Permit 'CITY OF TIGARD PLUMBING PERMIT
Pit DEVELOPMENT SERVICES PERMIT #: PLM2001 -00392
- r- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/17/01
SITE ADDRESS: 08048 SW SHAFFER LN NEW DURHAM PARCEL: 2S11360 -00300
SUBDIVISION: &ORQMAtl ELEMENTARY SCHOOL ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: El FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of (2) bury hydrants and (1) commercial backflow preventer.
FEES
Owner:
Type By Date Amount Receipt
SCHOOL DISTRICT NO 23J PRMT CTR 8/17/01 $79.60 27200100000
13137 SW PACIFIC HWY 5PCT CTR 8/17/01 $6.36 27200100000
TIGARD, OR 97123
Total $85.96
Phone 1:
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Misc. Inspection
Phone 1: 691 -6166
Reg #: 6 91 87906 RP /Backflow Preventer
g Final Inspection
PLM 34 -250PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You m o tarn a•ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issu d By :; k • .A:_%+ • Permittee Signature: _,0111110
Call (503 . • 75 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application I ' • ..
D'rr City of Tigard
Date received: g /'/ p/ Permit no.: '' CItjaoo / -e03yA
.F$s " -- Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd. Tigard, OR 97223
City ofTrgard Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
Fax: (503) 598 - 1960 Date issued: By: Receipt no.:
• Land use approval: case file no.: Payment type:
TYPE OF PERMIT �; ;
O 1 8t 2 family dwelling or accessory s: Commercial/industrial 0 Multi- family ❑ Tenant improvement
O New construction CeAddition /altcration/replacement 0 Food service 0 Other;
JOB SITE INFORMATION - • FEE SCIIEDULE (for special inftirn�atitinuse checklis t,' 1
Job address: !;o0 _1 5 u.) 5) ka.t L ,e Description Qty. Iree(ea.) Total
New
Bldg. no,: Suit o.: 1- and 2-family dwellings only:
Tax map /tax lot/account no.: (includes 100 ft. for eachutility connection)
SFR (1) bath
Lot: Block: Subdivision: SFR (2) bath
Project name: / u r i., 1C.vM , L t, \ SFR (3) bath
City /county :" A , A , a ZIP: ei, , , �' Each additional bath/kitchen
Description and 1. ation of work pPn premises: Slte utilities: .
f\.Qu) ^� t, �n 0,..en AEG Catch basin/area drain
Est. date of completion/inspection: q - I - 0 ( i Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: T w■H4 (..-y Manholes
Address: 1 \%ea S� S
t 1. • \ , _ !fain drain connector
City: ~ Z. a ZIP; -- I T (6 Sanitary sewer (no. lin. ft.)
Phone: t a . _ (,) at, b Fax :4a k.1 E -mail: Storm sewer (no. lin. ft.)
CCB no.: - i ei 0 (o Plumb. bus. reg. no: DSO Water service (no. tin. ft.)
7
City /metro lie. no.: Lt ; Fixture or item:
Contractor's representative signatu _ AlArTj MFM, Absorption valve
• '' ' 4 �� Back flow preventer
Print name: "' ∎'RUI;.ti4 I (Date: S - •D Backwater valve ,_-
CONTACT PERSON Basins/lavatory •
Name: Clothes washer
Address: — Dishwasher -.
Drinking fountain(s) .
City: [State: I ZIP: Ejectors/sump ( )
Phone: Fax: E -mail: Expansion tank
OWNER • Fixture/sewer cap
Name (print): , Floor drains/floor sinks /hub
' Mailing address: Garbage disposal
Hose bibb
City: • f State: [ ZIP: • Ice maker
Phone: [Fax: [ 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 .
Address: Water closet
Water heater
City: State: ZIP: Other• hNIa,Y -tt,u s
Phone: —1 Fax: E- mail: Total 3 7gk
Noi all jorisdictioya accept credit cads. pose call Jurisdiction for mare inraamadon. Notice: This permit application Minimum fee $ '79•
ID Visa astcrCard Plan review
sit f� and number. Ut T11 S143q 15D y pip y e xpires if a perm is not obtained
, � ,3 8 - 3 within 180 da s after it has been • State surcharge (8%) $ 63
i t/ k,2 vc 1-I a $ )C I t:icpircs y
TOTAL
Name of earshot • as shown •, credit car• accepted as complete. $ Q
• . older aignt+iute I. Amount 44a46I6 (6d00/QOM)
$$
Z0 39dd 9NIglll1d Neel:IOW TLL9t69E05 917:17T t00Z /bT /80
•
b ,
•
pi FASF COMPLETE:
:FIXTURES • (indivIclual):. :.-::. • • : :Total
Fixture Type Ouantity by Work Performed
Sink 16.60 .
•
Nbw Moved Replaced RernovadiCeopeci
..
Lavatory 16.60 Sink
_
Lavatory
Tub or Tub/Shower Comb. ' 16.60 TO or Tub/Shower Combination ----- -------
____ ....._._ _
Shower Only 16.60 Shower Only -. _ ___ _ __ - __. _..____ _ _ ___.. Closet Water Closet 16.60 Water Clo _ ---- ••••- - - • •- --- •-- ---•--.
Urinal_ ___ .._... ._.. ___... - -.. _
Urinal 16.60 Dishwasher
.- .._.. .__ - ...... ..._ ...._
• Garba!e Dis•osai
Dishwasher 16.60 ___.. __-____ __._._.-
• - Loynd Room Tray
Garbage Disposal 16.60 Washin• Machine
- _
Laundry Tray 16.60 Floor Drain/Floor Sink 2 -
•
Washing Machine 16.60
" - -- - ----- --- ------.
' .
Floor Drain/Floor Sink 2" 16,60 Water Heater
-.---- -
Olher Fix1ures Specif) -
3' 16.60 - - - --- - -
MYR?. Allr711.. 4. . •
4" 16.60
,..-r- -- - - -- ---
• .
..A.A7M■M . - ..._i -
Water Heater 0 conversion o like kind 16.60 • .. - - --
Gas piping requires a separate mechanical permit. . . •___ _______
MFG Home New Water Service ' 46,40
.
MFG Home New San/Storm Sewer 46.40
- . • COMMENTS REGARDING ABOVE: .
Hose Bibs 1%1%1 A rtgirctS _ - 2_ 16.60
Roof Drains 16.60
Drinking Fountain 16.60 - ,
. •
Other Fixtures (Specify) • 21.75
•- __,.
Sewer - 1st 100' . 55.00 -
Sewer - each additional 100' ' 46.40
Water Service - 1st 100' • • 55,00
Water Service - each additional 200' 46.40
•
Storm & Rain Drain - 1st 100' 55.00. '-
Storm & Rain Drain - each additional 100' 46.40
• 1
Commercial Back Flow Prevention Device . I 46.40 tit ito
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
••
Insp. of Existing Plumbing or Specially Requested ' 72.50
Inspections per/hr
Rain Drain. single family dwelling 65.25
Grease Traps 16,60
QUANTITY TOTAL - • 4,.., . .
--1 • • - -
Isometric or riser diagram Is required If Quantity Total is b. 9 ......! e : ,,■:,,,... . .,,
*SUBTOTAL •XtA.A -
110.4%.•:.:iA 4. c77-t-,-,4. •
1.. , • • zi
8% SURCH ai,A
ARGE f;: Nfi: k3
ogs144 .. , •
- PLAN REVIEW 25% OF SUBTOTAL
• Required only if Rehire qty. total is > 9 .41Zi;i:ap • ..,& i 1, .
TOTAL •W,,!::":i.74 " /051
. Veil - ''' 0; - ‘ - :' , P.: j
'Minimum permit fee is 372.50 *8% surcharge, except Residential Backnow Prevention
Device. which Is 536.25+0% surcharge. • •
- New Commercial Buildings (squire plans with Isometric or riser diagram and plan review.
. ' . .
. .
•
60 39Vd 9NISVI11d N631:10W ILL916960S 90:0T t�/VT/8
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
� BUP
Date Requested g-".?„-] AM PM BLD
Location We) 4 -/ 3 o^ , Suite MEC
Contact Person / Ph / -6 (1,C PLM 207) / 663?
Contractor Ph SWR
BUILDING Tenant/Owner ,� �/ �� ,��, ELC
Retaining Wall 4+�1` � ELR
Footing Access: ,,,.r �� '1��
Foundation � t FPS
Ftg Drain W"d a cot.
Crawl Drain Inspection Notes: SGN
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 r
Top Out F
Water Service
Sanitary Sewer r
Rain Drains
� • - PART FAIL
�� !1 1 7 - ANICAL
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 PI Oth /Sidewalk D .27 16 / Inspecto � r ' 1 C.� �q V61 E x t
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.