Permit A B PERMIT #: PLM2000-00459
OF TIGARD PLUMBING PERMIT
m�,iln DEVELOPMENT SERVICES DATE ISSUED: 12/20/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11700 SW TIEDEMAN AVE PARCEL: 1S135CC -00500
SUBDIVISION: GREENBURG HEIGHTS ADDITION ZONING: R -4.5
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE SF 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:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Water Service From Meter To House
FEES
Owner:
Type By Date Amount Receipt
STOVER, LAWRENCE W + SHARON A PRMT CTR 12/20/00 $72.50 27200000000
13432 SW 136TH PL 5PCT CTR 12/20/00 $5.80 27200000000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
ROTO ROOTER SERVICE + PLUMBING
HOFFMAN SOUTHWEST CORP
4248 NE 148TH AVE REQUIRED INSPECTIONS
PORTLAND, OR 97230
Phone 1: 682 -9774 Water Line Insp
Reg #: LIC 00013989
PLM 37 -76PB
•
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: Permittee Signature: /
Call (5 3) 639 -4175 by 7:00 P.M. for an inspection needed the n: t business day
Plumbing Permit Application
Date received: /A aOt 4d Permit no."1?),A4r 0 0
..,, „,,, City of Tigard
..44-. , `� 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: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industri. ) 0 Multi- family 0 Tenant improvement
❑ New construction OilOddition/alteratio . eplacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: / 0 560 ' "411411 4 Descri , tion Qty. Fee(ea.) Total
Bldg. no.: Suite no.: N ew 1- and 2 -family dwellings only:
Tax map /tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City/county: j x4/.) _ ZIP: ( o ? a. 3 Each additional bath/kitchen
Des lion an location of k on rem' e:: Qe/4 Site utilities:
WW- ,1-eCi// GQ NOM • ei -4, he ( 1 se.. Catch basin/area drain
Est. date of completion/inspection: , ,, / D Drywells/leach line /trench drain
t Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: o i J ,.,/ � / Manholes
Address: /'5q ,r-n y 5 -Alr"e ' ' / B Rain drain connector •
City: �ja,/ State: #f] ZIP: 9P070 Sanitary sewer (no. lin. ft.)
Phone ] 32' -f Fax: ,685- 9Ymail: Storm sewer (no. lin. ft.)
CCB no.: /3931 I Plumb. bus. reg. no: 3 7- 76 65 Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: /I IM Absorption valve
/ Back flow preventer
Print name: 40'1 ' sl , J Date: 0 -aQZ Backwater valve
CONTACT PERSON Basins/lavatory
Name: . Ar L Clothes washer
�lziey S -
Address: Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone:„..;- —$g'2 •' Fax: E -mail: Expansion tank ,
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): f _e.l.{ /`' 1'._ 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
Name: Urinal
ame:
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. fee $
Notice: This permit application at _ %
0 Visa 0 MasterCard expires if a permit is not obtained Plan review ( %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
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 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/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
• 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 5 Water Heater
Other Fixtures
Water Service - each additional 200' 46.40 (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 -1 a ' S
Required only if fixture qty. total is > 9
TOTAL $ g
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow` I " • v
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric 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 / Z ' Z ( AM PM BLD
Location / / 70 S w 7/10 Suite MEC
Contact Person AC er Ph 03 Zr'( PLM - co 4 -
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
P SS PART FAIL
PL
ost & Beam
Under Slab
To Out
, ater Service
Sanitary ewer
Rain Drains
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
. 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 `�
Other oach /Sidewalk Date Inspector , `�� Ext
Final
PASS PART FAIL DO OT RE OVE this inspection record from the job site.