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9600 SW Frewing Street
CITY OF T I GAR n PLUMBING PERMIT��_
DEVELOPMENT SERVICES PERMIT#: PLM2002-00229
DATE ISSUED: 6/18/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S102Cr)-00400
SITE ADDRESS: 09600 SW FREWING ST
SUBDIVISION: FREWINGS ORCHARD TRACTS TUNING: R 4 5
BLOCK: LOT: 025 ---.------,---JURISDICTION: TIG
CI ASS OF WORK: ALT GARBAGE DISPOSALS: i.AOBILE HOME SPACc.S:
TYPE OF USE: SF WASHING MACH: BACKFLOW ','REVN TkS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRA?S:
STORIES- WATER HEATERS: CATCH BASINS:
_
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAIN';:
— v SINKS: Y URINALS: GREASE TRAPS-
LAVATORIES: OTHER FIXTURES:
'rUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install approximately 50 I.f of water service. —
_ _ FEES
Owner: Type By Date Amount Receipt
DO`;D, LARRY + LAURA PRMT CTR _ 6/18/02 $7250 27200200000
9600 SVV FREWING 5PCT CTR 6/18102 $5.80 27200200000
TIGARCr, OR 9727.3 V —! — `— --
Total $78.30
Phone 1:
Contractor:__ _
ROTO ROOTER - WEST OFFICE
25599 SW 95TH B
WILSONVILLE, OR 97223 RL=OUIRED INSPECTIONS
Water Service Insp
Phone 1: 503.227-3330 Final Inspection
Reg#: I_:C 13989
PLM 37-76PB
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 suspen,jer_i for more
(han 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the G. --on Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-00)1-0080.
You may obtain copies of these rules or direct questions to OILING by calling (503) 246-1981 .
1--edauL
Issued B i e ! �s «, Permittee Signature: - —
Call (503) 639-4175 by 7:00 P.M for an inspection reeded the next business day
Plumbing Permit Application
Date•received.,,�?A Permit nosj,41UL.k✓
City of Tigard Sewer permit no.: Huddingpermitno.:
Address: 13125 SW Hall Blvd,Tigard,OR 9722{
CiryrjTigurd Phone: (503) 639-4171 ProjecUappl.no.: Expiredete:
Fax: (503)598-1960 Date issued: i By. - Receipt no.:
Land use approval: • Case file no.: Payment type:
r l &2 family dwelling or accessory U Cott mercial/industtial U Multi-family U Tenant improvement
U New constriction 18 Addition/alteration/rep)accntrn, U Food service J Odin:
l Information
Job address: 2-family
divel _ (?ti. Fee(en Totnl
5u{tc no.: -Ne" I-and 2-family dt�cllinfls only: �
Bldg.no.: (Includtw 100 fl.for each utility conuection)
Tax map/tax lot/account no.: �. SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath
Project name: SFR(3)bath
City/county: ZIP: _ Each additional bath/kile:hen
D scfiption an locsnio of work on premises:_ _ Sitcutilifies:
,eR _-�� Catch hasiri/t►rca drain
_- -- — - I�tywclls/leach line/trench drain
Est.date of completion/inspecdon:
Footing drain(no.lin. ft.)
-PLUMBING(.:ONTRACTOR Manufactured home utilities
Business name: Manholes
Address: S W its S t �kk,R- 3 _ Rain drain connector
City: State:M ZIP: q oSanitary sewer(no.lin.ft.)
Phon I9' Fax; E-mail: Storm sewer(no.lin.ft.)
cc I Plumb.bus,reg.no: ,.(e Water service(no.lin.ft.) t
Cit /metro lie.no.: Fixture or item:
Y �' ���`� /• ���`'"� Abso lion valve _
Contractor's representative signatures _ Back flow preventer
Print name: (1 Date ' Q Backwater valve
Basins/lavatory
Name: Clothes washer
--- - - --- --- Dishwasher
Address: —. Drinking fountain(s)
City: State: _ZIP: F�ectors/sump_
Phone: Fax: E-mail; Expansion tankWIN
fixture/sewer cap
Name(print): Floor drains/floor sinks hub
Garbage disposal
Mailing address: hose bibb
City: State: ZIP: Ice maker
Phone: Fax: E mail: nterceptor/grease trap
Oevner installation/residctttial maintenance only: The actual installation Primer(s)
will he made by me or the maintenance and repair made by my regularRwf drain(commercial) +
employee on the property I own as per ORS Chapter 447. Sin (s),basin(s),lays(s)
Owner's signature: _ Date: j Sump _-
-- - Tubs/shower/shower pan
Urinal
Name: - ---_---- - --- Water closet
Address: Water heater
City: - - tate: ZIP: _ Other:
Phone: l-ax: 1 E-mail:
Not all Jurisdictions ecce credit cards. lean call jurisdiction ror mrxe infamr,on. Minimum fee................$ •ti�
1 M p Notice:1•his permit application
U Visa U MasterCardPlan review(at _ %) $
expires if a permit isnot obtained State surcharge(8%)....$
credit cent number .___�_-_— -- csp�---lrcs L within 190 days after it has been a
..,(
Nerne d c roldrr ra slro�n on- rcreI era-
-- - accepted m complete. TOTAL ....................... _
3
Cardholder slptertrrc Amount 441)0,16(~'OKI)
PLUMBING PERMIT FEES:
PRICE TOTAL. New 1 and 2-family dwellings only:
FIXTURES (individual) 911 ea AMOUNT_ (includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection) _
One 1 bath $249.20 _
Tub or Tub/Shower Comb. 16.60 Two 2 bath _ _T $350.00
Shower Only 16.60 Three 3 bath_ 5399.00
Water Closet 16.60 - SUBTOTAL
Urinal 16.60 - 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbape Disposal 16.60 _ - �____..TOT A-L_ _
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16 60
16,60 PLEASE COMPLETE:
4" 16.60 _ _
Water Healer O conversion O like kind 16.60 _ Quantit b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Ca ped
MFG Home New Water Service 46.40
MFG Home New San/Storm Sewer 46.40 Lavato
60
Hose Bibs 16. Tub or Tub/Shower
_ Combination _
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 1660 Urinal
Dishwasher _
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer-1 st 100' itj 55.00 3" -
Sewer-each additional 100' 46.40 4"
Vater Service-1st 100' - 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
Storm&Rain Drain-+at 100' 55.00 (Specify)
Storm&Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention De ilce 46.40
Residential Backflow Prevention Device' 27.55 -
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 62.50
Requested Inspectionsper/hi 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 72, -- -
"SUBTOTAL. - -- - - ----- ---
8%STATE SURCHARGE _
"PLAN REVIEW 25%OF SUBTOTAL
Requircl only if fixture qty,total Is>9 -
TOTAL
w
"Minimum permit too Is$72.50+8%state surcharge,except Residential Backflow
Prevention Device,which Is$35 75•8%slate surcharge
"AIL New Commercial Buildings requlre 2 lots of plam with Isometric or riser
diagram for plan review.
t:\dsls\forms\pim-fees doc 12/23,01
CITU' OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BLIP
Received --- Date Req uest d o �AM PM BUP -— -
Location ��'(,� Suite _ MEC
` -75 z g ( PLM
Contact Person -___—�` L a. ( _) _
Contractor _- _ r Ph( ) �i _ SWR
BUILDING Tenant/Owner ELC —
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain _.—
Slab Inspection Notes: _ SIT _
Post&Beam - _--
Shear Anchors - - - - - —
Ext Sheath/Shear
Int Sheath/Shoar
Framing ----
Insulation
Drywall Nailing - --
Firewall
Fire Sprinkler �—
Fire Alarm -
Susp'd Ceiling —
Root
Other:
Final
PASS PART FAIL —
_P_LUMDING_
Post&Beam — - Z
Under Slab
Roo hJp�� ---��--
Ier S9rVIC0' - - -
SanitarySewor
Rain Drains - -- - —
Catch Basin/Manhole
Storm Di—,
Shower Pan
Other. —— —— ---- — ----- —
F'
PA. PART FAIL_ --- - - - — -
HANICAL
Post& Beam
Rough-In ---- ------ -------
Gas Line
Smoke Dampers _—. -- ------- - - ------
Final
PASS PART FAIL - -
ELECTRICAL
Service - -------------------
Rough-In ----
UG/Slab
Low Voltage
Fire Alarm
Final [� Reinspection fee of$ _required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: __ CJ Unable to Inspect-no access
Fire Supply Line
ADA 7
Approach/Sidewalk Dane _�A. inspector _ Ext
Other
Final DO NOT REMOVE this Inspection record from the job *11te.
PASS PART FAIL