Permit r 1�
CITY TIGARD PLUMBING PERMIT
i ' DEVELOPMENT SERVICES PERMIT #: PLM2001 -00322
AA ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/27/01
SITE ADDRESS: 10030 SW WALNUT ST 007 PARCEL: 2S1026D -02300
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT: 040 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 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: Water heater replacement.
FEES
Owner:
Type By Date Amount Receipt
HANSON, DOROTHY L PRMT CTR 7/27/01 $72.50 27200100000
c/o FINGER, ROGER A + PHYLLIS SPOT CTR 7/27/01 $5.80 27200100000
610 NW SPRING AVE
PORTLAND, OR 97229 Total $78.30
Phone 1:
Contractor:
STAN THE HOT WATER MAN
PO BOX 33157
PORTLAND, OR 97292 REQUIRED INSPECTIONS
Phone 1: 503 - 760 -2992 Final Inspection
Reg #: LIC 130755
PLM 26 -632PB
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 calli 503) 246 -1987.
Issued By: m Permittee Signature �,,,,,�, i/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit App ' tion
Date received /O 1 Permit no.: ( 1 )QD / (>03�
. . ,..„ . ,
,.
u.' i :�
„ 1,L .(� i City of Tigard permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tig O 223
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
❑ I & 2 family dwelling or accessory IR Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: l e'30 5.- te.. 1 ,rKl' Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 R. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
' ription and locathil of work on premises: 1 44'f Hai-Ey Site utilities:
.c c (• t 4 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 tc)•h -rl7 e id e/- m' 1 Manholes
Address:// 3 Nkj / J Psi/ it 2-f ' . - � Rain drain connector
City: 6 I State:CM I ZIP /9 7030. i Sanitary sewer (no. lin. ft.)
Phone: 74 - a 912- I Fax: 7rol - OS, I E -mail: L Storm sewer (no. lin. ft.)
Plumb. bus. reg. no: Water service (no. lin. ft.)
CCB no.: 30 �$ I g' Fixture or item:
City/metro lic. no.: &o 2 S'1070
�'I
Contractor's representative signature: 6��'v Absorption valve Back flow preventer
Print name: nla l/ t. Po q Date: 7-77 d/ — Backwater valve •
CONTACT PERSON Basins/lavatory
Name: C Z r} 6,efy Clothes washer
Address: / /003o St. QGl3 (,., Dishwasher
Drinking fountain(s)
City: T T ,1 e I State :6e I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): MA r sr fel'del' 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
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 $ /A-Si) .
❑ Visa ❑ MasterCard HWy expires if a permit is not obtained Plan revew (at _ %) $
C t card number: 4 CK W (003 rill 3 &,/ /) within 180 days after it has been State surcharge (8 %) .... $ S
M ib
N ardho as shown on credit card accepted as complete.
off $W.36
Cardhogaature Amount 440 -4616 (6A0/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
for each utility connection)
Lavatory 16.60 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 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 $7� 8% s surcharge, except Residential Backflow
Prevention Device, which is $38.25,8% state surcharge.
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review. -
i:\dsts\forms\plm- fees.doc 10/10/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested – I AM PM BLD
Location /0 0, Suite -7 MEC
Contact Person FP q/t) Ph (�, ,39 -SZ-Z7 PLM o`�pd --d0 32—
z
Contractor A Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS •
Ftg Drain SGN
Crawl Drain Inspection Notes: a ria
Slab ' -'`��' SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof 1)
Misc:
Final -
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service (.(J
Sanitary Sewer
Rain Drains
491
SS PART FAIL
NICAL
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 Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk
, s
Other Date / - 0 / Inspector � ' f/'e . Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.