Permit CITY TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES • PERMIT #: PLM2001 -00021
( DATE ISSUED: 1/25/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 07805 SW HUNZIKER ST PARCEL: 2S1016D 00103
SUBDIVISION: ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: U2 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace (2) sewer ejector pumps.
FEES
Owner:
Type By Date Amount Receipt
H G M CO 5PCT CTR 1/25/01 $5.80 27200100000
BY NOFtRIS BEGGS + SIMPSON PRMT CTR 1/25/01 $72.50 27200100000
ATTN: BLAKE HERING
PORTLAND, OR 97204 Total $78.30
Phone 1:
Contractor:
METRO ROOTER & PLUMBING
BARRICH INC
630 1ST ST REQUIRED INSPECTIONS
GLADSTONE, OR 97027
Phone 1: 503-652-2626 Misc. Inspection
Final Inspection
Reg #: LIC 106824
PLM 3 -265PB
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 (5.3) ' 6 -1987.
Iss ed By: " / layjklek Permittee Signature:
Call (503) - 4175 by 7:00 P.M. for an inspection needed the next busin - • ay
Plumbing Permit Application
Date received: / Permit no.: g -00 50)
.. . b:*; ., City of Ti .
A- 1 �� City 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:
TYPE OF PERMIT '
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
_ JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: '71OS dW /-tt )J7--'9 `C� 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.: SFR (1) bath
Lot: (Block: ( Subdivision: SFR (2) bath
Project name: W i 1 _L(�1,4 in- t //J1> SFR (3) bath
City /county: ( ZIP: Each additional bath/kitchen
Description and location of work on premises: f_ - Site utilities:
a ge u)1J - t i._e_, fA- �e.J- 5 Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTQ I Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: M1- ' bT t. 2 •f' bit H Li 1J' _ Manholes
Address: Co ( fir Rain drain connector
City: kabotA - &Lj� 'State: 00_1 ZIP: Q 7a- 2-2.. Sanitary sewer (no. lin. ft.)
Phone: 51)5 - ( Fax:, (E -mail: ' Storm sewer (no. lin. ft.)
CCB no.: 1p (. 4_ ( Plumb. bus. reg. no: 3- 26)5/6 Water service (no. lin. ft.)
City /metro lie. no.: Fixture or item:
Contractor's representative signature: , 0 4 Absorption valve
Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address:
Drinking fountain(s)
City: ( State: ( ZIP: Ejectors/sump SuJG/L A /b.110 56. .
Phone: Fax: E -mail: Expansion tank .
OWNER Fixture /sewer cap
Name (print): Floor drains/floor sinks/hub
Garbage disposal
Mailing address:
Hose bibb
City: (State: 1 ZIP: Ice maker
Phone: (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: (E -mail: Total ��yy
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 1O'+'� U
Notice: This permit application Plan review (at _ %) $
❑ Visa 0 MasterCard expires if a permit is not obtained
b g0
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $ 7 ,5 3a
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 =1aariii7 = family dwellings`.only -Y . ,,,, °
s �. T7 W , A sit: , PRICE OTAL, ,:
FIXTURES (indi-vidual) . ",.r - ..QTY: �.(ea) i4MOUNT R (includes all plumbing fxtures m T-
Sink 16.60 ilv+eliing andttie= first700 ft QTY �<(ea) AMOUNT
16.60 `.fore,,eaah utility.cdnhecttori).' c = .:. ,., .
Lavatory 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 " -.'� :Quaritityby Wor k Perforrried, •
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 35 , 0.0 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 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
Quantity Total is > 9
*SUBTOTAL -5-0
8% STATE SURCHARGE . a
:, rt 5.
"*PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9 = a�
TOTAL ' : .' $7g. 3t
•
`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 plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm- fees.doc 10/10/00 •
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP «�W_ •
Date Requested / / AM PM BLD
Location 1J "2) 54) Suite MEC
Contact Person Ate( I Ph 61 ' Z Z ei PLM ,G U Z r
Contractor Ph SWR
BUILDING S Tenant/Owner Riei0J IA / s / 7 / ci C / . ELC
Retaining Wall ivy) 64'‘, I/4 fd COV'e"• — ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing 4 S (7)
iL�C�
Firewall
Fire Sprinkler . .
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
ost & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
- • •rains
• RT FAIL
Post & Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL.
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS . PART FAIL •
• Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA [�
A
(cpe___
pproach /Sidewalk Z T
Other Date Inspector- Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site: