Permit CITY ' OF TIGARD PLUMBING PERMIT
N ' , 11 4 ‘ DEVELOPMENT SERVICES PERMIT #: PLM2003 -00049
_Al- I 13125 SW Hall Blvd., Tigard, OR 97223 (5 639 -4171 DATE ISSUED: 2/18/03
SITE ADDRESS: 11190 SW 106TH AVE PARCEL: 1S134DA -00302
SUBDIVISION: NORTHERN PINE ZONING: R -4.5
BLOCK: LOT: 013 JURISDICTION: TIG
CLASS OF WORK: REP 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: ft
WATER CLOSETS: WATER LINE: 58 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: R
FEES
Owner:
Description Date Amount
VENABLES, JOHN V AND
MEYERS - VENABLES, VICKI J [PLUMB] Permit Fee 2/18/03 $72.50
7120 SW 60TH AVE [TAX] 8% State Tax 2/18/03 $5.80
PORTLAND, OR 97219 Total $78.30
Phone :
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone : 503 - 771 - 9449 Water Line Insp
Final Inspection
Reg #: LIC 42671
PLM 34 -70PB
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
I sued By: / 4 M l /�/� ? Permittee Signature: I II',
Call (503 .39-4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
-, a r,:f' 4,460f, J ), „, T r; . t Date received: / Permit no.: hLH 3 /
i. J',':, City of Tigardxte ;M :.!) »'
�Lj. d I . - Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
Gay ofTigard Phone: (503) 639 - 417•_:•, • - Project /appl. no Expire date: • Fax: (503) 598 - 1960 Date issued: By Receipt no.:
Land use approval: t ` Case file no , Payment type:
TYPE OF PERMIT
l& 2 family dwelling or accessory '
R ' 0 Commercial/industrial ... ___i 0 Multi- family 0 Tenant improvement
0 New construction p Addition/alteration /replacement 0 1-ood service 0 Other.
JOB SITE INFORMATION FEE S('11F.)ULE (for special information use check ist)
Job address: i \ \ QO so3 0(o _ Description Qty. Fee(ea.) Total
Bldg. no Suite no.: '?! t,. ;•:.1 . i -1 New 17 and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map/tax lot/account no.: SFR (1) bath
Lot: Block: I Subdivision: SFR (2) bath
Project name: \ j z_yx ci_(o ltS SFR (3) bath
City/county: 1 lq 0. r Gtja d ( I ZIP: c r a Each additional bath/kitchen
s 3 Ea
Description and le�cation Sf work on premises: r e 1 p I ao v Site utilities:
iM fit 1/4 vv r,I..)0._:k - C_Y S t - r v i d. L Catch basin/area drain
Est. date of completion/inspection: A S . 0 •''- " -''" Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Btrtcine•ca name: to row .■ T I t.'.-v-. r) i v q ::: '. ; ` I Manholes
Address: s y 6 )._41 S e F r v. e. ■ ' � SS+ . Rain drain connector
City: ' p- L 0. yn.d I State :Of ZIP: cino_o( Sanitary sewer (no. lin. ft.)
Phone:1 `l i y y 9 I Fax: 771- 9 y5 1 E -mail: — Storm sewer (no. lin. ft.)
CCB no.: 4a b9 I I Plumb. bus. reg. no: 3 o - ?0 PB Water service (no. lin. ft.) Sg r j SS 55
City/metro lic. no.: 114 31 Fixture or item
Contractor's representative signature: V, aj Absorption valve
Back flow preventer
Print name: arc/ Date: c a - i3 - 03 Backwater valve •
Basins/lavatory
Name: C j" p,_� e.._.. Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: 'State: I ZIP: Ejectors/sump
Phone: Fax: , E-mail: Expansion tank
OWNER Fixture/sewer ca.
' Floor drains/floor sinks/hub
Name (print): So_ Ck Q yi 0- f p 1 t Garbage disposal
Mailing address: ( A 1 AO cj () [ ,? - Hose Bibb
City: -1 Urt l,ct✓w d 1 State: OK_ I 9 '1 g49 Ice maker
Phone: ( -' i S y 9 I Fax: _ -- 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
Urinal
Name: Water closet
- Address: Water heater
City: 'State: 'ZIP: Other.
Phone: Fax: 1E-mail: Total Sb' ; SS
Not all jurisdictions accept credit cards. please can jurisdiction for more information. Notice: Th it app Minimum fee $ " !of . SO
perm
Visa t] MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card Dumber <I $ 8 8 / -�o?9 Le s 11 / 10S 180 days after it has been S tate surcharge (8%) .... $ S. '' 0
/ ..e/9 ut_r1/ son h e n E p1fea accepted as complete. TOTAL $ '7 R. 30
I / Tlame cardholder alowo on cred '
t card
c. i -( L 7i )._a —i $ ? Y.3o
����aa7��. Cardholder signature Amount J 440-4616 (6UQCOM)
"� � 52 c Coe d -t- .e r-^'`t \ torte — Z'U VY∎te 0 -5 Soo v` 0. S OSSI ��e. S a
y <0
PLUMBING PERMIT FEES: , .,
.,: �;:a'r . .,..:TRICE., " ; ",..TOTAL.: 1 at4,, a4 . i!;1, ; ; 0 1,a,) � u � ' ,Jr, ri, ` .:t
FD URES .'(Itidlxidual) . .. QTY, ,,.;,,, ea) ? ..,AMOUNT e ICI) ,4, .t 4 I'1: rit , � u • • -
'` G f I d ` a I 1
Sink 16.60 ' .2 .�b�„ y� I i '1?,, NCI ea } n , • NT
Lavatory 16.60 `;�'■ ' - C "dill -,'" . `10 kiv.4 F "^ . ° .r,iai. .
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 1111111MNIIIMII
Urinal 16.60 8•/. STATE SURCHARGE ,; ; , 1 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 , "k> irA+ll ?Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type's �« � i €Nevi✓ IN oved ' 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
(SpeGfy)
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 l Af 1 xt4y ' r
Quantity Total is > 9 t x • .. .
'SUBTOTAL "r+c 'f "Y
, ,
,, ,, ,+A.
8% STATE SURCHARGE ,, °'
kCx� At
R'&1 , a w"?
"PLAN REVIEW 25% OF SUBTOTAL ,a A�, ,' // �[�
Required only If fixture qty. total Is > 9 ,y,.^"+41 " r .�x"�'' ' / y -t'
TOTAL s ` k ,. 4 ,- , $ l 10 4.5
, � C o * Minimum permit fee h 572.50 + 8% state surcharge, except Residential Backflow ` � �
Prevention Device, which Is $38.25 state surcharge. s '
"A11 New Commercial Buildings require plans with Isometric or riser diagram and
plan review. N/ t r v‘,_ 7-v ✓ �, J
dui � �
'I a
I � c.--- 1
i:Vdsts\forms\pim- fees.doc 10/1 0/00 '` c-1- 1.� � .- �V �'
t (
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION - Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ° / 41 AM PM BUP
Location / // 90 /0 6 tt-ti--e-- Suite MEC
Contact Person Ph ( ) PLM a2-00,3 —000 q
Contractor Ph ( ) 7 7/ — Veit? SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR 01 . , /2 C A _AZ og o
Crawl Drain
Slab Inspecticr otes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation l
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /
Susp'd Ceiling /
Roof 6 Other:
Final /
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
er e
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Othe _•
• I
P 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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA G
Approach/Sidewalk Date • Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL