7305 SW SHADY LANE i
7305 SW Shady Lane
/ 1\ CITY O F i I GA R D ___PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002-00123
13125 SW Hill Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/15/02
SITE ADDRESS: o7305 SW SHADY LN PARCEL: 1S12508-03400
SUBDIVISION: BOULEVARD HEIGHTS ZONING- R-4.5
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: OTR C '- 3AGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNT'RS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE i PAPS:
LAVATORIE.,: OTHER FIXTURES:
TUB/SHOWERS SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DIS14WASHERS: RAIN DRAIN. ft
Remarks: Installation of backflow prevention device.
--------— --- FEES
Owner: _--- — _ —
Type By Date Arnount Receipt
JOEL BARTHOLOMEW PRMT CTR 4/15/02 $36.25 27200200000
7305 SW SHADY LN 5PCT CTR 4/15/02 $2.90 27200200000
TIGARD, OR 97223
Total $39.15
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: RP/Backflow Preventet
Rey #. 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 calling (503) 246-1987.
�/ . Permittee Signature:
Issued By: v �_ IJ ( L fit_ , g
Call (503) 639-4175 by 7:00 P.M. for an inspection needed thy n xt business day
P umbing Permit Application
City of 'l'igard Datcrcce`ved: ViPermit no.::: �
�y✓l i—
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewerpermit no.: Building B permil no.:
Phone: (503) 639-4171 Project/appl.no.:
Fax: (503) 598-1960 x date:
Date issued: S
Y Raceipt no•:
Land use approval: cssc file no.: -
-------- - - Payment type:
1 '
U I &2 family dwelling or accessory U Commercial/industrial
U Nev construction ❑Multi-family U Tenant improvement
J Adilitinn/alteration/replacement U Food service
1 , 1 U Other, � --.------
1 -
Job address:
"'ii'r•e✓ Description Q1 pec(ea.) Total
Bldg,no.: Svite no.: — _-- NeN I-and. -Writ— ly dwellints only:
Tax map/tax lot/accounl no.: — (iocludes100fl.forcachutilltyconnectionl
Lot' Blot:k: Subdivision: — SFR(1)bath
Project name: — -- SFR(2)bath -- - ---
City/county: SFR(3)bath — -
ZIP Cach additional batWkitchcn
Description and location of work on premises:, i Speutlltlles:
- - - Catch basin/area drain
— —_----
st.date of completion/inspects m Urywells/leach line/irench drain
1 1 Footing drain(no, lin. ft.)
Business name: Man ctuctured home utilities
Address: - _ Manholes
city: --- Rain drain connector
State: ZIP: Sanitary sewer(no, lin.ft.)
Phone: Fax: E-mail: Storm sewer(no. lin, ft.) —
CCB no.: Plumb bus.reg,no: Water service(no. lin.ft.)
City/metro lic.no.: Fixture or Item:
Contmetor's representative signature: Abso tion valve
Print Warne: — Back flow rreventer
Backwater valve --
Basin--s/lavnlory 7Address:
Clothes washer- - Dishwasher
City: _ _ _ State: ZIP: Drinking fountain(s) —-
hone Fax: E-mail: Ejectors/sump
L'x ansion tank -
Fixture/scwer cap - -
Name(print): ��' Floor drains/floor sinks/Iwb -Mailing add ss: ►�� — Garba
g 05 �� ge disposal
City: ; u, St c: lip; Hose bihb
Phone: 111 3ad� Fax; E-mail: Ice Owner instal installation/residential maintenrrtce only: The actual installation Interco for grease trap
will be made by me or the maintenance and repair made h m regular
primer(s)
employee on the ro I Y yRoof drain(commercial)
p lx' Y I � s prr(,RS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature: M. pate: fj�IS-�, Sum
Tubs/shower/shower pan —
Name: _ Urinal
Address: Water closet
City: State: ZIp; Hater heater
Other:
Phone: --
I r Ax E-mail: 'rota
Not ell Juds i Adons accent creak cards,please call Jurisdiction for mn;r infonnmion.
d Visa U MaterC and Notice:This Permit application Mmrmum fee................ Gln.
Credit card number: _ / 1 expires if a permit is not obtained plan review(at — %) $ _
Ccpirer within 1$0 days slier it has been State surcharge(896) $ yr• c
— Name or cud—h—.2 r u Ihown on credo cant _ accepted as complete. TOTAL
C'anlhol r Ngnature — $
$
Amount
4144616(&W1 Coht)
;t
a�
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. TIQTY lea) AMOUNT
Lavatory 16.60 f_or each utility eo_n_neciion�
One 1 bath _x$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 - -
Urinal 18.80 SUBTOTAL -
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 O conversion O like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New MovedRr eplaced Removed/
permit. _ _ Capped
MFG Homo New Water Service 46.40 Sink -
MFG Home New San/Storm Sewer 46.40 Lavatory i _
Tub or Tub/Shower
Hose Bibs 18.80 _ Combination
Roof Drains 16.60 Shower
Drinking Fountain 1660 Water Closet
Other Fixtures(Specify) 16.50 Urinal
_. Dishwasher
_
Garbage Disposal
Laundry Room Tray
Washing Machine
Newer-1 al 100' 55.00 Floor Drain/Sink: 2"- 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-tsl 100' 55.00 (Specify)
Storm&Rain Drain-each additional 100 46.40
Commercial Back Flow Prevention Devin 46.40 ----
Revidenlial Backflow Prevention Device' 27.55 ---
Catch Basin 16.60 - --
Inspection of Existing Plumbing or Specially 62.50
Requested Inspections _ per/hr COMMENTS REGARDING ABOVE:
Rain L`-aln,single family dwelling 65.25
Grea�A TTra�a 16.60
i QUANTITY TOTAL --
Isometn^or riser diagram Is required If --
Quan1R Total Is >g
`SUBTOTAL - -------- - --- ---
8%STATE SURCHARGE -
"PLAN REVIEW 25%OF SUBTOTAL
Required onl If fixture 1 total Is>9 _
TOTAL $
*Minimum permit fee is$72.50+5 stale surcharge,except Residential Backflow
Prevention Device,which Is$38.25+8%slate surcharge
"All New Commercial Buildings requirm 2 sets of plans with Isometric or riser
diagram for pian review.
1:\dsts\forms\plm-fees.doc 12/26/01
CITY OF TIGARD 24-Hoar
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503) 639-4171 BLIP - -
Received -_ ___Date Requested T_S J AM -._—__ PM BLIP
_ • � c--, _
Location _3 U S- __ _- Suite M E C
r Ph( — ) �� '>7-U(_ PLM -�C)G6
Contact Person � ---
Contractor __. _ Ph( ) - SWR -
BUILDING Tenant/Owner __. ___ ELC _
Footing ELC
Foundation Access: t� / �� ELR
FigDrain
Cr -_
Crawl Drain SIT
Slab Ins ection Note�-�--L�=,•--s:
Post&Beam --
Shear Anrhors
Ext Sheath/Shear ----- -- '
Int Sheath/Shear
Framing
Insulation
Drywall NailingFirewall
Fire Sprinkler —
Fire Alarm —_ --- ------
Susp'd Ceiling —
Hoof _
Other:
Final -
PASS PART FAIL -
i'LUMBING
Post&Beam
Under Slab - - -
Rough-In
Water Service - --- --'� — -
Sanitary Sewer
Rain Drains - - -
Catch Basin/Manhole
Storm Drain
Shower Pan
Ot _
ma
PART FAIL
MECHANICAL_
Post&Beam T
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service —
Rough-In --
UG/Slab
Low Voltage ------ --- --
Fire Alarm
Final F-1 Reinspection fee of Srequired before next inspection. Pay at City Hall, 13125 SW Hall Bivd.
PASS PART FAIL
SITE —� Please call for reinspection RE: F-] Unable to inspect-no access
Fire Supply Line I 1 ,,�
ADA Date 4=�`—.-- Inspector "_S/Za __ Ext
Approach/31dewalk
Other:
Final DO NO REMOVE this Inspection record from the job site.
PASS PART FAIL