Permit �s CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 -00440
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/14/02
SITE ADDRESS: 14660 SW 76TH AVE 073 PARCEL: 2S112BD -00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 0 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Install plumbing fixtures.
FEES
Owner:
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 11/14/02 $83.00
#200 -L, MS63 [PLUMB] Permit Fee 11/14/02 $0.00
HILLSBORO, OR 97124 -3082 [TAX] 8% State Tax 11/14/02 $6.64
[TAX] 8% State Tax 11/14/02 $0.00
Phone 1: 503- 846 -4794
Total $89.64
Contractor:
ALBERTA PLUMBING
LEWIS TRANER
PO BOX 55031
PORTLAND, OR 97238 REQUIRED INSPECTIONS
Phone 1: 503 - 331 - 0657 Top-out Final Inspection
Reg #: LIC 96782
PLM 26 -707PB
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
r� ( /
i / Permittee Signature: Issued By: ,� ,�� �- fi Cf/� c��� 9 ,‘_ � - --
� _ . _ _ - —
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th - -next business day
Building Fixtures
- _ "Plumbing Permit Application ' � OFFICE USE ONLY ll
1 City of Tigard Date received: J /1 1.2)- Permit no.: L n �00; r.0 'U
t JJf °°
1 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: ByT Receipt no.:
Land use approval: Case file no.: Payment type:
- . TYPE OF PERMIT ,
❑ 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi - family ❑ Tenant improvement
0 New construction 0 Addition /alteration/replacement ❑ Food service D Other:
.1011 SITE` INFORMATION _ FEE SCHEDULE (for special information use checklist
Job address: / 7
1 Description Qty. Fee(ea.) Total
` & 0 IA) '` / 1�0 ` New 1- and 2- family dwellings only:
Bldg. no.: L�( Suite no.: includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: � Y
SFR (1) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
PLUMBING CONTRACTOR = Footing drain (no. lin. ft.)
Manufactured home utilit Mill
Business name: A 1 _ t , , - 0 1 ,,,,,L1 • Manholes
Address: /4 1 lti / , Rain drain connector
�'Y State: ZIP: Sanitary sewer (no. lin. ft.)
III
Phone: 0 0 , A E -mail: Storm sewer (no. lin. ft.)
CCB no.: 4 ,-7g- 7 Plumb. bus. reg. no: 11 , , Water service (no. lin. ft.)
City /metro lic. n6.: Fixture or item:
Contractor's representative signature: Absorption valve
- R - - Back flow preventer
Print name y , ; .. r .
• Backwater valve MI
CON PERSON • ' � �� Basins /lavatory 111111 14
r!zw, C--
.. �� . �_ Clothes washer MI
, _
Address: Dishwasher III I (p Ad -
City: 4 p7� 1' 7 - I St j ZIP: Ej ecting u ptains)
II Pho (� Ejectors/sump
m
ion tank
ne: Fax: E -mail: Expansion -
xpaion tank
.• . _: OWNER ,... y'' , . Fixture /sewer cap
Name (print): Floor drains /floor sinks/hub
Mailing address: Garbage disposal • 11.9 .1
Hose bibb
City: I State: 1 ZIP: Ice maker
Phone: 1 Fax: I E -mail: Interceptor /grease 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. Sink(s), basin(s), lays(s) 1 1, W
Owner's signature: Date: Sump
ENGINEER Tubs /shower /shower pan
Urinal
Name: Water closet
114 cif)
Address:
Water heater
City: State: ZIP: Other:
Phone: I Fax: E -mail: Total �/ /�
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 7 J ' t1
Notice: This permit application
O Visa ❑MasterCard Pl review (at _ % $
( )
expires if a permit is not obtained u
Credit card number: / / within 180 days after it has been State surcharge (8%) $
Expires TOTAL $ $q , to ki
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6 /00 /COM)
PLUMBING PERMIT FEES:
- P ,R1qE12
FIXTURES (individual) ;' ,-•;•• , -(VICIOc10;i11:iotiirnp)064*(toot,ik - : PRICE TOTAL
Sink 16.60 CAMOUNt4.,
:
Lavatory 16.60
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
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 ,2A F .Quantity by WorILPerfod»
Gas piping requires a separate mechanical FuxtureType * Moved Replaced 4 ,Relpsied/
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 1.6.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal
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 - lst 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 62.50
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 2 sets of plans with isometric or riser
diagram for plan review.
hdsts\forms\plm-fees.doc 12/26/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Litre: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
1 BUP
Received Date Requested // — AM PM BUP
Location / (.( 0 S &I, 70 .04 '1 '-< Suite 7 3 MEC
Contact Person Ph ( ) 7 '/t PLM ?-r.)0 2. — U Q R1 U
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
FtgDrain Lock goo , 0 n 11 F _ ELR
Crawl Drain ll��
Slab Inspection Notes: - SIT
Post & Beam
Shear Anchors [� ( / t ►
Ext Sheath/Shear �f 1 (���
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall •
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling — — — " "f
Roof
Other:
Final
PASS PART FAIL
LUMBIN
ost & Beam s! /C J/ .;4011,-''.0/r/
Under Slab
Rough -In •
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot -:
PART FAIL
� f ANICAL
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 LI Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date I Inspector Ext
Other:
Final ) 0 NOT REMOVE this inspection record from the Job site.
PASS PART FAIL