Permit CITY TIGARD PLUMBING PERMIT
**see DEVELOPMENT SERVICES PERMIT #: PLM2001 00273
DATE ISSUED: 6/26/01
'`---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11710 SW WALNUT ST PARCEL: 2S103BD 00200
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: 1 SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Fire restoration of residential plumbing. Replacement of (1) sink, (1) lay, (1) toilet, (1) laundry tray, (1) water
heater, (2) hose bibs and (1) backflow device for existing boiler.
FEES
Owner:
- Type By Date Amount Receipt
CAPPOEN, RAYMOND J PRMT CTR 6/26/01 $72.50 27200100000
SUZANNE 5PCT CTR 6/26/01 $5.80 27200100000
11710 SW SW WALNUT ST
TIGARD, OR 97223 Total $78.30
Phone 1:
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone 1: 503 - 642 -7323 Top -out Insp
Reg #: LIC 24184 RP /Backflow Preventer
PLM 26 -162P6 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 m fal -, •ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
I ued By: k _,./,_'j * q p24 Permittee Signature:
- Call (503) 63 4175 by 7:00 P.M. for an inspection needed the next business day
•
iili . ,_ 6i-e, of„., 5 47n,, t 26o/ - e
Plumbing Permit Application
Date received: 60 dip G/ Permit no.: Ghe,00/ goP-21
City of Tigard and
,:� � ' `J Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 r�yy Project/appl. no.: Expire date:
Fax: (503) 598 -1960 a �d� Date issued: By: ( Receipt no.: . .
Land use approval: r Case file no.: Payment type:
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: / / ? J o 5J VJ/1 ( Ai V f 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 (I) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Project name: OA/ p p 6 EN SFR (3) bath
City /county: To Aeo / fAsH. I ZIP: Each additional bath/kitchen
Descri lion and 1 a on of work premises: Siteutilities:
i �f r p•W Catch basin/area drain
Est. date of completion/inspection: Drywalls/ leach line trench drain
PLUMBING CONTRACTOR I Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: ' f/C1? L � G ( //!78i /t! 2(C Manholes
Address: / Coif 60 Sv.1 / ErGo o Rain drain connector
City: 804 (.f b,.J I State: O2 I ZIP: 9 ? 00(o Sanitary sewer (no. lin. ft.)
Phone: 6 C IZ ? 323 I Fax:l rZ ?7.SS I E -mail: Storm sewer (no. lin. ft.)
CCB no.: Z Cif 7e f I Plumb. bus. reg. no: Z( ( re Water service (no. lin. ft.)
City /metro tic. no.: /9 5 x Fixture or item:
Absorption valve
Contractors representative signature: / 6 AA: . e Back flow preventer
Print name: ilk A IVCl _ Date: - -6 Backwater valve
Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s) •
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion 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) g
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 acre n Notice: This permit application credit cards, please call jurisdiction for more information. Minimum fee $ 7P ' 5
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ _ gO
Credit card number 1 / within 180 days after it has been State surcharge (8%) $ .5
Expires • 30
Name of cardholder m shown on credit oars p accepted as complete. TOTAL $ 7
S
Cardholder signature Amount 440-0616. (6100ICOM)
PLUMBING PERMIT FEES. . , ilk
PRICE' .:TOTAL , New 1 and 2- family dwellings only:
FIXTURES (individual) QTY . (ea) AMOUNT ' (Includes all plumbing fixtures In PRICE -TOTAL
Sink i 16.60 the dwelling and the first100 ft. QTY -(ea) ': ,AMOUNT
16.60 for each utility connection)
Lavatory / One (1) bath $249.20
Tub or Tub /Shower Comb. 16 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 )like kind 16.60 Quantity by Work Performed
Gas piping requires a separate echanical (, 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 2 - 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
Other Fixtures
Water Service - each additional 200' 46 40 (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 ---I,r0 I l i e..---- _ 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
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP •
Date Requested ! 2—O AM PM BLD
/
Location / 1 /0 / Suite MEC
Contact Person Ph ,— 73 2,3 PLM <A d0/ D O 7 - 3
Contractor Ph - SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: • SGN
Slab SIT .
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing •
•
Insulation
Drywall Nailing •
Firewall
Fire Sprinkler •
Fire Alarm
Susp'd Ceiling
Roof
. Misc: .
Final
PASS PART FAIL
PLUMBING
-
Post & Beam
Under Slab
Top Out
Water Service .
Sanitary Sewer
Rain Drains
final' /
PART FAIL
M ANICAL
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 Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk
Other Date V7400 i Inspector � i / G�fie • E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site: