Permit r �
4 CITY O F TIGARD PLUMBING PERMIT
, , 4 0 , DEVELOPMENT SERVICES PERMIT #: PLM2001 -00039
.0 r�I II 13125 SW Hall Blvd., T i gard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/7/01
SITE ADDRESS: 10610 SW WALNUT ST PARCEL: 2S102BC -02006
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 024 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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 90 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 90' of sanitary sewer line for connection to sewer system. Septic tank must be filled, capped and
inspected, or removed and inspected.
FEES
Owner:
Type By Date Amount Receipt
EDWARDS, ANNE D + HARVEY 0 PRMT CTR 2/7/01 $72.50 27200100000
10610 SW WALNUT ST 5PCT CTR 2/7/01 $5.80 27200100000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone 1: 939 -5246 Sewer Inspection
#: L IC 110314 Misc.lnspection
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: • 21 Permittee Signature:.,ot�� \)\\\
all (503) 639 -4175 by 7:00 P.M. for an inspection needed the next • usiness day
•
w
• Plumbing Permit Application
Date received: Permit no.:P,1 /00 %®d0 5?
.,d, City of Tigard
j `� Sewer permit no.:,210/_ jai 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:
TY PE OF PERMIT
1 & 2 family dwelling or accessory O Commercial/industrial ❑ Multi family CI Tenant improvement
New construction ❑ Addition/alteration/replacement
0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: ) O
Description Qty. Fee(ea.) Total
S ��� - P
1 New 1- and 2- family dwellings only:
Bldg. no.: Suite no.:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: I Block: I Subdi ision: SFR (2) bath
Project name: ��\,),) SFR (3) bath
City /county: • ZIP: Each additional bath/kitchen
Desc " tion and location of work 9n remise • Site utilities:
C t- S er Ma / k t .,. ( Catch basin/area drain
Est. date of completion/inspection: i „ .. ; .. gm Drywells/leach line/trench drain
PLUMBING CONTRACTOR Manufactured drain (no. lin. ft.)
Manufactured home utilities
Business name: ib b i (. 1 ` A. (_ Manholes
Addre s: _ , I (r `} b. Rain drain connector
City; Z' ]
v ZIP: Sanitary sewer (no. lin. ft.) 9p ►
`'
Phone: 71 - 13 Fax: -3p 1 E -mail: _Storm sewer (no. lin. ft.)
CCB no.: \ \ O ' 1 I Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signature:„�IN Absorption valve
Back flow preventer
Print name: ' ' t C 1. � .__ Date: , - - Backwater valve - _
CONTACT PERSON Basins/lavatory
Name: C 13. 5 Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: -E' Fax: E -mail: E xpansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): 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. Minimum fee $ 7� s Cl
Notice: This permit application Plan review (at _ %) $
O Visa O MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ .5 . ePa
Expires TOTAL $ 7,, 30
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 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
for Lavatory 16.60 One (1 each utility connection)
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
Urinal
Other Fixtures (Specify) 16.60
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 plans with isometric or riser diagram and
plan review.
i :\dsts\forms\plm- fees.doc 10/10/00
IT OF TIGARD BUILDING INSPECTION DIVISION `
24 -Hour Inspection Line: 639 -4175 Business Line: 6 -4171 M 'r
e2p, - -0663 f
. Date Requested r - 5 AM PM B LD
Location (66 / Sw J4% S f Suite MEC
Contact Person Ph P3% 52 VG-
Contractor Ph Syy ? J — CX"-S
BUILDING Tenant/Owner ELC
Retaining Wall ELR
r- ,. .. ..1 F PS .
Footing y : ,;.��:��+ ��
,. ��� ?�! r p j:.•5 +:� ^�` f Y; • '
Foundation � "`J;^' s � ° �c+ �> ,7i'' �y e r4 %1� r} �.•:•'�.,` ±G. r'v: �`
Ftg Drain '17,`Z.0 o, •. (4 ,. r ± _ "x • � �:SLr fir':: r2)'
Slab
Crawl Drain Inspection Notes: �, SGN
Post & Beam SIT
Ext Sheath /Shear _
Int Sheath /Shear (ci
Framing _ �� 1 /)
Insulation /_ / r U
Drywall Nailing L .-� l
Firewall /' • � 6
. Fire Sprinkler - .
Fire Alarm . --
Susp'd Ceiling .
Roof
Misc:
Final
PASS PART FAIL
cTLUMBING>
Post & Beam
Under Slab 41)4'2
Top Out '`--N `` \ Y1 '
= . Water Service
a rntary3ewer�
ain Drains
Fin
ASS ART FAIL - r
MECHANICAL
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
•
BackfilUGrading
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
Approach/Sidewalk
ppr Date P' b
A Inspector / Ext J ( � 1
Final
PASS PART FAIL . DO NOT REMOVE. this- inspection record from the job site. •