Permit CITY OF TIGARD PLUMBING PERMIT
. ,I , DEVELOPMENT SERVICES PERMIT #: PLM2000 -00431
VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/27/00
SITE ADDRESS: 10620 SW WALNUT ST PARCEL: 2S102BC -02005
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Sewer reversal under house for connection to USA sewer.
FEES
Owner:
Type By Date Amount Receipt
FRISBIE, OWEN P JR AND PRMT CTR 11/27/00 $72.50 27200000000
E L 5PCT CTR 11/27/00 $5.80 27200000000
10620 S
10620 SW WALNUT
TIGARD, OR 97223 Total $78.30
Phone 1:
Contractor:
LARRY CAMERON PLUMBING
1812 SE 158TH AVE
PORTLAND, OR 97233 REQUIRED INSPECTIONS
Phone 1: 503 - 256 -2705 Sewer Inspection
Reg #: LIC 49792 Final Inspection
PLM 26 -366PB
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: "1 i _ Permittee Signature. �� �J
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b i ss day
A Plumbing Permit Application
1
Date received: Pennit no.Pm 2, -a9 y3/
- , ,. City of Tigard
�! `, 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: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
1 I & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi family ❑Tenant improvement
New construction ❑ Addition/alteration/replacement ❑Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special iuforn ation use checklist)
Job address: /04?.r.) Sic) 4.4-z12/4// 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: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
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: ,dip /y. cow/el-21,9A) a4 , Manholes
Address: /02i y S 0 - Axj,C Rain drain connector
City: 4j/2 State:on I ZIP:972„ / & Sanitary sewer (no. lin. ft.)
Phone:477-2s •77 Tax: t r I E -mail: Storm sewer (no. lin. ft.)
�6 3(06 �� Water service (no. lin. ft.)
CCB no.: S - 2/ Plum bus. re g . no:
0 74
lic. no.: 6 7t, Fixtu a or item:
Contractor's representative signature: `r . •
_ , Absorption valve
at Back flow preventer
Print name: /, I r 9 " I _ , Backwater valve
CONTACT PERSON Basins/lavatory
Clothes washer
Name: 44-4/1.4 t!°� f71�}u10 Dishwasher `
Address:A z / ti 5e il t /,e s✓ .5c Drinking fountain(s)
City: isteR-r V I StateaL I ZIP:92 21 (/ Ejectors/sump
Phone: - Ls'b - 27 : E-mail: Expansion tank
Fixture/sewer cap
Name (print): Floor drains/floor sinks/hub
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 healgr
City: I State: I ZIP: Other.. 7JL
Phone: I Fax: I E -mail: Total
Not all information. jurisdictions accept credit cards, please call jurisdiction for more infoation. Minimum fee $ 2-- Z
Notice: This permit application Plan review (at _ %) $
C1 Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires TOTAL $ 7? . 3 U
Name of cardholder as shown on credit card accepted as complete.
w
$
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
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
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 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 1 , .-..
8% STATE SURCHARGE ' '
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty total is > 9
TOTAL $
u * Minimum permit tee 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.
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