Permit .� CITY OF TIGARD PLUMBING PERMIT
, Ak ;, D EVELOPMENT SERVICES PERMIT #: PLM2002 -00136
- - ' 41-1 ' - ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/3/02
SITE ADDRESS: 08260 SW HUNZIKER ST PARCEL: 2S101BC -02100
SUBDIVISION:, ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B 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: 18 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 18' of pvc pipe with copper.
FEES
Owner:
Type By Date Amount Receipt
ANNAND, JOHN D II + EDNA N PRMT CTR 4/25/02 $55.00 27200200000
8260 SW HUN RD 5PCT CTR 4/25/02 $4.40 27200200000
TIGARD, OR 97223 7223
Total $59.40
Phone 1: 503 - 620 -8668 •
Contractor:
EARL WISDOM
3966 NE GARFIELD
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone 1: 503 - 528 -9551 Water Line Insp
Reg #: LIC 122960 Final Inspection
PLM 26 -620pb
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.
/-2 r
Issued By: et ,i,:t -ems _1 /1_, Permittee Signature: � �� ?� Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
A Plu. mmHg Permit Application
a g Datereceived: a < Z Permit no.P( V?
11 � ,� -00/ ► &
, City of Ti aryl
A- . � City 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. a 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 0 Addition/alteration/replacement ❑ Food service ❑ Other:
.JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Description Qty. Fee(ea.) Total
Job address: a( s w 14(2 N 21 ►� �'Z New 1- and 2- family dwellings only:
Bldg. no.: I Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
_ 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: g O [,) 15 YbrYM P 4 Manholes
Address: '-a.240 c , /yam' t✓- Et g2--,C) Rain drain connector
City: 7 I State ZIP: 9 - a Z Sanitary sewer (no. lin. ft.)
Phone:82 ? .57k. 8561 Fax: E -mail: Storm sewer (no. lin. ft.)
CCB no.: ta:y...9 (o-Q I Plumb. bus. reg. no: r 6,.-0P2) Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature:�,a/,. Absorption valve
Back flow preventer
,e Print name: e e ii//5°D s ,,� Date: - - t� Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer -
Dishwasher
Address:
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER - Fixture /sewer cap
Name (print):. Floor drains/floor sinks/hub
Garbage disposal
Mailing address:
Hose bibb
City: I State: I ZIP: 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
- l Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: 1E-mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information.
Minimum fee $ `� .46
p p � N otice: This permit application
❑ Visa O MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ ' `/. O
Expires TOTAL $ 5 , r i�
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
PLUMBING PERMIT FEES: '...,..-- . ,..,
•.
1?.RIP91:, !Now;tarld52.fiiiii!if,
1 F.IXTURESAindiVidLialF --- .-,i "••• o'"-.-AMOUNT A - - - i9,06104*yiiii.Ifibliiii4iittire0G:g;',,,,.a ',IR 40717AL*-4,
..„.•.,.., - - -
Sink 16.60 Itle7dvfelling -: " , , :OW (04) • : AMOUNT
Lavato 16.60 foreadhlitilitY:'..co.nnectrori)..: ...!= •,, • i. -.., '- -`, • - 4 . •1, „",. ' " . ,
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 '-: .,"-,-•., i - •.-..- '-
Urinal 16.60 8% STATE SURCHARGE i-`,' , ..• , ' -''
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 , .•-,- ,;', ,'. :-• '. - - < :QUantitlay Work Performed
..
Gas piping requires a separate mechanical Fixture Type ''.. 'tNeint" 'Moved 2 Replaced 1Farncivect/
. , , , A .
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 .
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 t;i5 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 62.50
Requested Inspections ' per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL .
,,*-A,4;6.
Isometric or riser diagram is required if •;; 4:0*-1'::10-..: ,:,,,.; , ,, , t,- --,,, .,,,,,,,,-
Quantity , :;V;;01!":1!.45 . ‘.5':COZ ,1, ;;
"SUBTOTAL
8% STATE SURCHARGE
-/ . LI , I
'-'rO
**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 $86.25 + 8% state surcharge.
** All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
BdstsVorms\plm-fees.doc 12/26/01 •