Permit r
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2002 -00223
=► ! DATE ISSUED: 6/17/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD PARCEL: 1S133AD-02200
• SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: E2 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing fixtures for classroom. Adding 1 lay and 1 toilet. Moving 1 lay. and 1 toilet. Capping 1 clothes
washer. Moving 1 water heater and 1 drinking fountain (other).
FEES
Owner:
Type By Date Amount Receipt
WESTGATE BAPTIST CHURCH PRMT CTR 6/17/02 $116.20 27200200000
12930 SW SCHOLLS FERRY RD 5PCT CTR 6/17/02 $9.30 27200200000
TIGARD, OR R 9722 97223
Total $125.50
Phone 1:
Contractor:
KEVIN SHARPE PLUMBING
3851 SW CULLEN BLVD
PORTLAND, OR 97221 REQUIRED INSPECTIONS
Rough -in Insp
Phone 1:
R Underfloor /Underslab
Reg #: LIC 00112898
Top -out Insp
PLM 26 -593PB
Drinking Fountain •
Insp existing /capped fixtures
Final Inspection
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: 62,,,,e(-0.44,-. e Permittee Signature: , d
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
SLUR boa - aoa-ab
Plumbing Permit Application
Datereceived:6 ,7_O Perm itno.:� � -G(Jo�3
�.n City of Tigard
- ,`•. �! S ewer permi no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 7223
City of Tigard Phone: (503) 639 -4171 (n Project/appl. no.: Expire date:
Fax: (503) 598- 1960r , n�� 61, 11"/ Date issued B)� ,QJ I Receiptno.:
Land use approval: V Case fil no.: Payment type:
TYPE OF PERMIT
U 1 & 2 family dwelling or accessory Commerci. • • :n trial U Multi family U Tenant improvement
U New construction ❑ Additio• alteratio• replacement U Food service U Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: 10/({ 3 5(,J �rtoU,S rCoaz ,/ Rh.. Description Qty. Fee(ea.) Total
Bldg. no.: C Suite no.: New 1- and 2- family dwellings only:
S 133 4 D SFR (1) bath
0 Z lob (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: 1
l /
Lot: - 'Block: Subdivision: SFR (2) bath
Project name: G RoiLUI' (_ febtA r cn..) SFR (3) bath
City /county: -I' frie N kltyt . ZIP: 27� � 3 Each additional bath/kitchen
—
Description and location of work on premises: INJCP SI CT: 1 Site utilities:
pipOtrtonl aF a GLftSSizOdPns (77 (, (3U1Ltd O Catchbasin/areadrain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: . E,/Zh/ r RPE PL Olvfl3Z'f'6 Manholes
Address: 3g57 .5 / j CULCEn/ 1 z.0) Rain drain connector
City: IOQT G 4 t D I State:6 .. I ZIP: X1 �2 Sanitary sewer (no. lin. ft.)
Phone: 5 0 3 - 293 - (3/9j Fax: /3'/9 I E -mail: - Storm sewer (no. lin. ft.)
CCB no.: //L3 f I Plumb. bus. reg. no: 20413 Water service (no. lin. ft.)
City /metro lic. no.: y- i i -03 =_ - 2,1 —453 Fixture or item:
Contractor's representative signature: /'i — Absorption valve
Back flow preventer
/ Print name: fZEV274/ Sff ' ' PE II ate: 76 Joke -cr 2- Backwater valve •
CONTACT PERSON Basins/lavatory
Name: Clothes washer /
Dishwasher
Address: Drinking fountain(s) /•
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): � S r C ,�� 1 ft cHC Floor drains floor sinks/hub
Mailing address: ,/Cr nl� SGNnu5 1✓ Garbage disposal
� 1/ 3] Hose bibb
City: 'f G.iE4h, I State:QR I ZIP: 723 Ice maker
Phone: K03 52q 35001 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: 2—
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 $
Notice: This permit application Plan review (at _ %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) $ I /Ilr -
Expires within 180 days after it has been �
Name of cardholder as shown on credit card accepted as complete. TOTAL $ .s
$ /l
Cardholder signature Amount q • ' 3 0 440 -4616 (6100 /COM)
1 /x5.50 e (MM w
PLUMBING PERMIT FEES: 00. -'`
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)
• 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" 16.60 PLEASE C OMPLETE:
' - 4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas - pip ni g 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 I I -
�se Bibs
Tub or Tub /Shower
f r 16.60 Combination
Drains 16.60 Shower Only -
inking Fountain 16.60 Water Closet • 1 1.
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
• Washing Machine .Yirt 1
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 1-
Water Service - each additional 200' 46.40 ' Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00 111X11y(11.1c Fal1A7i Al
Storm & 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 62.50
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 $
A
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review. .
is \dsts \forms\plm - fees.doc 12/26/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
c�
Received Date Requested / // d AM PM BUP
Location / 9,3Q Adt-,- , t,? / Suite MEC ; '00 3-
Contact Person .44-4.%_.) Ph ( ) D 7" 44_ 7 PLM e2 — 06 c=
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
g Access: q �`
i - ap7 47, --c -7( ELR
Ft Drain /v eS l Crawl Drain
Slab Inspection No s: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing � % - ��
Firewall �� _� � - % , 4� • r,, /��
Fire Sprinkler
Fire Alarm 1 r. Susp'd Ceiling ' I A i�
Roof
Other:
Final
PASS PART FAIL
PLUMBING � _
Post & Beam 7a1111111ff— l
Under Slab
Rough -In r „, i
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot
in
PA RT FAIL
HANIC
Post & Beam
Rough -In
Gas Line
Smoke Dampers
in
4 or PART FAIL
TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date C o 6 Inspector /v Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
{ • a