Permit CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2001 -00158
t �� h DEVELOPMENT SERVICES DATE ISSUED: 4/18/01
13125 SW Hall Blvd., Tigard, OR 97 (503) 639 -4171
SITE ADDRESS: 06955 SW LOCUST ST MODEL HOME PARCEL: 1S136AA -09300
SUBDIVISION: $ NQ@JRA ESTATES ZONING: R -4.5
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 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: Installation of irrigation backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
WINGATE CORPORATION PRMT CTR 4/18/01 $36.25 27200100000
15840 S POPE LANE 5PCT CTR 4/18/01 $2.90 27200100000
OREGON CITY, OR 97045
Total $39.15
Phone 1: 503 - 657 -3300
Contractor:
I M PLUMBING
411 HARNEY WAY
VANCOUVER, WA 98661 REQUIRED INSPECTIONS
Phone 1: 310 -2083 RP /Backflow Preventer
Reg #: LIC 115262 Final Inspection
PLM 37 -357pb
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: Permittee Signature: 74 / ay--T- /0
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
1 Datereceived: /j�/ /0 / Permit no.: Poi to0/-60 /5f'
,�
.} ` City of Tigard
J � 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: byfrtifeceipt no.:
/lsra000 - ZOO yy9
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
K New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address:G' 55 6 L - st Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
Tax map/tax lot/account no.: 5 '3( ( - o9 10 0 ( S F R (1) 100 •foreachutilitycoonection)
Lot: ('1 IBlock: !Subdivision: \(.61Tppil - f-i SFR (2) bath
Project name: SFR (3) bath
City /county: Teo-¢b I ZIP: ci ZZ3 Each additional bath/kitchen
Description and location of work on premises: 1..4 fT" -r `.) Site utilities:
T .- t 6 ( IN7\cr4 S 4 c. 1' vy1 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: '$; M , PLA3 M gt t„Ct Manholes
Address: H J t } e-t, wink{ Rain drain connector
City: VA n ► czo q I State:tj.3 I ZIP:q((66 1 Sanitary sewer (no. lin. ft.)
Phone:360.613 -51111 Fax: 1E-mail: Storm sewer (no. lin. ft.)
CCB no.: t j 5262 'Plumb. bus. reg. no: 34 -356 Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer /
Print name: ESco latErt` 0 • I t 0 t Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: 'State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): GO/4/64 C�j° Floor drains /floor sinks/hub
Mailing address: / 5-71/4, s /� zA) Garbage disposal
Hose bibb
City: %N c ' cr y I State: Q/Z1P: 9 74 . Ice maker
. 5 4 3 Phone: ( 5 7 -) [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: I State: I ZIP: Other:
Phone: !Fax: 1E-mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information Minimum fee $
Not This permit application Plan review (at _ %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $ r e'2 • 9 V
within ithin 180 days after it has been TOTAL $ c7 9, 4.5"
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 1 and 2- family dwellings only:
FIXTURES (Individual) QTY , (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavato _ 16.60 for each utility connection)
�' 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 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
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 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
Other Fixtures
Water Service - each additional 200' 46.40 (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
8% STATE SURCHARGE
*`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 $36.25 + 8% state surcharge. .
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
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