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Permit JJ CITY TIGARD PLUMBING PERMIT i I DEVELOPMENT SERVICES PERMIT #: PLM2002 -00313 ..�II 13125 SW Hall Blvd., Tigard, OR 9722/ (503) 639 -4171 DATE ISSUED: 8/8/02 SITE ADDRESS: 12805 SW WATKINS AVE PARCEL: 2S1026C -02400 SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -4.5 BLOCK: LOT: 026 JURISDICTION: TIG CLASS OF WORK: OTR 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: 60 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install service from meter to house, approx. 60 I.f. FEES Owner: Type By Date Amount Receipt RIZZUTTO, CLYDE ALLEN PRMT CTR 8/8/02 $72.50 27200200000 JULIE ANN 5PCT CTR 8/8/02 $5.80 27200200000 12805 SW WATKINS TIGARD, OR 97223 Total $78.30 Phone 1: Contractor: BEAVERTON PLUMBING INC 13980 SW TUALATIN VALLEY HWY BEAVERTON, OR 97005 REQUIRED INSPECTIONS Phone 1: 643 -7619 Water Line Insp Reg #: LIC 12889 Final Inspection PLM 34 -4PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued By: j :, � �� /L'_ i Permittee Signature. A ' at Call (503) 639 -4175 by 7:00 P.M. for an inspection nee ed the next b siness day , YY Plumbing Permit Application Date received: • f 0, Permit no7L , 1g - — /5 --$. -- Ci of Tigard ' i I `J 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 PkItMIT ® 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service 0 JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: 12805 SW Watkins Tigard, OR 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: Tony Rizzutto SFR (3) bath City /county: Tig. /Wash . I ZIP: 97223 Each additionalbath/kitchen Description and location of work on premises: Install Water Site utilities: Service from Meter to House. Catch basin/area drain Est. date of completion/inspection: Drywells/leach line trench drain I'LUI\113ING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities = Business: name := Beaver_t on_P_lumbing, =INc_. -- - Manholes_ _ Address: 13980 SW Tualatin Valley Hwy. Rain drain connector City: i vc rtry , I State: OR I ZIP: 97007 Sanitary sewer (no. lin. ft.) Phon: • _ . _ • . Fax: • _ . i E -mail: Storm sewer (no. lin. ft.) CCB no.: 012889 M -1,914Y Plumb. bus. reg. no:210 119 Water service (no. lin. ft.) Id City/metro tic. no.: * 9 ?R Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print name: John Woo 1 er 8 1M®2 8 / 7 / 0 2 - Backwater valve - • CONTACT PERSON Basins/lavatory Name: John Woolery i Clothes washer Dishwasher Address:13980 SW Tualatin Valley H Drinking fountain(s) City: Beaver ton - I State: OR I ZIP: 97007 Ejectors/sump Phone:503 643 - 761 Fax:6437620 E -mail: Expansion tank Fixture/sewer cap Name (print):Tony Rizzutto Floor drains/floor slnks/hub Mailing address:12805 SW Watkins Garbage disposal Hose bibb City: Tigard I StateoR I ZIP: 97 223 Ice maker Phone: 5 01 _ fi R 9_ 7n i d 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 Name: Urinal 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 e information. Notice: This permit application Minimum fee $ - 2,-2 .. SO more Cl Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number / 7 within 180 days after it has been State surcharge (8 %) $ Expires TOTAL $ Name of cardholder as shown on credit card accepted as complete , :v $ Cardholder signature Amount 440 -4616 (6/00/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 flrst100 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 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 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 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. Bdsts\forms\pim- fees.doc 10/10/00 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested SI I AM PM BUP Location / a SD .S (.CJ Suite L' MEC Contact Person Ph ( ) PLM a — 6 0 3/ 3 Contractor Ph ( ) CQ 4 ¢3 - 7 CO' 17 SWR BUILDING Tenant/Owner ( U ELC Footing ELC Foundation SS 9 Ftg Drain ELR Crawl Drain _ Slab Inspection Notes: SIT Post & Beam r = ' '- _ — Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm _ Susp'd Ceiling Roof Other: - = - – - - - Final PASS PART FAIL PLUMBING . Post & Beam Under Slab Rough -In Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fi PART FAIL ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line 7 ADA � ��G' �. Approach/Sidewalk Date 6 �" Inspector Est Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL