Loading...
Permit /4 i CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2001 -00470 l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/2/01 SITE ADDRESS: 10200 SW TIGARD ST PARCEL: 1 S135CC -00100 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Remarks: Installation of plumbing fixtures. Dishwasher, ice maker and sink. FEES Owner: Type By Date Amount Receipt ROGER DAY PRMT CTR 10/2/01 $72.50 27200100000 10200 SW TIGARD 5PCT CTR 10/2/01 $5.80 27200100000 TIGARD, OR 97223 Total $78.30 Phone 1: 503 - 670 -1704 Contractor: OWNER REQUIRED INSPECTIONS Phone 1: Top -out Insp Reg #: 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: / , f , �� ,/ /% Permittee Signature: , Call (503) 639 -4175 by 7:00 P.M. for an inspection needed'the next business da J i ° (• PlumbingPermit Appli 'on - - - -- — — - A Date received/ Permit no.: L i _ouy a. # 0 l 1 1'(' City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, 7223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: CI= Receipt no.: Land use approval: Case file no.: Payment type: . - • TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: /0 5 W j a o-o� S f Description Qty. Fee (ea.) Total Bldg. no.: I Suife no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no:: SFR (1) bath Lot: , ; I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: T ce ,,d t.(i4, , I ZIP: 973 Each additional bath/kitchen Description an of work on premises: 5:4/ fi 4 r Site utilities: J(C;, Lien f 0/44 w a1S c,-, a.-r a( jGe 4.1.: 4 1 /re,- Catch basin/area drain • Est. date of completion inspection: Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lib. ft.) Manufactured home utilities Business name: o) I ) -2 Manholes Address: Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: • Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print name: Date: • Backwater valve CONTACT PERSON Basins/lavatory Name: g a p- D Clothes washer �c Dishwasher _I_ Address: / 2 ael (iti r e.r ree Drinking fountain(s) City: 7 e "State: t%k ZIP: 97.2..23 Ejectors/sump Phone: g47- 235-7 Fax:(i7r// -/7/sell E -mail: - — Expansion tank . Fixture/sewer cap Name (print): 2 c -' e.5-- !' 4 ; � Floor drains /floor sinks/hu Mailing address: Garbage disposal g � ��'O' Sw y� Hose bibb City: • 7' at ro t �S6 te: pytIZIP: y722.3 Ice maker _L Phone: G 70-l7aiL I Fax: t:'70 /7afl 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) / x Owner's signature: Date: d a Sump Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: , Fax: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ /o� �� Notice: This permit application Plan review (at %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / within 180 days State surcharge (8 %) .... $ V Expires ays after it has been S t TOTAL $ -7E, 30 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00/COM) PLUMBING PERMIT FEES: PRICE- TOTAL NeMr.1'and2- family dwellings only: ,. ' ', FIXTURES '(indivIdual): ' • QTY `, (ea)� ' AMOUNT ' (includes all in PRICE -, ,TOTAL _ S ink / 16.60 the dvuelling.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- ew • 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 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 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. _ i:\dsts \forms\plm - fees.doc 08/29/01 , CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 7 /ice AM PM BUP Location / — ..etr Suite MEC Contact Person �. . _.�. ; •h ( ) PLM 66 q76 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear 7 /7 Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL IN Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Othe final PASS PART FAIL MECHANICAL 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 call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA n Approach /Sidewalk Date I Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL C ITY OF TIGARD BUY DING INSPECTION DIVISION ' ' `'. � " ' '.. . 24 -Hour Inspection Line: 63 175 Business Line: 639-4 � _ . ,�Z�BUP r� Date Requested . `i — 3 AM PM BLD Location / D 2 0 0 ' 4.4 Sfi uite .� "/: `.' „ : Contact Person ... ., P r Ph �47 a-3S7 p D ( ov 410 Contractor C ' h _ SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Foundation FPS Ftg Drain SGN Slab Crawl Drain I ction Notes. 61-- K2.) -Y L2Jt� Post & Beam ,(�� SIT Ext Sheath /Shear Y 6 _ _ / _ _ ! ' Int Sheath /Shear Framing I Insulation /� 1 _ r Drywall Nailing `' Zflo 1 - V `°-C �/ ' is Wr4k9•+ ,_.-(,t c•UCRJ S Firewall l � Fire Sprinkler / - I I P l Fire Alarm Susp'd Ceiling - ' — v Roof Misc: Final PASS PART FAIL UMBBile & Be Under Slab 1 Water Service • Sanitary Sewer Rain Drains 4114 ' • ‘ - di 0 \ \ _u — C e 0 Fin- • � ) • = - T F • IL� r . Post i ° / Ct, d 1 Z 0 Rough rQ 5 ,- 4- 41 1 5 6 le i s Smoke Dampers Final .417' PART FAI d+h + � ' � S ° ELECTRICAL _ ° • Service /4 - __/ I I es d �/ ' - fo . 6 1 OQ AP If l ' r : , Rough In 1 / �) A . UG /Slab °) ` � ' 6 J / -' Nia. TS , f • Low Voltage 4 `� ,0 �C� 0 / — 00 / )-- 3 ( /IS � , se F / // Q / Fire Alarm v // 22 Final / 47�"e l�� /' s L PASS PART FAIL / / -� /-� / / • SITE EGG 0)--do / — 0Q / F-3 ( l j a_ <- Se -7/57/0 0 — Backfill/Grading /� Sanitary Sewer / / ` 3 c.e. r pc,.-1 •a..Q 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 4 Approach /Sidewalk Date q ate ff �/ ( /� Ext3 1 " �l Other 3I I Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.