Permit CITY OF TIGARD
PLUMBING PERMIT
; y y ft w f DEVELOPMENT SERVICES PERMIT #: PLM2001 -00197
r�' I� 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 5/15/01
SITE ADDRESS: 10865 SW WALNUT ST PARCEL: 2S103AA -00101
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: E2 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of one drinking fountain on the east exterior wall of the weld /wood shop.
FEES
Owner:
Type By Date Amount Receipt
SCHOOL DISTRICT NO 23 J PRMT CTR 5/15/01 $72.50 27200100000
13137 SW PACIFIC HWY 5PCT CTR 5/15/01 $5.86 27200100000
TIGARD, OR 97223
Total $78.36
Phone 1:
Contractor:
DAVE MCDONALD PLUMBING
PO BOX 341
SEASIDE, OR 97138 REQUIRED INSPECTIONS
Phone 1: 503 - 738 -7046 Top-out Insp
Reg #: LIC 144866 Final Inspection
PLM 4 -45PB
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
Notifica .. I Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
•u may obtain opies of these rules or direct questions to OUNC by calling (503) 246 -1987.
AO Issued By. : , _�i,�!1111j� / ,_//jj Permittee Signature: jL 1
Call (50 639 -4175 by 7:00 P.M. for an inspection needed t, next businesi ay
C/6
, . A Plumbing Permit Application
Date received: , j Q ( Permit no.:Paippo/-06 197
� ,. a , City of Tigard
-101 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: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory . ercial/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: fGc 1 0 R ,4 / . • 1 S 6 C'a Description Qty. Fee (ea.) Total
Bldg. no.: /b g' Ls A-‘,/ li/Ab , Suite no.: New 1 -and 2- family dwellings only:
Tax map /tax lot/account no.:
(includes
(1) 100 ft.
h
Lot: Block: I Subdivision: SFR (2) bath
' Project name: / r , l W4, - c / jj , o / SFR (3) bath
City /county: i ct ZIP: 9 3 Each additional bath/kitchen
Description ,and tiop gf work on remis s: Site utilities:
(�)�/ , , (91,40 �j� 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: l / Manholes
Address: ,fJ tj 5/ r" Rd 6i Rain drain connector
Sf.4 -
City: , ,rT d, ( f � State:d A I ZIP: 7/ 7 Sanitary sewer (no. lin. ft.)
Phone: 515i 7j ,+ 7, I E -mail: Storm sewer (no. lin. ft.)
CCB no.: t if '114(0 I Plumb. bus. reg. no: 17 r p Water service (no. lin. ft.)
City/metro lic. no.: 9 —1/5-P5 Fixture or item:
Contractor's representative signature:
Absorption valve
• Back flow ow preventer
Print name: _ , VA,:, , , , 611 Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: ' Arriffiem .. — Clothes washer
Address: , q ��W ,� - Dishwasher
��� Drinking fountain(s) 7
City: _ , // Ljjj wl�J t:��2�1 Ej to
Pho ga:M „ii /ieu E-mail s le - NI _ .f ",tsft . tank
OWNER Fixture/sewer cap • _
�- -� '� Floordrains/floorsinks/hub �'
Name (print): re ---/ y( Sr �r �[ Garbage disposal
Mailing address: , • , / t401 / ' • Hose bibb _
City: /..! I al ZIP: 4 21, _f!/C Ice maker
Pho - .1'VV iTi �.i " -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 $
Plan review (at %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 4t-- 6 - e ” . 6 ± ( 1 - 1 1 - 1 / � I / � „ /i ggp.q(16 (6/00/MM) � /� -yet
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" 1660
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 1 / �o 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
I. 33
*`PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL 1-/T.36 Or
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** AII New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:Wsts \forms\plm- fees.doc 10/10/00
Accumulative Sewer Tally I
Tena; t Nari,.e: for, 'L4 Q. 1'1 r 1,VI.� ' - O This SWR# 1J/ *
Address: 10 %(5 01.0 wrruJt.ti This PLM #: 114.0oo/—Col 97
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added • #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/VVhirlpool 4 .
Car Wash - Each Stall 6 ,
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4 4
- Domestic 2 /
Drinking Fountain 1 / /
Eye Wash 1
Floor Drain/sink - 2 inch 2
- 3 inch 5
- 4 inch 6
- Car Wash Drn 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48 - ,
Ice Machine /Refrigerator Drains 1
•...Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16 -
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar/Lavatory 2
- Bradley 5
- Commercial 3
- Service 3
Swimming Pool Filter 1
" Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
TOTALS
59 a, 59 3 593
i
Total fixture values: 5 divided by 16 = 3 7 07 EDU -.111) t ro. �l-t..- s
HISTORY 5 AA &rte, g 7 '
PLM# EDU# SWR# . PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# - PLM# EDU# .SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
r fists swrtay.doc
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested - 7 - I - 0 I 1 AM PM BLD
Location 16965 ‘2(A) L J a� t� v+ Suite MEC
Contact Person 1J 1 , -J e mat d ( , Ph PLM 200I - 00/g7
Contractor lJ a‘) Vl c bovvai P E+ ►�I � ._ Ph SWR
`1,
BUILDING Tenant/Owner • U ELC
Retaining Wall - ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
? 2
Ext Sheath /Shear c
Int Sheath /Shear
Framing
Insulation •
Drywall Nailing
Firewall
Fire. Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
FAIL
PLUMB
am
Under Slab p r'
Top but FpQ 111ilrl '
Water Service
Sanitary Sewer
R -•,_• -ins
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
Othe D a t e
oach /Sidewalk 7 — / 8- O / I - " " E x t
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
/!
Date Requested (l0 /l AM PM BLD
Location f52/5(CIS a A/01 Suite MEC
A g '-f— Contact Person Ph PLM c964/ - OO tT7
Contractor Phr C) ?D 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
Int Sheath/Shear /
Framing / /) �YI S �q /( WC{ 1, - e A- pry ellr��s� g -per
Insulation , /
Drywall Nailing q 1 v1 I Gv��.. a,, ...2y 1 -e /ac.J (X a e l.a ,
Firewall U J -
Fire Sprinkler 2 )7 1 70V idt� a /T. d .,i'�•v: c�.r• %� /ii' / t - r ( IA)
Fire Alarm
Susp'd Ceiling 3. LcJ,rQ' -� t - Eh � ' ((Yrs.( tee— 7' ,c0 u c2iv -&
Roof ' /
FP al PART FAIL « 1 / ' w. %C/-e a Pk 0c c 1`r-- '€ �-c-
LU 1 7 'v F c _ ter—
Post & Beam ( '_ /9n /� /J I
Under Slab ED C-) [ -f� , akz W�LC'�lp�r,�,� a
Top Out __ 4 a
Water Service 6144,
Sanitary Sewer „
Rain Drains �� � .5' 3/5-- �Q // 3�-" L . `H -c c d G+
Final
PASS PART erA ttGK a e,' Pt .*
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
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 Date 0
Other ( / [ / Inspector . 7c . if / 6V-t. • Ext
Final -
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD INSPECTION DIVISION
24 -Hour Inspection e: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested 7 / AM PM BLD
Location l j 5 t✓ Gc/e2,61 / Suite MEC
Contact Person sc4& CK4k/ -'7 Ph 711- -Zl 7 y PLM
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 /i 1vt di/ R. 7 .2 ret;..a /-e 7V L p V C
Insulation 1 B
Drywall Nailing . pt old �Pri /C & c_ a 0/ 4� eg- c ✓rte-.
Firewall
Fire Sprinkler 6 U q / s a ` (.0 Ci c` $
Fire Alarm
. Susp'd Ceiling 2P') hS C V L G 4—. AP 4 – 4 /f
Roof ,
Misc: L " � f ct l ► �!G✓ , � G 14.4 — C
Final
PASS PART FAIL
SLUM = INt-
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
.rains 3 /y r4S 3* C' Pv
S PART FAIL
MECHANICAL
Post & Beam S C �'ao��t, VC u (" cJ II k •
Rough In
Gas Line -
Smoke Dampers
Final /
PASS PART FAIL /��) Q G / , G r - ,
ELECTRICAL / 7
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 D — 2— / � — G / Inspector l // CK'� ✓`e - E xt
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.