Permit i CITY OF TIGARD PLUMBING PERMIT
Al k ` D E SERVICES PERMIT #: PLM2002 - 00459
Ai_ I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DA TE ISSUED: 11/26/02
SITE ADDRESS: 07330 SW LANDMARK LN PARCEL: 2S112AB - 00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Back flow preventer
FEES
Owner:
Description Date Amount
SUMMIT PROPERTIES INC
4444 NW YEON [PLUMB] Permit Fee 11/26/02 $72.50
PORTLAND, OR 97210 [PLUMB] Permit Fee 11/26/02 $0.00 •
[TAX] 8% State Tax 11/26/02 $5.80
[TAX] 8% State Tax 11/26/02 $0.00
Phone 1:
Total $78.30
Contractor:
LARSEN + SONS PLUMBING CO.
7800 SW 36TH AVE.
PORTLAND, OR 97219
REQUIRED INSPECTIONS
Phone 1: 246 - 7004 RP /Backflow Preventer
Reg #: MET 00004370
LIC 37650
PLM 26 -281PB
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 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued By: / � Permittee Signature:
Call (503) 39 -4175 by 7:00 P.M. for an inspection needed the next business day
-\.BuildingFixtures
Plumbing Permit Application OFFICE USE ONLY
Date received: /j l,2 CP/0 `)._ Permit nof(.'fl 2.0 —oz 'S7
Cit of Tigard
. Y 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 0 Commercial /industrial 0 Multi- family ❑ Tenant improvement
❑ New construction 0 Addition /alteration/replacement 0 Food service ❑ Other:
JOB SITE INFORMATION - FEE SCHEDULE (for special information use checklist)
Job address: 73 ? C) ;7,c.1 /Q/ti M /12 A 61 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: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on P premises: T4 // Site utilities:
R,4 (1�� /o (k) 71.77
J F e_eL41-- 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: / 4g sC'") t 50 Ai P Manholes
Address: ' 3 7 SLV ,S Rain drain connector
City: AA-,--/ I State: liIZ ZIP: q 72i9 Sanitary sewer (no. lin. ft.)
Phone: Z96 1 I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: 3 7G 5 -0 I Plumb. bus. reg. no:7 6 -Z, &/ (.,B Water service (no. lin. ft.)
City /metro lic. no.: 41.3 7 D Fixture or item: .
Contractor's representative signature: a -� Absorption valve
Back flow preventer f
Print name: --", , ' „ ,A/ he 47:1/ Date: /14 GI— Backwater valve
CONTACT PERSON Basins /lavatory
Clothes washer
Name:
,el -e. Q S ,a66v., Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
'.i K , 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
ENGINEER' Tubs /shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: State: ZIP: Other: .
Phone: I Fax: E -mail: Total
t credit cards, please call jurisdiction for more information.
Minimum fee $ -5-62 Not all jurisdictions accept P Notice: This permit application Plan review (at %) $
l7 Visa — 0 - MasterCard - - - — expires if a- permit -is- not - obtained u
Credit card number: / / within 180 days after it has been
State surcharge (8%) .... $ 9
Expires Ex i
Name of cardholder as shown on credit card P accepted as complete. TOTAL $ Q
$
Cardholder signature Amount 440 -4616 (6 /00 /COM)
PLUMBING PERMIT FEES
PRICE 'TOJTAL NovAyaiid.;g4ojivA*eijintisfoilty::: > -
4 FIXTURES, (individual) QTY . AMOUNT (inidesIl plumbing fixtures in PRICE TOTAL
Sink 16.60 "theszWellitid :andlitie,fii*tiObtf( ;'AmOuNT
Lavatory 16.60 -
foreachutilitli7corinecticiri)
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 - t-,Quantityty WorkRe o m
Gas piping requires a separate mechanical qN!00d RepIcd 0
permit.
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
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 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
Quantity Total is >9
*SUBTOTAL
.317zI-11
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL
•
Required only if fixture qty. total is >9
TOTAL $
<kg
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** A I I New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts\forms\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 Requ - ted / AM PM BUP
Location Suite MEC
Contact Person Ph ( ) / PLM
- oo V
,
Contractor Ph ( ) 2 T 6 ' - 70 o ? / SWR
BUILDING Tenant/Owner l � ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 1 j / SIT
Post & Beam
_
Ext Sheath/Shear
ea th /S r) /� „` , `24 6_2, �/�
Ext eah/hear y�.� (,.�► `!� ✓/
Int Sheath/Shear / / /
4,
Framing . 4L -co ,rr
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling /
Roof /
Other:
. Final
PASS PART FAIL
PLUMBING
Post & Beam •
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: '
i
AS PART FAIL
HANICAL
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: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date / Inspector 1 7 7 */ f ✓ Ext
Other:
Final 0 NOT REMOVE this inspection record from the job site.
PASS PART FAIL