl1ez.it. RD Rain drain connector City: /D,). 1 7) V / / /e, I State: 6RIZIP: 97076 Sanitary sewer (no. lin. ft.) Phone- -(j7(, e/l/Fax:6g - 9 ,f7A,E -mail: Storm sewer (no. lin. ft.) CCB no.: 6/36, I Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: 003 a/ Fixture or item: Contractor's representative signature: ( ,#-.) ', a M �rc,t Absorption valve Back flow preventer i .'7. SS a7, Print name: ,� ' . s / - yr1Zv 0 ate: I - ' Backwater valve CONTACT PERSON Basins/lavatory Name: - g — /-/ Gam) vc Clothes washer Dishwasher Addressa'/ >q s jc 1J) Q/( Drinking fountain(s) City:CU/ / gnl a / / 6 I State: t IP: y 7 Ejectors/sump Phone:6Q- 607(0 • ii Fax: toe, -9876, E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): A MoYLSK �-r , z3rr+ t s Mailin g addres LJ Floor drains/floor sinks/hub � • / S i) ( / Garbage disposal D /06 Hose bibb City: ..LIZ& (� n I State:C 703y Ice maker Phone: 1 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 $ oZs Notice: This permit application Plan rev (at _ %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / State surchar (8 %) .... $ a . 9 ( Expires w ithi n 180 days after it has been 39. /5 Name of cardholder as shown on credit card accepted as complete. TOTAL $ 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 (ea) AMOUNT Lavatory 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 P ) Storm & Rain Drain - each additional 100' 46.40 e,c ., Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device" ! TSt (P7, 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 8% STATE SURCHARGE a ` 9C *PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL 39.6- $ Minimum permit fee is $72.50 + §o state su rrha pt Residential Backflow Prevention Device, which l36.25 5+8% Jans 7 state surcharge. * All New Commercial Buildings require pl1th'Isometnc or riser diagram and ' plan review. is \dsts \forms\plm- fees.doc 10/10/00 • CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP • Date Requested //" ' / AM PM BLD Location / Z " f .5 4://t 41 r ���C.�C Suite MEC Contact Person Ph 2v,--4 t 3 y PLM 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 PLUMBIN Under Slab Top Out '/( . Water Service � �f�f / �(,/�j Sanitary Sewer Rain Drains F PART FAIL CHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final FAIL E ICAL S *vice Rough I UG/ iier .1. ace Fi a PAS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ j 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 U 4% 61 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 Line: 639 - 4171 BUP Date Requested //++�1 /- Z4 AM PM BLD Location (Z /9 Z. 5w C�OGc t i i Guct Suite MEC Contact Person 12r' G) 53 Ph .Sb 3 G J Z A0'74 PLM vvr - V U Y Contractor Ph ex 2 / 7 SWR BUILDING Tenant/Owner ELC Retaining Wall ELR e°v'6b-v 2 � 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 �— �� V PASS PART FAIL Post & Beam Under Slab Top Out b f • Water Service Sanitary Sewer Rain Drains F'n - PART FAIL ANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL LECTRI ervice Rough In UG /Slab Q VnMage> Fire Alarm Fi PART 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: [ ] Unable to inspect - no access ADA Other oach /Sidewalk Date // Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.