Permit 414 CITY OF TIGAR® PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2001 -00521
'I DATE ISSUED: 10/11/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11030 SW 78TH AVE PARCEL: 1S136CA 00500
SUBDIVISION: MLP1999 -00002 ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
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: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Sanitary sewer line.
FEES
Owner:
Type By Date Amount Receipt
PRMT CTR 10/11/01 $72.50 27200100000
5PCT CTR 10/11/01 $5.80 27200100000
Total $78.30
Phone 1:
Contractor:
IKE & SONS CONSTRUCTION
21855 SW BLAINE ST.
ALOHA, OR 97006 REQUIRED INSPECTIONS
Phone 1: 503 - 649 -5714 Sewer Inspection
Reg #: LIC 145754
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.
Issued By: L Permittee Signature: ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi s day .
'1
Plumbing Permit Application
Date received: /4/ O/ Permit no./1//g40/1445.2/
,, City Tigard
///
, � y o gar Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/app1. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By, /i / 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 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: i I p 3 Q 6u3 - 70 - /tUQ -_ Description Qty. Fee (ea.) Total
Bldgrne- - Strite-not New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: l S (zi,,,C A. 00seo SFR (1) bath
Lot: 'Block: I Subdivision: SFR (2) bath .
Project name: NIA SFR (3) bath •
City /county: ( a>J (),)c k • t`a) I ZIP: �l7ZZ� Each additional bath/kitchen
Description tlocation of worc on premises VFW ceuxf (t't�- Siteutilities:
p to $,OL ‘.‘149.-- d \- -N,� p,iotae,•'�• ( Catch basin/area drain
Est. date of completion/inspection: to (/L o t Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
/ Manufactured home utilities
Business name: 'i k �tn.S �tti fat_ t / LA.L. Manholes
Address: ZI ( occ S L) t (et; ,./se_ S . Rain drain connector
City: A-to ,. k I State: CAL- I ZIP: 91000 Sanitary sewer (no. lin. ft.) /
Phone(So3� ( q __714 I Fax: ( -1/c1,1 E -mail: Storm sewer (no. lin. ft.) /
CCB no.: Hr 7St.( (,15010y1 Plumb. bus, reg, no: Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: L;Ol " ' `r , f°`r,,e, Absorption valve
Back flow preventer
Print name: (,t/ • ' .e C — : IC 11 .,, Date: - 6 —j i Backwater valve
CONTACT PERSON Basins/lavatory
Name: , ) 1:. ■ Clothes washer
Address: ((57S St_, t` 0, i T L FAA • I ( Dishwasher
City: ' (� „it St ate: o (LI ZIP: Cr 1 v2, 3 Drinking fountain(s)
Ejectors/sump
Phone:( p3 o -9sic Fax: ,; ;. -mail: Expansion tank .
. OWNER Fixture /sewer cap
Name (print): ( ( ,(,tm_,9_ z Floor drains/floor sinks/hub
Mailing address: ( (03o St-,o 76e- >✓. Garbage disposal
Hose bibb
City: i� q , a I State: Da- I ZIP: ' 72Z3 Ice maker
Phone: O I 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)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Name: Urinal
Water closet
Address: Water heater
City: I State: ZIP: Other:
I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 7R • So
Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $ rs, ero
Expires TOTAL $ 7 et' , 30
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 family tlwellings ony x jt,Tf
FIXTURES (iiidiyidual)<., ' , QTY `"(ea) ' AMOUNT (includes all plumbing.fixturessin PRICE TOTAL
Sink 16.60 the dwelling and the•fiistl`(10 =ft. QTY . (ea)
Lavatory 16.60 for each :i tility 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 SU BTOTAL
Urinal 16.60 8° /u STATE SURCHARGE .
Dishwasher 16.60 PLAN REVIEW 251/4 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 Quantity by Performed
Gas piping requires a separate mechanical .FixtureType New, , Moved °Replaced Removed /
permit a., ;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
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Sewer - 1st 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
(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' 7.r
**PLAN REVIEW 25% OF SUBTOTAL
only if fixture qty. total is > 9 ' t aa `°:'
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.
i : \dsts \forms\plm- fees.doc 08/29/01
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested / �' , /® /AM PM BLD
Location fie-3a ��''— � . Suite MEC
Contact Person Ph PLM c7 O 6 ' / - 0 1 ( ) . - 3 - 8 /
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation tf / �t
Drywall Nailing ti / e
` c i / - - / ` � /y2
-P,./ 6
Firewall
.. ( 7 6 -
.. Fire Sprinkler v` .
Fire Alarm
Susp'd Ceiling
Roof
. Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam * (
Under Slab
Top Out
Water Service
Sanitary Sewer
Ra'. Brains
(4110, 4
PART FAIL
NIECHANICA L
Post & Beam -
Rough In
Gas Line
Smoke Dampers
Final •
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE ° -
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk / l ��``
Other Date 1���(G�61 Inspector �� ll�r� - t. Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.