Permit ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00237
�• I� DATE ISSUED: 6/24/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 08485 SW HUNZIKER ST PARCEL: 2S101BC 01000
SUBDIVISION: KNOLL ACRES ZONING: R - 4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: E3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 1 GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Addition of bathroom and remodel of existing bathroom. Adding (1) water closet, moving (1) lavatory, and
capping (1) water closet and (1) urinal. No change in EDU's.
FEES
Owner:
Type By Date Amount Receipt
CLICKENER, ROBERT R + PATRICIA PRMT CTR 6/24/02 $99.60 27200200000
13855 SW PACIFIC HWY 5PCT CTR 6/24/02 $7.97 27200200000
TIGARD, OR 97223
Total $107.57
Phone 1:
Contractor:
NORTHWEST PREMIER PLUMBING
P.O. BOX 23338
TIGARD, OR 97281 REQUIRED INSPECTIONS
Rough -in Insp
Phone 1: 503-624-0582
Reg #: LIC 135022 Insp existing /capped fixtures
PLM 34 -348PB 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.
Yo may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Is ued By: L 'L�� d 1 Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1 Plumbi P ermitplic ' on / /
•
C Date received:(p A Op- Permit no. • S -co 37
�1 c , City of Ti and
g Sewer permit no.: Building permit no.:
" Address: 13125 SW Hall Blvd , g , d, OR 97 23
City of Tigard Phone: (503) 639 -4171 iLI LUUL Project/appl.no.: ,.Expi :date:
Fax: (503) 598 -1960 CD ' U j; I Al. Date issued: 111I2 Receipt no.:
NEN
Land use approval:B 0 DDS OP Case file no.: Payment type:
`` TYPE OF PERMIT '
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction tti Addition/alteration /replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
r ,- ? - ? J k z e
Job address: _� SK 2. Description Qty. Fee (ea.) Total
( r� F4 1 6:F44a ei a6 q5 Lf 5tt New d -and 2-family each c
dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: 7_ ,I) o/ •3 C - O / 000 SFR (1) bath
Lot: O ' 5" !Block: I Subdivision: KN 61.L / sZ 5 SFR (2) bath .
Project name: -� .-p C /-koL,, SFR (3) bath
City /county: — e--9 t I ZIP: L 1 7_23 Each additional bath/kitchen
Description and location of work on premises:az7aD --J Siteutilities:
0 F.-3 m, p p i p r E'yt,.7.:4i1 - atch 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: r di,ti . ,,/ M/ u ii/L - Manholes
Address:Pe Rix a?333g Rain drain connector
City: 4r.ey State: ZIP: Z,291 Sanitary sewer (no. lin. ft.)
(�� Phone:�j j -( Fax & . q p E -mail: Storm sewer (no. lin. ft.)
'P CCB no.: /3572,2 I Plumb. bus. reg. no: 34e _34 .. Water service (no. lin. ft.)
City/metro lie. no.: /U g-" % -U/ y .o -o Fixture or item: •
A/ �� /ma Absorption valve
Contractor's representative signatuji Back flow preventer '
c'7 Print name:, /, / , A? Date: b ,RY 1,,2 Backwater valve
CONTACT PERSON Basins/lavatory
Name:3. g C L� -) E{Z Clothes washer
Dishwasher
Address: j o S 1 *q C
�`` Drinking fountain(s)
City: Vii Zbj o I State:a(L I ZIP: , 7 7...211 Ejectors/sump
Phone 5 0* -7 Fax? _toyer E- mailt' °^Lk'L Expansion tank
OWNER Fixture/sewer cap
Name (print \.'� b. " y . lit_ c.. -ej L Floor drains/floor sinks/hub
Garbage disposal
Mailing address: f 2 19 i(p 5(,,.) / g e , Hose bibb
City: ���2.p 'S tate: U ZIP. 7ZZri Ice maker
Phone-5 3 `.( FaC U -5, -/ . E- mail:Cd 'r 4-4 ' 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 3
Address: Water heater
City: I State: I ZIP: Other: • '
Phone: 'Fax: 1E-mail: Total [p
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ l / //
Notice: This permit application plan review (at %) $
CI Visa O MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $ 7 . Q
Expires Ex within 180 days after it has been
p accepted as complete. TOTAL $ /D
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
„ .
„ -
PLUMBING PERMIT FEES: .
,
::,!,;: --, .,- -
, oTm.., f Nqlin,r!-VMjdi2tfaqilly4clyy:011!ri:fp-',p:nly: ,7. :T._:
VEYtio'REt•'(iiiiillidiNr * ' - -,-;- 4, '1'.•`.. - - - -= 4 . ''''' : VAMOON:Tr' - IRiCliicre:0 ':---- - 7 IRIC
': - -
Sink 16.60 ,ite'ticivielking:and , QTY •:.;:(0 77
);.; A ,A
Lavato 16.60 -
.foreacti cOrinettton)' ' '::
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 •., •S 7,- , g•.;',., ' ' ' 4,,,:',; . 4:, , 1Quantitijr:..by Worl(Perfocmed, •- -
Gas piping requires a separate mechanical Oiik6re;'ityitia:' 'i `,,„- r ,-- RepriCetr Reinbiied/
permit. - ,., l'Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory / .- -* • i•
Tub or Tub/Shower .-
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet <4.,
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 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
,
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 ,„ * „.N.;,.; r...,N, „,,
Isometric or riser diagram is required if
Quantity Total is >9 : --:-....-,,..-:,
*SUBTOTAL t;,„,";:i, !' ': ' .-.' .,:::4:41t:',
:1--•''' '
8% STATE SURCHARGE r- -- -- '7; , ' , . , •;', '','.7-4111:
- - -
**PLAN REVIEW 25% OF SUBTOTAL ;'." ,!•'-..--.
Required only if fixture qty. total is > 9 , 'Q ' -,. ':
TOTAL ;->:::;';':: :::: 7 :' ' $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25+ 8% state surcharge. '
** Ail New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
. .
iAdsts\forms\plm-fees.doc 12/26/01 '
. •
�a
Accumulative Sewer Tally
Tenant Nam ..---- e: 0 LdA/ )i. Ta`l, This SWR#
Address: "yk.` �� Al n j This PLM #: / 21 A - c0 a 3 7
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
Ba.tist /Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4 .
Car Wash - Each Stall 6
- Drive Through 16 .
Cuspidor/Water Aspirator 1 ,
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 ,
- 3 inch 5
- 4 inch 6
- Car Wash Drn 6 .
Garbage Disposal 16
- - Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 42
.._._,ice Machine /Refrigerator Drains , 1
Oil Sep (Gas Station) 6 .
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2 .
Sink - Bar /Lavatory 2 / 4 9 - / 9
- Bradley 5
- Commercial 3 ,
- Service 3 •
Swimming Pool Filter 1
Washer - Clothes 6 .
Water Extractor 6
Water Closet - Toilet 6 / , t A /,
Urinal 6
TOTALS
/(,0 l 4 / / / /
Total fixture values: / 6) divided by 16 = / EDU 9 /
e 04_,_
HISTORY e
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
is \dsts\swrtaly.doc
D ,Q h ee ��
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line:' (503) 639 -4175
INSPECTION,DIVISION Business Line: (503) 639 -4171 - MST
BUP
Received Date Requested 7-- 3 -L— AM PM BUP
Location 6 �S Sv /�C.- Suite MEC
Contact Person Ph ( ) �O 2 4 2 ( z z&iiz -!J 6 Z 37
Contractor Ph ( )
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation �J
Drywall Nailing /95 / � / / 7 // / /p\ 5%,K
Fi rewall
Fire Sprinkler
Fire Alarm (fit
Susp'd Ceiling
Roof
Other: •
Final
PASS PART FAIL
LOMB
os & Beam •
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
•. -;
Fi .�
` �>
F0 PART . FAIL
r ha•+'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 reinspection RE: n Unable to inspect — no access
Fire Supply Line
ADA �xc
Approach /Sidewalk Date ( u Z Inspector I( Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL