Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00016
�'I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/16/03
SITE ADDRESS: 11865 SW 91ST AVE OFFICE PARCEL: 1S135DC-02000
SUBDIVISION: ° AFL ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: 300 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 800 ft
Remarks: Buildings 3 and 4
for a total of 800 ft of footing drain and 300 ft of storm
FEES
Owner:
Description Date Amount
VILLA LA PAZ LIMTED PARTNERSHIP
BY COMMUNITY PARTNERS FOR [PLUMB] Permit Fee 1/16/03 $485.40
AFFORDABLE HOUSING INC [TAX] 8% State Tax 1/16/03 $42.20
TIGARD, OR 97281 Total $527.60
Phone :
Contractor:
REQUIRED INSPECTIONS
Phone : Storm Drain Insp
Rain Drain Insp
Reg #: LIC 66416 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
Issued By: %/� �� _ Permittee Signature:
Call (503) 63' -175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
• OFFICE USE ONLY
•
Plumbing Permit Application
. City of Tigard Date received: t , - 3 Permit no.R47) app,- - -
r{=
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: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 l & 2 family dwelling or accessory 0 CommerciaUindustrial lijkii h= famil}� trj 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 t i S Sw if/ Description Qty. Fee(ea.) Total
no.: .4 t I New 1- and 2- family dwellings only:
Bldg. S uite no.:
(includes 100 ft, for each utility connection) •
Tax map /tax lot/account no.: SFR (1) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Project name:. G reenb ‘.0..,3 Gtlk /4/,„r+M'ie„iS SFR (3) bath .
City /county: 71- 4pcd A/Q _ a.. ZIP: 972 Z Z Each additional bath/kitchen
Description and location of work on premises: Rep Gies Atte. limbic Site utilities: ---,-----
% ri1 ONAS Mi v N , Qep lace Shr+w OA e • Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain:(no:;1in:401 $pp
Manufactured home utilities
m
Business:nae: aviary Pat, s'c CA411. Manholes
.Address:- 116.cb S W G7 'Ave Rain drain connector
City: , Pe JQ,b1j = State:'&( ZIP:972Z5 Sanitary sewer (no. lin. ft.)
Phone: SI:63 639_311:8, Fax:437 -7 I E -mail: Storm sewer (no. lin. ft.) 340
CCB no.: 4G4,1‘, I Plumb: bus: reg..no: Water service (no. lin. ft.)
• City/metro lic. no.: 00001$13 Fixture or item:
• Contractor's representative signature: .040/4/4/ Absorption valve
.4'
Back flow preventer
Print name: Sam W;ge „o4 a., Date: /_ /11_6 3
Backwater valve •
CONTACT PERSON . Basins /lavatory -
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E -mail:
Expansion tank
OWNER Fixture /sewer cap
t; �M Floor drains /floor sinks/hub
Name
(print): «Nm,'y Pcv+mirs For" 46 1 tom.
Mailing address: pp B z3 2e G Garbage disposal
Hose bibb
City: TI.34 eel lState:p(. I ZIP: .g72Z 3 Ice maker
Phone: 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
Address: Water closet
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 $
Notice: This permit application u
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: Expires / within 180 days after it has been State surcharge (8 %) .... $
TOTAL $
Name of cardholder as shown on credit card accepted as complete.
Cardholder signature Amount
/ � 440-4616 (6/00 /COM)
. . .... . . ,._.... ......._..._ ...__.....
PLUMBING PERMIT FEES: . . • ,
., .,
PRICE: i. • New .:t andfamily•rcliivellinbs:onlf: •: -‘.:' k ' ',-'; .: .':'.' '.' :•;',;.::.,: 1
FIXTURES:, (individual) - - =- -- 'z-; :- QTY (ea) --'--, `;;:=AMOUNT: (includes olt.plumbin - . .-.:;:.. ;-PRICE - . ; . , :,•17_91A,4-,
Sink 16.60 the Ovelikiliant*ihe fitfOt'ft;:?"''': , QTY (-i•:(ea) .tel A
Lavatory 16.60 fb'reiCfAitility 6oniiiiiiiii):'• -'::•L,.-:
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 - ..:-:. r • -:-=,'-:- '
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 . -- :.;'' ., . . : , f- ' ':.:.Quantity IrtWorkrPerfornied.:.
Gas piping requires a separate mechanical F ixture Type .4 . ' - .. - :.Ne'lAi,. Moved z.i'Ret.lace0. !ZRertio:Ved/
permit. . ; a:,: -.,.:H. ' , ;?--. =::T;- : - ?' ,- - ' • ` 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
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.10Cr. 55. O0J
Storm & Rain Drain - each additional 100' , , - - A48.4P , . 1
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 ;,,W.'::;
*SUBTOTAL '-.-- '':„:.,.''''3 0(7
•-- :',Fp,,,.,--4';:4 r-
0
8% STATE SURCHARGE ' . '
_D d.., 1 1 c i
P 55, 0 a j Ok-
'LAN REVIEW 25% OF SUBTOTAL .-.,j'' kl,"',4tg gsX1
Required only if fixture qty. total is > 9 ----:--- 1 '
TOTAL fan,4 ,4::AV;;p $ Li 6 ' '4 0
P,-;41 f
-2 S
* Minimtim permit fee1072.50';81(gitate surcharge, excepial
Prevention Device, which' is i3872 8% state t Resident Backflow
surcharge. 54 L f & qo 9,-. c6 D
** All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review. 41
..r
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 3 a! AM PM BUP
Location / / 8G S ' 7/,' Suite MEC
Contact Person IYA- 6 Ph ( ) 5 � I — SS 3/ PLM 3 D 66 /A'
Contractor Ph ( ) SWR
BUILDING Tenant/Owner Al ' ' 1 .l A -, L � -< � " ELC
Footing
Foundation Access: ELC
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 '-/ i
Roof.
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanita Sewer _
'Catch Basin / Manhole
Storm Drain
Shower Pan
• er
PART FAIL
M HANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 111 Unable to inspect - no access
Fire Supply Line •
ADA r Approach /Sidewalk Date ;f Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL