Permit iA
(S 1 .e
1 CITY OF TIGARD
PLUMBING PERMIT
#lr DEVELOPMENT SERVICES PERMIT #: PLM2001 -00651
� � � 13125 SW Hall B Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/12/01
SITE ADDRESS: 12065 SW WALNUT ST PARCEL: 2S103BA -01003
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW 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: 10 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing residence to newly installed sewer lateral. Reimbursement District #18 fee paid on this date.
FEES
Owner:
Type By Date Amount Receipt
WASHINGTON COUNTY PRMT CTR 12/12/01 $72.50 27200100000
1400 SW WALNUT ST MS #18 SPOT CTR 12/12/01 $5.80 27200100000
HILLSBORO, OR 97123
Total $78.30
Phone 1: 503 - 846 -7840
Contractor:
KERR CONTRACTORS INC
19350 SW 89TH AVE
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 692 -5514 Sewer Inspection
Reg #: LIC 72599 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.
/� 7
Issue By: !k. � � ! : t ea k , L / 444 Permittee Signature:x!/
Call (503) 639 -175 by 7:00 P.M. for an inspection needed the next business day
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Plumbing Permit Application
Date received: / / pi Permit no.: 1L- 11,A00 /_poo5`/
41--, i i i i
A. City g of Tigard
� 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: 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
0 New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: il,pbs Wa \v.�'t ST 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: Y , ,N cr 3 i,va,v.,,T sr SFR (3) bath
City /county: T, gene a I ZIP: Each additional bath/kitchen
Description and location of work on premises: cre.p".. Site utilities:
Swwc \c.�,..X 1".. S ?.vJ n& 1ta"n.t. Catch basin/area drain
Est. date of o mpletion/inspection: Vt..— Il,\_o\ Drywells /leach line /trench drain
/' PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
/ Manufactured home utilities
Business name: Kz« Com1ro.c:tr,c4 roc_, Manholes
Address: \g3SO SW W Av� -- Rain drain connector
City: 'l' „ I State: a . I ZIP: clr i Sanitary sewer (no. lin. ft.) ICY /
Phone: 6 03- (,c0 I Fax: 663- 0%1-atsy E -mail: Storm sewer (no. lin. ft.)
CCB no.: '11.0x\ I Plumb. bus. reg. no: '1').Ecn Water service (no. lin. ft.)
City /metro lic. no.: `1,l,$' Fixture or item:
Contractor's representative signature: tit/ (.,(/4"....... Absorption valve
Back flow preventer
Print name: torll, C,\n.51 Date: t ?- t \ -o\ Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
to f�ln,sl,01a.. Dishwasher
Address: tcaco $°1 iav-e-
Drinking fountain(s)
City: To,.. tz , I State:a(. I ZIP: c\-t0(,Z Ejectors /sump
Phone: l, _ - 5 - 1q Fax: v • L E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): wo.SL.•
""� ,A°`^ C. °,,..T� Garbage disposal
Mailing address: moo s ,, ,,,,„1,3c. , ,,,,„1,3c. s i - MS * tzi. Hose bibb
City: kA. ,\ \ybf,ro I State:0L I ZIP: R-It '-3 Ice maker
Phone: gt.(t - 78#0 I Fax: gob- 7g5 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 $ 2.9, 50
Notice: This permit application Plan review (at _ %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained ►' • $U
Credit card number: ./ / within 180 days after it has been State surcharge (8 %) .... $ ')
Expires p accepted as complete. TOTAL $ g • 3 ®
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
PLUMBING PERMIT FEES:
PRICE TOTAL • N ew 1-and 2- family dwellings only: '
FIXTURES (individual) • QTY (ea) . AMOUNT (includes all plumbing futures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. ' ' QTY (ea) AMOUNT
Lavato 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 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
-� � v Floor Drain /Sink: 2"
Sewer - 1st 100' -- \s_ 55 00 / W'1830 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 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 flee is $ 8 °/ state surcharge, except Residential Backflow .
wh
Prevention Device, ic i '$3fi 25 + 8% state surcharge.
** All New Commercial Buildings require plans with Isometric or riser diagram and .
plan review
is \dsts \forms \plm- fees.doc 10/10/00
CI1OF TIGARD BUILDING INSPECTION DIVISION fi' •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 C�
BUP
Date Requested (F AM PM BLD
Location / a 0 (Qs , _Lit- Suite MEC
Contact Person Ph 9 - ? 3 E/ S PLM ,DO / d` 6S7
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: •
Slab SIT
Post & Beam
Ext Sheath /Shear
Ina Sheath /Shear
Framing �. C...�� V�/\ l SS L�✓1 `
Insulation
Drywall Nailing
Firewall I 1 \ , n
Fire Sprinkler " �--��� 0 V f /�
Fire Alarm ' UV '"'� CIS ��. ` .:
Susp'd Ceiling •
Roof
Misc:
Final
PASS PART FAIL • -
PLUMBING
Post &Beam - •
Under Slab
Top Out
Water Service__
Rai �r •
Fi
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 C
Approach /Sidewalk Date (� \ l
Other \ 2 / A( / Inspector C� Ex
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.