Permit ..... i
,
IT TIGARD PLUMBING PERMIT
, , �I�; DEVELOPMENT SERVICES DATE ISSUED: PLM2001-00207
13125 SW H all Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11675 SW 66TH AVE PARCEL: 1S136DD-03800
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 007 JURISDICTION: TIG
1
CLASS OF WORK: ALT 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: SFIRAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocate building sewer due to demolition on adjacent property.
FEES
Owner:
Type By Date !Amount Receipt
SOURCE ONE NETWORK
11650 SW 67TH AVE PRMT CTR 5/18/01 ' I $72.50 27200100000
TIGARD, OR 97223 5PCT CTR 5/18/01 $5.80 27200100000
Total $78.30
Phone 1: 503 - 624 -6020
Contractor:
CONSTRUCTO INC
P.O. BOX 54
WEST LINN, OR 97068 REQUIRED INSPECTIONS
Phone 1: 503 - 557 -7562 Sewer Inspection
Reg #: LIC 61926 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 ' work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules - opt:d by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 throug OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by callinc, (503) „- •1987
Issued By: f � Permitte Signature: l� ,`
iv
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Perniit Application
Datereceived:s' // 0/ Pennit no.:A9114200 /-WW- 1 7
. :
r,. , 1 ,.,, City of Tigard
`: :; g 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: G! ai Receipt no.:
. Land use approval: Case file no.: Payment type:
T1 PE 0 1 PERMIIT.
O 1 & 2 family dwelling or accessory O Commercial/industrial U Multi - family O Tenant improvement
O New construction O Addition/alteration/replacement U Food service O Other: _
JOB SITE • FEE E'S(:11EDUI,E (for special information use checklist):
'� Job address: ' rj S S u,) • . �}U e t • a j Descri ' tion Qty. Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no Suite no.:
Tax map/tax lot/account no.: 1 S 36 CD 190 0 (SFR ( ft. for each utility connection) bath
Lot: Block: Subdivision: SFR (2) bath M
Project name: 60,c a/ e r ■3e4 -war - . SFR (3) bath =
City /county: ZIP: Each additional bath/kitchen
OM
Description and location of work on premises: Site utilities: ) ■ -. .
i• • - Loe�.d • . Catch basin/area drain
of completion/inspectton: Drywells/leach line/trench drain =
Est. date
: • Footing drain (no. lin. ft.) MI
1'LUn9111NG CONTRACTOR , Manufactured home utilities
Business name: CoN S r ZN C . Manholes MI -_
Address: C ♦ S Rain drain connector =
City: L& g2 s{ \ N °• State: 02 ZIP: °t 70 (x$ Sanitary sewer (no. lin. ft.) rfin
Fax: E -mail: Storm sewer (no. lin. ft.) =
Phone: Water service (no. lin. ft.)
CCB no: .: $,, . .. S - • ' ' t
City/metro lie. no.: m Fixture or item: ■ -�
�' � � Absorption valve
Contractor's representative signature: Back flow preventer ME
Print name: & ets3e Al 1 .�w , r4 Date: S 14 Backwater valve
' - (:QN CA Pr- 11.SON Basins/lavatory NM
Name: Clothes washer ME
Address: Dishwasher -0
Drinking fountain(s) 111111
City: State: . ZIP: Ejectors/sump Mil
Phone: Fax: E -mail: Expansion tank ME
OWNER Fixture/sewercap 111111 Floor drains/floor sinks/hub
Name (print): Garbage disposal _
Mailing address: Hose bibb
City: State: ZIP: Ice maker 0
Phone: Fax: E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primers) MI
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), tiasin(s), lays(s) _
Owner's signature: Date: _ Sump =
ENGINEER, Tubs/shower /shower pan
Urinal -__
Name: Water closet
Address: Water heater IMI
City: State: ZIP: Other: MI
Phone: " Fax: ' E -mail: Total IME
Minimum fee $ 7,2 ' 50
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ' U MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ • (PO
TOTAL $ 7f, 3,)
Name of cardholder as shown on credit card accepted as Complete.
$
Cardholder signature Amount 440 -4616 (6/0O/COM)
J
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. 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
Water Service - each additional 200' 46.40 Other Fixtures
(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.
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