Permit CITY TIGARD PLUMBING PERMIT
IN DEVELOPMENT SERVICES PERMIT #: PLM2002-00041
DATE ISSUED: 2/11/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10440 SW VIEW TERR PARCEL: 2S1 11 BC 03001
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Remodel bath, relocating (1) lay and (1) shower pan. Install (1) new sink in workshop
FEES
Owner:
Type By Date Amount Receipt
DUNKLEE, JOHN + MARGARET PRMT CTR 2/11/02 $72.50 27200200000
10440 SW VIEW TERR 5PCT CTR 2/11/02 $5.80 27200200000
TIGARD, OR 97224
Total $78.30
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: Rough -in 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 ifwork 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.
Issu d By: , /, Permittee Signature: x ,l A
-- Call (513) 639 -4175 by 7:00 P.M. for an inspection needed th next business day
L. _. PlumbingPermit Application
'- A Date received:A // Off- Permit no. c //spa _ avgli
1,- ' City of Tigard � � � g Sewer p 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: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction 1 Addition/alteration /replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: JD 'f4'O 5A) v 16--c-. 1 f Description Qty. Fee(ea.) Total
Bldg. no.: Suite 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: 77 t -d I ZIP: q 72.z- Each additional bath/kitchen
Description and location of work on premises Refo o6(; t5 hFti( Site utilities:
/vl O v ful to l J M) / rg fi/-ooA d • 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: (70 )10 9 e , 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 nt .: I Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Absorption
Contractor's representative signature: Back flow flow valve
Back preventer
Print name: Date: Backwater valve .
CONTACT P ERSON Basins/lavatory
Name: TD (� n D k i n l(! Clothes washer
Address: 1041-c{0 5 V j E J / e f ff cF Dishwasher
Drinking fountain(s)
City: 71. /lFd 'State: OK I ZIP: 9722c Ejectors/sump
Phone: 503 - 620-/4 Fax: E -mail: Expansion tank
Fixture/sewer cap
Name (print): �(7 k.. . f) J h k /EC- Floor drains/floor sinks/hub
Marlin address: Garbage disposal
g /D y 'fo S cJ V / T@ 5 Hose bibb
City: -- 71/h.4 I State:Ole I ZIP: x 7729 Ice maker
Phone: 503 £ l /ygra 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 prope e I own . - r RS Chapter 447. / Sink(s), basin(s), lays(s) An / / ,/ 2-
Owner's signature: _ „i • Date: 2 Sump
ENGINEER Tubs/show /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. Notice: This permit application Minimum fee $ 7 A . 5r)
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at — %) $
Credit card number / / within 180 days after it has been State surcharge (8%) .... $ .5 • i
Expires TOTAL $ 7 fl , 3O
Name of cardholder as shown on credit card accepted as complete.
$_
Cardholder signature Amount 440.4616 (6100/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 ' 4 , 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 ) 4
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 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 $
* 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.
l:ldsts \forms\plm- fees.doc 12/26/01
Ci1TY'OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested s' 7 AM PM BUP
Location / yi/l) /c /LA Suite MEC
Contact Person Ph ( ) PLM GO cc D ql
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain . ^s1 � „) 7� a ELR
Crawl Drain /pi 7c I A /0 2 B�� > �.
Slab Inspection Notes: SIT
Post & Beam -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling / 4 /
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam -
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain -
wer an •
er:
Final
PART FAIL
it • ANICAL
Post & Beam
Rough -In / a
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 ®� / A `
ADA
Approach/Sidewalk Date �- Inspectors - Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL