Permit C ITY OF TIGARD PLUMBING PERMIT
k I DEVELOPMENT SERVICES PERMIT #: PLM2002 -00297
x � J I ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/5/02
SITE ADDRESS: 11430 SW GREENBURG RD PARCEL: 1S135CA-01403
SUBDIVISION: GREENBURG HEIGHTS ZONING: R -12
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: U WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: 255 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1 catch basin, 2 manholes, 255' storm sewer.
FEES
Owner:
Type By Date Amount Receipt
JAMES CASTILE PRMT CTR 8/5/02 $164.40 27200200000
8100 SW DURHAM ROAD PLCK CTR 8/5/02 $41.10 27200200000
TIGARD, OR 87224 5PCT CTR 8/5/02 $13.15 27200200000
Phone 1: 503 - 314 -8042 Total $218.65
Contractor:
BERRYHILL BROTHERS EXCAVATION
20897 SW SCHOLLS - SHERWOOD RD
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 503 - 625 -1611 Storm Drain Insp
Reg #: LIC 62191 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 / Permittee Signature. - _
Call (503) 639-1175 by 7:00 P.M. for an inspection needed le next business day
4 t117 - _...
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Plumbing Permit Application
a v ,. � Date received: t �� Permit no �/ �J jca . cY )/
*is:4 Il i , City of Tigard i v t(�,1 W1 -'-
Sewer perm no.: Building permit no.: II
'► " Address: 13125 SW Hall BjI ; \T igard, L OR 97223
City of Tigard Phone: (503) 639 - 4171 c� Project/appl. no.: Expire date:
Fax: (503) 598 - 1960 w ' ttga0Z e' �� �s Date issued: Bl& Receipt no.: V ti ii � .*s Case file no.: Payment type:
Land use approval: � L .i_� d �`' r � y yp
mites 3 *011MU v=
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
st New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
• JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: ( 14..co J 1443v 50 61-e_e..1-( (2E L Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: 1 S (( 3,� ,CRl t 4 O '3 # ( Soo SFR (1) bath
Lot: '^ I Block: — I Subdivision: SFR (2) bath
Project name: ES Ai- e S T - S SFR (3) bath
City /county:" cjts,d / (4111.1- 1 ZIP: 4i 7:2-3 Each additional bath/kitchen
Description and location of work on premises: Site utilities:
4-liz: e t4.4. 'D t.cz t.., Catch basin/area drain
Est. date of completion/inspection: - 11- q ( O 2- Drywells/leach line /trench drain
i'''. �PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
■ Manufactured home utilities
Business name: $coil tit( $,0tt,.1:.-S Ece-kuc iNo :.. C . Manholes ,
Address: 2.. e h g ..t1 Scam (l S- rite.- d tzx.Lg, Rain drain connector
City: G e.. I State:p - I ZIP: '. t4.( o Sanitary sewer (no. lin. ft.)
Phone: to 2S l (e t I I Fax: to 2-$ 3 c s o I E -mail: Ita.ne (02 e9l-e .net Storm sewer (no. lin. ft.) 77s
CCB no.: 6 l q 1 I Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lic. no.: Coo° 3S 14 fl e-!`rIZo C- 4- c- e44-5e Fixture or item:
Contractor's representative signature: (,k,,,i,- Absorption valve
Back flow preventer
Print name: "D (eL-t $e v VI ( it : 7 t a z Backwater valve
CONTACT I'ERSON Basins/lavatory
Name: — Doti - Be ry j IA t I t Clothes washer
Dishwasher
Address: 4 S c b o U e Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: ZOt? 4 332- Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): Sct.vt,e%S d 164. 1 S 44 le Floor drains/floor sinks/hub
address: Garbage disposal
Mailing �(oo Sry �u rv. -. Hose bibb
City: TIsye.'v' 1 I State:012-- I ZIP: ci 1 -2.z'.( Ice maker
Phone: 3U $o4 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 i Tubs/shower /shower pan -
Urinal
Name: vv is - W. cOtcpu..1Q 5( ((-. e. u_akC.s Water closet •
Address: ('Z 9u.) 4.-t( '(._c4. Water heater
City: Ti 4.'�A I State: U2. ZIP: q 1 2 - 13 Other:
Phone: ( - 4 3 4 s 3 I Fax: 4 31 12.3 2 E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at _ %) $
❑ Visa ❑MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been
TOTAL $
Name of cardholder as shown on credit card
accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00/COM)
•
1
, •
PLUMBING PERMIT FEES: ‘ :(
'e
FFticr; . r.:11 - grAL::u
FIXTURES '(i r nifiiiiiit.ial) i-CITY::A ..7",kr(ea)%,,,.14MOUNT},:„ (irdltide*alli3O1.0010:6 t i ; ,,. , ' PRIC,E. --IOTA(
Sink 1660 Alie*Veliiiii*idte,,firaf:i88* • : 'ply . (4y i .
,., , .
Lavato 1660 .fOieardiiIitilitk,?..doiineCiion)
ry
.
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 '',‘ ;:i.:,'„. ; ,':.'-' „-, ' '. ,01.-'"A "-QuantitY Performed.,
Gas piping requires a separate mechanical Fixtute`Type:" , New ' .Moved r 'Repladed , ; '
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
l 0-A&A A.-P -e_- 2 .... 16,6 t 3-4 A0 Laundry Room Tray
i. :,, 0 0 Washing Machine
. - !
Floor Drain/Sink: 2"
Sewer - 1st 100' i 00 55.00 Al 3"
Sewer-each additional 100' 155 46.40 '- . 6, , 4 0 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
1 16.60 i i LA
"e tu - •
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 -,-, -,,, -q-,„ ,%,-, ,
Isometric or riser diagram is required if
Quantity Total is >9
*SUBTOTAL
8% STATE SURCHARGE ..:',,, :`,.';:-,'':,''t
/3 i 13
- _
**PLAN REVIEW 25% OF SUBTOTAL ,, A:Y.7!' ' Li i i A .
Required only if fixture qty. total is >9 :, 'V' '1 -',,: %:::.! / l I 1 v
TOTAL :1:','
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow g / .
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:Vists\forms\plm-fees.doc 12/26/01 .7