Permit . l♦
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT PLM2003-00579
03
`--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13556 SW CLEARVIEW PL PARCEL: 2S104DC 04200
SUBDIVISION: BENCHVIEW ESTATES ZONING: R -4.5
BLOCK: LOT: 042 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF 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: ft
WATER CLOSETS: WATER LINE: 85 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 85' of water service
FEES
Owner:
Description Date Amount
HOOGEWERFF, MARIUS A J + LOUISE
13556 SW CLEARVIEW PL [PLUMB] Permit Fee 11/10/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 11/10/03 $5.80
Total $78.30
Phone : 503 - 590 - 6726
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008
REQUIRED INSPECTIONS
Phone : 503 - 642 - 7323 Water Service Insp
Reg #: LIC 24184
PLM 26 -162PB
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 ( ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
City Plumbing Permit Application OFFICE USE ONLY
Date received: Permit no.: 'Li ,,�, ...m.„ t 'IL y of Tigard 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: •
. „ ... , r - - TYPE OF PERMIT '
1151 & 2 family dwelling or accessory ❑ ommercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ N ew construction ! "dditiontalteration/replacement ❑ Food service ❑ Other:
:,;:'' r; .; ": JOB, SI // T __ E,INFORMATION:' • .; %,, FEE. SCHEDULE (for special information use checklist)
Job address: l 3 5 $ p 510 C I EFfry 4 Eu> FL- 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: Subdivision: SFR (2) bath
Project name: N-p pq E W e /Z. F7 SFR (3) bath
City /county: , J I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
/l.J EtjJ (AJ 5 G(J l C,E ( I NE Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
�. Footing drain (no. lin. ft.)
? 1, r` PLUMBING ,CONTRACTOR,, Manufactured home utilities
Business name: f C4 i l___ - Ft (/j'Y) 6 ;#..)- 4+'-)G Manholes
Address: / 4,,c) 00 Sii') y ' e"2tO r. p. J Rain drain connector
City: v. I Stater te_ 1 ZIP: q1-00(o Sanitary sewer (no. lin. ft.)
Phone: ( Fax:(pt,(z,`? -}s5 E -mail: Storm sewer (no. lin. ft.)
CCB no.: 2,..C.11 V./ Plumb. bus. reg. no: 24' ( 12.3 Water service (no. lm. ft.) — f'5 55
City /metro lie, no.: 1 "9 5 g .Wig Fixture or item:
�1 Absorption valve
Contractor's representative signature: t'`�'"' % Back flow preventer
Print name: ; j A- -ic.i-i 4, Date: —9 Backwater valve
fi ,; ,, ,„ 7, ;, : , :CONTAC_T, , ` ' . Basins /lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: 'ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
i t/m ;;=;:." -, +' OWNERS f , ," ' • 3 '; Fixture /sewer cap
Name (print): R'r% (J,s ✓ t- W E/.-rF Floor drains/floor sinks/hub
�`/�1�Y1 E Hose bibb
disposal
Mailing address:
Hose bibb
City: I State: 1 ZIP: Ice maker
Phone: gq Q - 61'26 Fax: 1E-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: 1 Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This Minimum fee $ r ,��
s permit application Plan review (at %) $ Si. U
❑ Visa ❑MasterCard expires if a permit is not obtained o
Credit card number: / / within 180 days after it has been State surcharge (8 /o) $
Expires TOTAL $ 7S. 3 D
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6 /00 /COM)
. ..,
PLUMBING PERMIT FEES .
,-,PRICE`,'-:: '-liTOTALS11 ri;NeWtOdil-ifaitiilii.4•011iiitOrilY: 4' ''3
_ ,_..-1.L.-:&., TURES ,;,,,- ,--r ,..". --;. '; M
r 1 1 s
d' Y - r"' r ''' ' '',' ''- ;PRICE' 'OTAL.
TIX: :,.' ' -.:' '.:''.;'.':,;-,,.:::.,-;.; .':.':CITY.-4.41 ea
, 1-„Ar'''.3 s.::',AC)UN7r;, 0c„„ct ap,tatp I us :.,, , .- : .,,,,.:, ,,, ,44 ,-.,,,,,
Sink 16.60 ltieldwellitiOtidAif.:141001t:, : ,-44 '-QT.Y.,, el,l(pavN i -, ,Apil ou NT;
4814i8fiAiiiiit9':&iiieEtIOWA:` , ':-.!. ..f.:':
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 -:;;..:, Vi",..,7:.,;:'
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL -.:,, ' .:', : ,,r .,,
TOTAL
Garbage Disposal 16.60
_
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 . •
3" 16.60 .
PLEASE COMPLETE°
4" 16.60
Water Healer 0 conversion 0 like kind 16.60 - , -.7::". 13 Peifatirie11 - i
Gas piping requires a separate mechanical (iiiiiikTiiie:'*. -:NeW.i': .:4P119 -;'.Ftefila;Cedi Removed/
permit. S.,.,;.;: ;,: :.1 da 0 ped
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 Corribination
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 2"
•
Sewer - 1st 100' 55.00 " 37
Sewer - each additional 100' . 46.40 4"
Water Service - 1st 100' / 55.00 _ 55 . - f ....2) 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 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 ,i0w ,..7,v,14:
, ,,,i:vr,
Quantity Total is >9
*SUBTOTAL
8% STATE SURCHARGE ;'
A
**PLAN REVIEW 25% OF SUBTOTAL if2,1,-PIA!:':It4i,*51 .
Required only if fixture qty. total is > 9 "5-?.. , „-,,:-4.-.), , i:,
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.
lAdStSVOrMS\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 /1 — /a AM PM BUP
}
Location ` ✓ ��� �r-47 D f — Suite MEC
Contact Person Ph ( ) PLM 3 0 d ' 7?
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation 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
Sanitary ewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
?;
ASS PART FAIL
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 - ❑ Please call for reinsp-ction RE: ❑ Unable to inspect — no access
Fire Supply Line
A DA
o D • Inspector Ext
pp ach /Sidewalk •
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL