Permit CITY TIGARD PLUMBING PERMIT
r l DEVELOPMENT SERVICES PERMIT #: PLM2002 -00310
.��(I DATE ISSUED: 9/16/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13745 SW 121ST AVE PARCEL: 2S103CC 00300
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW 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: 5
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 1,365 ft
Remarks: Site Utilities: (5) manholes and 1365 feet of storm sewer.
FEES
Owner:
Type By Date Amount Receipt
VENTURE PROPERTIES INC PRMT CTR 9/16/02 $741.20 27200200000
4230 GALEWOOD ST, #100 PLCK CTR 9/16/02 $185.30 27200200000
LAKE OSWEGO, OR 97035 SPOT CTR 9/16/02 $59.30 27200200000
Phone 1: 503 - 387 -7604 Total $985.80
Contractor:
NORTHWEST EARTHMOVERS INC
PO BOX 1467
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503- 624 -0363 Sewer Inspection
Reg #: LIC 62761 Storm Drain Insp
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 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: I P (40 Permittee Signature: A��
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed ext iness day
p .. ._ • -- U ( 1-/ TlEl . `/3 Ir'."1 (0,9.
Plumbing Permit Application
' A Date received: / Permit no.: ?Lir /)t7t .0,0 6 /CO-
tr l i C ity of Tigard . ewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 974f
City of Tigard Phone: (503) 639 -4171 r 1 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 4 , , Date issued: By Receipt no.:
„�
Land use approval: 1) fl('.' Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family U Tenant improvement
l New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address:
/ 7//5 / / Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: 1 Subdivision: SFR (2) bath
Project name: Whistler's Walk Subdivision SFR(3)bath
City/county: _Each additional bath/kitchen
�`igard / WASH Ct IP:
Description and location of work on premises: New Siteutilities:
Construction Storm 1 i ne Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: Northwest Earthmover's Inc. VManholes s /6 g .s.
Address: P . 0 . Box 1467 Rain drain connector
City: Tualatin S ( ZIP: 97062 Sanitary sewer (no. lin. ft.)
Phone: (503) 624 -03 f Fax :639 -1634 E -mail: /Storm sewer (no. lin. ft.) ( M.5 (0 S8.2 16.5x'
CCB no.: 62761 1 Plumb. bus. reg. no: Water service (no. lin. ft.) _
City /metro lic. no.: Tigard # 6937 Fixture or item:
Contractor's representative signature: ��i- / Absorption valve
Back flow preventer
Print name: A . it /e I l a .� Backwater valve
CONTACT PI:RSdN Basins/lavatory
Name: Philip Hansen /Northwest Earthmovers Clothes washer
Dishwasher
Address: P. 0. Brix 1467 Drinking fountain(s) _
City: Tualatin 1 State: OR ZIP: 97062 Ejectors/sump
Phone:503- 624 -036 . Fax: 639 -163 E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor Name (print): Venture Properties Inc. Garbage disposal
Garbage dispposal osal sinks/hub
Mailing address: 4230 1;alewood Street , Suite 100 Hose bibb
City:Lake Oswego I State: OR IZIP: 97035 Ice maker
Phone:5 03 -38 7 -7 6041 Fax38 7 -7 615 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
Tubs/shower /shower pan
Urinal
Name:W & H Pacific Water closet
Address: 8405 SW Nimbus Ave 1 Water heater
City:geaverton 1 State: OR I ZIP: 9 7008 Other:
Phone:503 -626 -04551 Fax526 -0775 I E -mail: Total
7 p se)
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application 3d
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 das after it has been State surcharge (8 %) .... $
Expires y TOTAL $ 5-' 8o
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 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
3" 16.60 PLEASE COMPLETE:
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
H RtJHoc-LS 5 *Zoo g3•°° 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
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' f 55.00 55,00
Storm & Rain Drain - each additional 100' / 3 46.40 6„
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 CA9z, (AM
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.
i:\dsts \forms\plm- fees.doc 12/26/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / ��-�AM PM BUP _
Location 3 7 l 02 Suite cI MEC
Contact Contact Person Ph ( ) T ! -- gS — PLM a 63 /
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
of ir 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 / 0
Approach/Sidewalk Dat l Inspector -: Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL