Permit C ITY OF TIGARD PLUMBING PERMIT
i , DEVELOPMENT SERVICES PERMIT #: PLM2002 -00115
.-..<<{ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
DATE ISSUED: 4/9/02
SITE ADDRESS: 10915 SW 74TH AVE PARCEL: 1S136DB -01400
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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: Install residential backflow device.
FEES
Owner:
Type By Date Amount Receipt
SMURTHWAITE, PAUL R + NORMA TR PRMT CTR 4/9/02 $36.25 27200200000
10915 SW 74TH 5PCT CTR 4/9/02 $2.90 27200200000
TIGARD, OR 97223
Total $39.15
Phone 1:
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 691 -6166
Reg #: LIC 87906 Final Inspection
PLM 34 -250PB
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 call g (503) 246 -1987
Issued By: C Permittee SignaturA k4 4/61:_,e 1���
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t' bus day
.- j • Plumbing Permit Application : '
Date received. /. d - 2 Permit no. R.Frl 0 - 00/ /,
) ., • City of Tigard /
.� `J 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: By:Br3 Receipt no.:
Land use approval: Case file no.: Payment type:
.,
L, :T YPE OF PERMIT = ,• :", -1'', d, . ■ •
® 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
O New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
s_ .� v: • `' .
,. �; � ; �� . JOB SITE � . FEE'SCHEDULE(for special , ,
1 Description Qty. Total
New 1- t only:
Bldg. no.: Suite no.:
ll ft. for
Block: Tax map/tax lot/account no.: SFR (1) bath
Lot Subdivision:
Description Project name: , SFR (3) bath
• c. ion of . on
drain Catch basin/area drain
Drywells/leach line/trench
date of • . • . •
Footing drain (no. lin. ft.)
'PLUMBING CONTRACTOR _
Business name: yytt7rj;4 Q ^ t i vtA • _
Address! i/ A ,() l (Lt.t.S if) ti-( C. l.." CLc Rain drain connector _
City : O ( ,1 I Stat enyLl ZIP: 1 - iri )- •
Phone:/ 09 I - (t? 1 to ( I Fax ici I ` 61 _�'I E-mail: Storrn sewer (no. --
CCB no.: 01 9 0 fr, I Plumb. bus. reg. no:, IAA Water service • —
City /metro lic. no.: 2 �f & Fixture t item: _ ■
:
Contractor's representative signature, �VL- K Absorption
ri 4 z. m l B • _— •
Print name: f 1(UC Ff2SX ate: y'G O .)-- Backwater valve 1' "
CONTACT PERSON : • .
Name:
Clothes Dishwasher
Address:
City: I State: I ZIP: Drinking
Phone: Fax: E -mail: Expansion
OWNER ` .
Name (print): 5 Li (4 W i 4 0 — I • • , • S —
Mailing address: • to 9 15 s 1 y co City: �: c -d I o {'" :' I a Hose . er ■
State: Z IP:
Phone: ( 1-pu I Fax: I E -mail: . • . I=
Owner installation/residential maintenance only: The actual installation
will be made by me or the maintenance and repair made by my regular Roof drain •
employee on the property I own as per ORS Chapter 447. basin(s),
Owner's signature: Date: Sump
ENGINEER Tubs/shower/shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: ZIP:
Phone: Fax: E -mail: Total
at
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This Minimum fee $ J " ' � �
s permit application
Plan review (at %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained 0 Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ .- • 7
Expires TOTAL $ - F9 , / S
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
PLUMBING PERMIT FEES:
PRICE:- - TOTAL. 'New 1 and 2 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
Lavatory 16.60 for each utility connection) .
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 WorkPerfornied
Gas piping requires a separate mechanical Fixt • ' Moved , %:rReplaced Rernovedl
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.
is \dsts \forms \plm- fees.doc 10/10/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
j BUP
Received Date Requested �� ✓� 1 AM PM BUP
Location / /5 ?/ 7 ( c Suite MEC
Contact Person fin - Ph ( ) / G> / J} PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Acce - ELR
Crawl Drain / irka cr/^ w�� - 77
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Ina Sheath/Shear 1 "I . S 7 4 Framing J z: 1�.5 a 7.41' c. �Y e t4. 0:4 - � ' ��
Insulation —7 I t'
Drywall Nailing ) 7a�v t`/J'E. C� l i / €ae``'`tie. e 'b . 72. .
Firewall 'PeViiL-e
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In I .
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan L
Ot� ' _ .
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: Unable to inspect - no access
Fire Supply Line
ADA /�� ../ - - Ext
Approach /Sidewalk Date _. / /'- Insp ®ctor C Ql
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL