Permit � 4
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CITY TIGARD PLUMBING PERMIT
Ajl PERMIT #: PLM2000 -00450
DEVELOPMENT SERVICES DATE ISSUED: 1/25/01
�'J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12730 SW WATKINS AVE PARCEL: 2S102BC -04200
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 031 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: 300 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 290 ft
Remarks: Site plumbing for development of minor land partition. Installation of 300' of sanitary sewer line and 290' of
storm sewer line.
FEES
Owner:
Type By Date Amount Receipt
SAMUEL A COTTER JR. PRMT CTR 12/12/00 $295.60 27200000000
12925 SW PACIFIC HWY 5PCT CTR 12/12/00 $23.65 27200000000
TIGARD, OR 97223
Total $319.25
Phone 1: 503 - 639 -1111
Contractor:
JOHN FRANK
7739 SW 171ST PL
ALOHA, OR 97007 REQUIRED INSPECTIONS
Phone 1: 503 - 260 -7780 Sewer Inspection
Rain Drain Insp
Reg #: LIC 62819
PLM 2801J 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 callin• 503) 246 -1987.
Issued By: Permittee Signature. / , 1
1 ,
Call (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the next business y
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Plumbing Permi Application
• Date received: /ate/ oO Permitno.:/DG� - c29
Ali
sy r City of Tigard
`a Tigard Sewer permit no.: Building permit no.:
- -° Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 Project/appl. no.: Expire date:
Nz
Fax: (503) 598 -1960 Date issued: By: I Receipt no.: y
e
Land use approval: H ?-ood'G evo Case file no.: Payment type: ,,
f TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/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: I a7 30 Swr 'rr K t ry S, 'r t cm R0,64. Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
Tax map /tax lot/account no.: J 1 0 a 6 C - TL 4 JO O (includes (1) 100 • for each utility correction)
Lot: IBlock: 1 Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: T ( E,R p / w Asti • I ZIP: Each additional bath/kitchen
Description and location of work on premises: IlMI hj 0 r TO Site utilities:
Ix) A 1 KS 2 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: .3 FRIN K CO. Manholes
Address: •p 7 2 9 ,s w 171 s , - PL Rain drain connector a
City: h L 0 t-t o4 I States I ZIP: 97 00 7 Sanitary sewer (no. lin. ft.) /a / so 30&
Storm sewer (no. lin. ft.)
Phone: ��p. -� I Fax: 1E-mail: Water lin. ft) � d4D
CCB no.: 6 a, it 1 ej I Plumb. bus. reg. no: aer service (no. -
City /metro lic. no.: 3 6 o °f Fixture or item:
Contractor's representative signatureY Absorption valve
Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: S_A C 0 Tr-q, 2 Clothes washer
Address: loran Sw mJRoo CK ST
Dishwasher
Drinking fountain(s)
City: Tt C-,4 ,2 £ I Sta te I ZIP: 57 A. lc/ Ejectors/sump
Phone: 6,3 - ...4 1, 9 Fax: - 0665 E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): SP C oTf s J R, Garbage disposal
Mailing address: )2,77c- S G O P A-C t i` t c 4 - Y Hose bibb
City: - r_ .4 State: pQ IZIP: '7x23 Ice maker
Phone: G.3.7 — t l I 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 prope I own as er 0 S Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date:�.St/B° Sump
Tubs/shower /shower pan
Name: Urinal
ame:
Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Minimum fee $ 2515. 6"
Not all jurisdictions accept credit cards, please call jurisdiction for more infomtation. Notice: This permit application
❑ Visa 0 MasterCard Plan review (at _ %) $
expires if a permit is not obtained i
Credit card number: / / State surcharge (8 %) .... $ 3• /?J
Expires Ex within 180 days after it has been
p accepted as complete. TOTAL $ / �• oZ 5
Name of cardholder as shown oo credit card
$
Cardholder signature Amount 440 -4616 (64)0 /COM)
tX2 2/ "ee
0 re. ry F,st/F
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
Lavato 16.60 for each utility connection)
ry 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
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' IF i 55.00 . 65 09 3^
Sewer - each additional 100' , 46.40 , 0 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 55,00
Storm & Rain Drain - each additional 100' 2 46.40 9,.9 ,60
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 a9 --s)
8% STATE SURCHARGE
0 .44 i-1.a4
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL j1 9 aka
* 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.
is \dsts \forms \plm- fees.doc 10/10/00
CITY.OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST6
/� BUP
i Date Requested . J to r12 I AM PM X BLD
Location l al Li) ( k I'✓LS _ Suite MEC
Contact Person Ph C O — OO. C.
Contractor Ph SWR
BUILDING Tenant/Owner • ELC
Retaining Wall ELR
Footing Access:
Foundation _ PS
Ftg Drain i44 al U�- �n( !i S-/ / 1 �� / SGN •
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
_ Ext Sheath /Shear
Int Sheath/Shear _I�! /� 9
Framing �`� T -mil t V �f �U *)
Insulation • Ad,
Drywall Nailing
Firewall
Fire Sprinkler eS S�S) l G� •
Fire Alarm
Susp'd Ceiling ‘lq A .+^ 1vA
Miscf: / - C�� LAY` f'"? `r' k Off' •
Final . - A..� -8■✓1 .- Gn-* re_ Le.mj • •
PASS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service frecS v' Q R k c,„3- .
nary Sewer (c-k—e",■)--- 6 Fi:,_�
��i PART FAIL
MECHANICAL
Post & Beam -
Rough In .
Gas Line .- k. 1) k
Smoke Dampers / 1 V'\,.\ C.....?/V\ L�.L
Final
PASS PART FAIL N2_-.12-,.../N G--IC-` I
ELECTRICAL _ /
Service 0
Rough In
UG /Slab / i
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 1 ( b Inspector /(� Ext�
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .