Permit C ITY OF TIGARD PLUMBING PERMIT
44 `441 A ` DEVELOPMENT SERVICES PERMIT #: PLM2001 -00125
'� DATE ISSUED: 3/29/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12162 SW SCHOLLS FERRY RD PARCEL: 1 S134BC -00200
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Condensate Pump
FEES
Owner:
Type By Date Amount Receipt
SAUNDERS, WILLIAM W TRUSTEE PRMT CTR 3/29/01 $72.50 27200100000
2155 KALAKAUA AVE STE 500 5PCT CTR 3/29/01 $5.80 27200100000
HONOLULU, HI 96815
• Total $78.30
Phone 1:
Contractor:
MYERS + SONS PLUMBING
6024 SW JEAN RD, BLDG F
LAKE OSWEGO, OR 97035 REQUIRED INSPECTIONS
Phone 1: 684 -6602 Final Inspection
Reg #: LIC 00040389
PLM 26 -305PB
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: �/ 1 Permittee Signature: � .1 , ��U
Call 3) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
`
A Date received: 3 — / b( Permit no.: l
City of Ti and
° ` �L `J g 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: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
'II PE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCI1EDULE (for special information use checklist)
Job address: /Z /4/ 2. SW SCNO //S F&E V RO Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: ' New 1- and 2- family dwellings only:
Tax map/tax lot/account no.: (SFR ( 1)1b00dtft.foreachaWityrnnnecdon)
Lot: 'Block: I Subdivision: SFR (2) bath .
Project name: l CJ!/% 0 SO> T7(NS SFR (3) bath
City/county: -r, 6 AzJ 14/40,11 ZIP: Each additional bath/kitchen
Descriptiorl and 1pcation of work premises: //VSTA /1 e0A/CeSaTC Siteutilitles:
.1)24//t/ f DUND fR walk IN (xJLe, _ Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footingdrain(no.lin. ft.)
/ Manufactured home utilities
Business name: ge es DNS Pluivig✓i(/e7 Manholes
Address: (p0 24 S /•t) ,764A/ eal /3k4 /_ /70 Rain drain connector
City: LQKL 05 O I State:CP I ZIP: q703- Sanitary sewer (no. lin. ft.)
Phone: d,8* -6Go2 I Fax: ( 6Z( I E Storm sewer (no. lin. ft.)
CCB no.: 44456 9 I Plumb. bus. reg. no: 0 26 -305-P8 Water service (no. lin. ft.)
City/metro lic. no.: ,S/38 Fixture or item:
/ / - Absorption valve
Contractor's representative signature: // Ode Back flow preventer
Print name: j %/�M MTZt� Date: 3 e- 0 Backwater valve •
CONTACT PERSON Basins/lavatory
Name: _q.em-/ - AS A BQy Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I 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: I ZIP: Ice maker
Phone: 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
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other: (IDNO€NSA7 PUtifA
Phone: I Fax: 1E-mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $
❑ 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 %) .... $
Ex TOTAL $
Name of cardholder as shown on credit cars accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00/(.'OM)
10 3SI
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 flrst100 ft. QTY (ea) 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 PLEASE COMPLETE:
3" 16.60
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/Stomt 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
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
(Speci ) �/
Storm & Rain Drain - 1st 100' 55.00 ( , { l yl , �1um+) 1
S & 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 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
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $ .
* Minimum permit tee is $72.50 + 8% state surcharge. except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is fists \forms\plm- fees.doc 10/10/00
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
• -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
y 32 BUP y
' / Date Requested -3 v AM PM BLD rI '
(
Location / / C Z- GI./ £,
G Gl(S c Ay Suite MEC
Contact Person / Ph 57)3 -- 6,c/ (G6 Z PLM 2 U / 2J
Contractor SWR
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BUILDING Tenant/0 er 1 Id ,.5 1.47/ C CA., CA /D AA EL
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
Drywall on
Pr) Drywall Nailing c
Firewall
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling
Roof -
Misc: . �
Final cThe - (_
^..�jf
` L
PASS PART FAIL
UMBING
ost & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
R ' Drains
AS PART FAIL
M 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 7?))/IN
Approach /Sidewalk .x / 0 Inspector Ext
/ nspecor x
Date / (((
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.