Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2001 -00441
'6M6 DEVELOPMENT SERVICES DATE ISSUED: 9/17/01
-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11315 SW WILLOW WOOD CT PARCEL: 1 S134AC -02610
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R-4.5
BLOCK: LOT: 167 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
MIETH, RICHARD C + BETTY M PRMT CTR 9/17/01 $36.25 27200100000
11315 SW WILLOW WOOD CT 5PCT CTR 9/17/01 $2.90 27200100000
TIGARD, OR 97223
Total $39.15
Phone 1:
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 682 -6076 Final Inspection
Reg #: LIC 6136
PLM 11558
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: - i - Permittee Signature: 9i✓ f9/ /% /0// ' /1/1/z
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Datereceived:9 /q /D/ Permit no.:Pz.1 9!DO9
City of Tigar
-�., ' CEIVED PLANNING Sewer permit no.: Building permit no.:
Address: 13125 SW Hal va,' OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 SEP 12001 Date issued: 9/i ,/0 / BReceipt no.:
Land use approval: CITY OF TIGARD ICasefileno.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
• ew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: ! /315 .W w I I. 01 W � ....al rr Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1 -and 2- family dwellings only:
Tax map /tax lot/account no.: to ,55 Cot. (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: R i ch( ct / V e. - fl SFR (3) bath
City /county: TI rvd. - U)f.I... p: 5 Z2.3 Each additional bath/kitchen
Description and li tion of work on premises: Site utilities:
6 /-q-e46 7 7U1'J Z) tJ I (P. Catch basin/area drain
Est. date of completion/inspection: • --. a g -Q/
Drywells/leach line/trench drain
PLUMBING CONTRACTOR
Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: ° res&racc La.'? <) Manholes
Address CjS / </,1.73' ecit. Rain drain connector •
CitY:i j /A-C1/01. le , I Staten /L_ ZIP: 970 70 Sanitary sewer (no. lin. ft.)
Phone '3 loVA - 60761 Faxl, - 9&'7 6 E - mail: - Storm sewer (no. lin. ft.)
CCB no.: (p /3 (o I Plumb. bus. reg. no:
Water service (no. lin. ft.)
City/metro lic. no.: 0038 - Fixture or item:
Contractor's � s representative signatur Q4.4..er..J Absorption valve
Print name: . . Date: 9 $ _0 Back flow preventer
Backwater valve
CONTACT PERSON Basins/lavatory
Name: /-77/(z) W c ,, A- rr7Ju,..) Clothes washer y
Address: Q g 1 S 5-4-43 Ke-17 Srifl llc.n. "2O Dishwasher
City: LU / J -pyl vi 11 I Statec I Ziw:9 D Drinking fountain(s) •
Ejectors/sump
Phone:
( - 4,0949 Fax: (pg 2-9.S 1 7 ., E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): /2 ; char- d- 8 /h t d'h Garbage drains/floor d sinks/hub
Garbage disposal
Mailing address: l / 31 S SW W 1 07-V (,000,14 � Hose bibb
7-
City: i �l,cl, I State:p/21 ZIP: 9 7 2?3 Ice maker
Phone: 51>- 377/ 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)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Name: Urinal
Address: Water closet
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: fee $
Notice: This permit application
❑ Visa ❑ MasterCard Plan review (at _ %) $
Credit card numbs: / / within 180 180 da after permit is not obtained
it has Mend State surcharge (8 %) .... $ o2 , X 10
Expires withies been TOTAL $ .39. /S
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-4616. (6i00/COM)
PLUMBING PERMIT FEES: W • - •
.X '', ;; •,.,•; . ",�� �; ;. ; Y ANew;1`and 2= famlly:dw,ellings,:only: i f `` s' ' :
RE ' ' air ` ' i' " ; :-'; '� _TRIPE'
. 'AMOUNT` • :`. `(includes`all: plumbing fixtures i n ; w� `. PRICE -•' TOTAL
SiXTU <�:, ._ ; , =QTY (e a)%' andt e. .QTY - ` =(ea)`•:'-''AMOU T;
16.60 'the dwelling h � ;;��
Sink for.eacli utility cohnectionj" ,•,. ` -�� .,-=r:
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 ' ' '
TOTAL :- ?' `ti -
Garbage Disposal 16.60
Laundry Tray 16.60
Washing Machine 16.60
•
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
•
3" 16.60
4" 16.60 ?,
_ ..Quantlty bygWork ; Performed : „ �:y;
16.60 :ra.,r��;:= -a.:a', °`4 �:..'? n
Gas piping Heater 0 conversion a paa O like kind ;
"Fixture =Type: � ' .- ". `New.: < ?�Moved�': '' ReplacediA °Removed/,
Gas piping requires a separate mechanical , !' " "Capped.`: • permit. Sink
MFG Home New Water Service 46.40 Lavatory
MFG Home New San/Storm Sewer 46.40 Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
16.60 Water Closet
Drinking Fountain Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3°
46.40 4°
Sewer - each additional 100' 46. Water Heater
Water Service - 1st 100' 55.00
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 B fiO 1
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' / 27.55 a7, 5s'
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 / rs! l+ 9- °
, "
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE -• ' 7 .: k % - � r "
dSv j
**PLAN REVIEW 25% OF SUBTOTAL -
Required only If fixture qty. total is > 9 •
TOTAL 9 To
* Minimum permit fee Is $72.50 * 8% state surcharge, except Residential Backflow
Prevention Device, which :436.2- :Mr e surcharge.
* 'All New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
i :\dsts\forrrs\plm- fees.doc 10/10/00
CITY OF TIGARD BI "LDING INSPECTION DIVISIO "
24 -Hour Inspection Line: 6. 4175 Business Line: 639- /1
BUP
Date Requested / — 11 AM PM BLD
ocatio j
:3/.c DO d C Suite MEC
Contact Person Ph ( 2— 7So GrO, 00` -o o ¥L (
Contractor Ph ' - 1 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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler •
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
9" L i
PLUMBING
Post & Beam (
Under Slab
Top Out • �'
Water Servi
Sanitary Sewer
Rain Drains
Vi
% PART FAIL
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 Other
Date \V \� U 1 Inspector
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •