14705 SW HALL BLVD 14705 SW Hall Blvd
CITYOF T!C A R D PLUMBING PERMIT
.y DEVELOPMENT SERVICES PERMIT#: PLM2002-00010
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/11/02
SITE ADDRESS; 14705 SW HAIL BLVD PARCEL: 2SI11AD-06100
SUBDIVISION: PINEBROOK TERRACE ZONING: R-4.5
BLOCK: LJT: 083
-----_--.----JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 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: 25 ft
WATEP CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repair 25'of sewer line,
Owner: FEES_ _
BLOCH, JEAN AND HELE NE Type By Date Amount Receipt
7835 SW 87TH 5PCT CTR 1/11/02 $5.80 27200200000
PORTLAND, OR 97223 PRMT CTR 1/11/02 $72.50 27200200000
Total $78.30
Phone 1;
Contractor:
ROTO ROOTER - WEST OFFICE
25599 SW 95TH B
WILSONVILLE, OR 97223
REQUIRED INSPECTIONS
Phone 1: 503-227-3330 Sewer Inspection
Reg #: LIC 13989 Final Inspection
PLM 37-76PB
This permit is issued subject to the regu:ations 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 wl!I expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 day,->. 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 vAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503)246-1987.
Is6ued By- � J �t1e4 1 Permittee Signature: -
--
Call (5C3) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Per mit Application
Date received: / // fl. Permit no.: ��
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,'Figard,OR 97223
C'iry„/Tin Tigard Phone: (503) 6394171 ProjecUappl.no.: _ Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: - Case file no.: Payment type.
U 1 &2 family dwelling or accessory U Commercial/industrial Multi-family U Tenant improvement
U New construction U Additinnl/aiternttion/replacement U Fr"I service U Other: _
Job SITIF 1 orspccInI Informal hill iise check list)
Job address: �(t 1 v,� � [Icscri rtiun 4py. h 4-, ea. 1Total
Bldg.no.: Suite no.: y — " New 1-and 2-family dwellings only:
- (Includes 100 ft.foreach Wilily connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot: Block: Subdivision: ---..,_
SFR(2)bath
Project name: _ SFR(3)bath
City/county: � �zm N Each additional bath/kitchen
L scription and location of work on premises:— _ Siteutilitles:
!:2e W e 1/' 'Ce (Jp,N C- Catch basin/area drain
Est.date of completion/inspection" —_ _ Drywells/leach line/trench drain
Footing drain(no. lin.ft.)
Manufactured home utilities
Business name: TZ C) C> c. a O Manholes
Address: S 9 S vi Rain drain connector
City: I State: ZIP: q-7 07O Sanitary sewer(no.lin.ft.) ;t,S
Fax: E-mail: Storm sewer(no.lin.ft.)
Phone: , 7- 3 i 3 Water service(no.lin.ft.)
CCB no.: 13� � Plumb.bus, rcg.no: B '7 -3 —
City/metro lic,no.: Fixture or ken:
Absorption n valve _
Contractor's representative signatu W: C� Q Back flow preventer -
Print name: f�G� - I)atc t - 1)-OZ-- Backwater valve _ ----_
Basins/lavatory
Clothes washer
Name:
-Dishwasher
Address: --- Drinking fountain(s)
City: _ State: ZIP: _ Ejectors/sump _
Phone: Fax: E-mail: Ex ansion lank
Fixturelsewer cap �! _
Name(print): _ Floor drains/floor sinks/hub
Garbage dis 531
Mailing address: _— — Hose Bibb
City: State: ZIP: ce maker! _
Phone: Fux:— Email: Interceptoe 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. 3ink(s),basin(s),lays;,,) _
Owner's si nature: Date: Sum
Tubs/shower/shower pan _
Urinal _
Name: -- Water closet T
Address: _ _ Water heater _
CStatc: ZIP: Other:
Phone: Fax: Email: Total
Na atl)ud"Lliodr&=rt crena cardr,please can Iurledicaar r«nae Infmmallon. Notice:This permit application Minimum fee................$
Plan review(at J 96) $
U Visa U MuterCard expires if a permit is not obtained '-
Credtr cmd rumba:_ — Le within I80 days atter it has been Slate surcharge(8%)....$
►ptrer accepted as complete. TOTAL .......................$ � _�(�__
— dna d u a an credlr c
S _
rider rlpurnrre Amount 440-4616(610(YCOM)
PLUMBING PERMIT FEES:
^ PRICE TOTAL New 1 and 2-family dwellings only: 1
FIXTURES (individuals QTY ea AMOUNT (includes all plumbing fiytures In I PRICE TOTAL
Sink 16 60 the dwelling and the first 100 ft. QTY ,ea) f AMOUNT
Lavatory 16.60 for each utility connection)
$249.20 _
Tub or Tub/Shower Camh. 16.60 One 1 bath
Two(2)bath $350.00 -
Shower Only 16.60 - Three 3)bath $399,00
Water Closet 16.60 _
_
Urinal 16.60 SUBTOTAL8%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 O conversion O like kind 16.60 uantity 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 49.40 -Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16,60 Water Closet _
Other Fixtures(Specify) 16.60 Urinal
Dishwasher _
Garbage Disposal
Laundry Room Tray
Washing Machine _
Floor Draln/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
Storm&Rain Drain-1st 100' 55.00 _(Specify)
-
Storm&Rain Drain-each additional 100' 46.40 _
Commercial Back Flow Prevention Device 46.40 --
Residential Backflow Prevention Device' 27.55 -
Catch Basin 1660 -
Inspection of Existing Plumbing or Specially 62.50
Requested Inspectionsper/hr COMMENTS N.EGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps _ 16.60
QUANTITY TOTAL
Isometric or riser diagram Is required If - --- - ---- -
__ Wanifty Total iss>9
'SUBTOTAL - -___-
8%s STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL v
Required only If fixture qty.total Is>g _
TOTAL a
Minimum permit fee Is$72 50.6%state surcharge,except Residential Backflow
Prevention Device,which Is$36 25+e%state surcharge
*"All New Commercial Buildings require 2 sets of plans with Isometric or riser
dlagrim for plan review.
I:klatsVormftlm-fees.doc 12/26/01