Permit CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT #: PLM2001 -00438
1 II DATE ISSUED: 9/13(01
13125 SW Hall Blvd., Tigard, OR 97223 (5 639 -4171
SITE ADDRESS: 12698 SW SORREL DOCK CT PARCEL: 1S133AD -14700
SUBDIVISION: SUMMER LAKE ZONING: R -7
BLOCK: LOT: 028 JURISDICTION: TIG
CLASS OF WORK: ALT 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 back flow preventer device.
FEES
Owner:
Type By Date Amount Receipt
HERSHEY, WILLIAM T + CAROL J PRMT CTR 9/13/01 ° $36.25 27200100000
12698 SW SORRELL DOCK CT SPOT CTR 9/13/01 $2.90 27200100000
, TIGARD, OR 97223
Total $39.15
Phone 1:
Contractor:
TRYON CREEK LANDSCAPE INC
11400 SW NORTH DAKOTA ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone 1: 624 -2174 RP /Backflow Preventer
Reg #: LIC 11525 Final Inspection
PLM 6296
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 B j I / Permittee Signature:
0 � " " -
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t e " t business day
Plumbing Permit A l l lication ,
4 I 1 City Date received:R / z, Permit no _G _,� I
' ty of Ti and `J g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, 1 • i ' 97223
City of Tigard 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 •
P . 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi - family 0 Tenant improvement
• New construction 0 Addition /alteration/replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special inforn ation use checklist)
Description Qty. Fee(ea.) Total
Job address: rZ6q Q 5t,) -�RRz OacK New l- and 2- family dwellings only:
Bldg. no.: I Suite no.:
Tax map /tax lot/account no.: (includes 100 ft. for each utiltyconnection)
SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: - I --Cokb I ZIP: oriZZ3 Each additional bath/kitchen
Description and location of work on premises: Site utilities:
-cout
T 6470 Yf ✓aqr - 5Pr IA tt: tD✓ Sy S 4e40✓v Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
-
Manufactured home utilities
Business name: - 17'lev\ C p 1,1 s ft + INC. Manholes
Address: 114 /7r7 SO 1`LrTt -I -b i<, SP- Rain drain connector
City: *j- -1(.UR/A I State: oR I ZIP: clyZ?3 Sanitary sewer (no. lin. ft.)
Phone: 6Z 4-Zls, 4 I Fax: I E -mail: Storm sewer (no. lin. ft.)
reg. Water service (no. lin. ft.)
CCB no.: t15Z 5— I Plumb. bus. g' no: Fixture or item: -
City /metro lic. no.:
Contractors representative signature: A Absorption valve
Back flow preventer i
Print name: v`!A[ u • Date: ci Ib 0 Backwater valve
CONTACT PERSON Basins/lavatory
Name: J�7Z,LGy t,, °V Clothes washer
l Dishwasher
Address: Drinking fountain(s)
City:I State: I ZIP: Ejectors/sump
Phone: Fax ' ' - E -mail: Expansion tank
OWNER Fixture/sewer cap
4414'4(4 Floor drains/floor sinks/hub
Name (print): 761 ti Atha , 1171, Garbage disposal
Mailing address: 127,9v 3 ryd iOpic Hose bibb
City: '7 I State ZIP: q 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: -
Phone: I Fax: I E -mail: Total /
Not all jurisdictions accept credit cards, please call jurisdiction for more information.
Minimum fee $ �P
Notice: This permit application Plan review (at _ %) $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $ 0'7.
Expires / within 180 days after it has been
TOTAL $ 5
Name of cardholder as shown on credit card
accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00/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)
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 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
Other Fixtures (Specify) 16.60 Urinal
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
(Specify)
Storm & Rain Drain - 1st 100' 55.00
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 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, whi 8% state surcharge.
** All New Commercla uire 2 sets of plans with Isometric or riser
diagram for plan review.
i:\dstslformslplm- fees.doc 08/29/01
CITY OF TIGARD BUILDING INSPECTION DIVISION
ST ,_
24 -Hour Inspection Line: 639 -4175 Business Line: 639-41
BUP
Q
Date / ' I -5 ----d AM PM BLD y /3
• Location 7i j 9 �j !� G U 4} MEC - r d / — °P
Contact Person Ph 4grio
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab A.7. SIT
Post & Beam C
Ext Sheath /Shear ' '& �� ^ -+ ,
Int Sheath /Shear
Framing
Insulation I
Drywall Nailing l - �� 0� `c / Q
Firewall
Fire Sprinkler ?�
Fire Alarm
Susp'd Ceiling
Roof
Misc: � S C LJJ c./
Final
P T FAIL
PLUMB!
Post & Beam
Under Slab ��� /i;- �1� 1 C./ —
Top Out ` � C �
Water Service �/� /� � 2-�iV
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL (1-\1 �� /'� ,\
Post & Beam v " `
Rough In `4p 4
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 1 -
Approach /Sidewalk G (3) l Inspector C-' `-� Ext 3 r Cf
Other Date
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVI'SIOM' Business Line: (503) 639 -4171 MST
BUP
Received Dat- Requested I ' d AM PM BUP
Location C • 1 ..44, Suite MEC
Contact Person Ph ( ) PLM . 20° 1 6 �3 8
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Accessc
Ftg Drain � , ELR
Crawl Drain / K ptrvr
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler //
Fire Alarm � i
Susp'd Ceiling G
Roof
Other:
Final
PASS PART FAIL
e'
��'' Beam -�
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P 9 , %
Other:
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 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please cal for rei spection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL