Permit •
CITY TIGARD PLUMBING PERMIT
ik DEVELOPMENT SERVICES PERMIT #: PLM2000-00438
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/4/00
SITE ADDRESS: 0944 SW LOCUST ST PARCEL: 1S126DC -04900
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace existing bar size sink with new full size sink.
FEES
Owner:
Type By Date Amount Receipt
BBH INVESTMENTS PRMT CTR 12/4/00 $72.50 27200000000
9445 SW LOCUST 5PCT CTR 12/4/00 $5.80 27200000000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
CANYON PLUMBING + HEATING
8101 SW NIMBUS AVE #11
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone 1: 646-5096 Top -out Insp
Reg #: LIC 4219 Final Inspection
PLM 34 -317pb
•
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
NotificatiCenter. 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.
.411111 nA
/
Issued �l'� 'O�LI __ Permittee Signature: � v
Call (503) -.39 -4175 by 7:00 P.M. for an inspection needed the next business day
r_ Plumbing Permit Application
Date received: A - /00 Permitno.: Ap ® ` s '3
. C of 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 Cl Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address:
Ctt..-11..1 5 . 1 DC US k_ 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: • . C . SFR (3) bath
City/county: '' �.f 10 1111, ' Each additional bath/kitchen
Description and location of work on re ises: Site utilities:
' i N))// �i mt� 12(ti( Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. din. ft.)
Manufactured home utilities
Business name: CANNNelJ 6 \)M�1 p0 Manholes
Address: No , U l . 1N) l M e ) Jr 1 ` I Rain drain connector
City: /�Ur -(j — ^) State:OE, I ZIP: Cr( Sanitary sewer (no. lin. ft.)
Phone: 0t.1 (? -s b Fax:( 1 T7 E -mail: Storm sewer (no. lin. ft.)
3 �- _ p 6 Water service (no. lin. ft.)
CCB no.: y a l ej I Plumb. bus. re g . no: 1 _
City/metro lic. no.: Fixture or item:
Contractor's representative signature: ►) AI - Absorption valve
Back flow preventer
Print name: G i • _ _ — — _! Date: it J. $ - Backwater valve
CONTACT PERSON Basins/lavatory
Name: WI C ,r teiz )rte Clothes washer
Address: NCj\ •_.w. Nin'Z t�4 Dishwasher
Drinking fountain(s)
City: j ) . State: GC ZIP:9:10( -) Ejectors/sump
Phone: a . • • _ 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) 1
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name:
Water closet
Address: Water heater
City: State: I ZIP: Other:
Phone: Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Z92_6"-P___
Notice: This permit application Plan review (at %) $ S . O 0
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires TOTAL $ 7C • W
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
PLUMBING PERMIT FEES: •
_ ;' 8`" , N. ;PRIC ,TOTAL:' New:,4 "and 2=family<dwellingo only:;'.: , ; =° w ;°'
'-FIXTURES. (individual) ° , QTY .11,(ea); AMO U NT- "`(includes all plurfbing iri -. PRICE <# TOTAL ; _ -
Sink 16.60 ,the dwelling and Itne, first400 ft , . , QTY (ea) ;AMOUNT
Lavatory 16.60 - for._each`.utility connection) '4 ' -, F .- ^ '
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" 166.660 0 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 '''- . - ` ; Quantity by Work'Perfdrmed .,
Gas piping requires a separate mechanical Fixture Type:7'' , : 1"New Moved. ';Replaced, : Renio "ved/
P 9 q P _ - :. 3 .71 , 1 1 1 « _, - "`Capped .
permit. w " �� � ' "^ _ . ro �
MFG Home New Water Service 46.40 Sink I
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 'z'._�
Quantity Total is > 9 :2, , ,w = l '
*SUBTOTAL ' y" 4 M '= , >;,i
8% STATE SURCHARGE .. :'.' :'Qi < :_ rn `'-
**PLAN REVIEW 25% OF SUBTOTAL '' <-''A.' s ° ":..'"' ", ' ::
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.
* * AII New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm- fees.doc 10/10/00 •
II 11 Accumulative Sewer Tally
Tenant Name: t�oLZ(ofrt CO • • This SWR# N I/ //
Address: / c ' , 4 7 • -dd.( 5' This PLM #: 9 - — ooq 3
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 .
Baptistry/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) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
' Shower - Gang (Per Head) 1
w - Stall 2
Sink - Bar /Lavatory 2 / 9.
- Bradley 5
- Commercial 3
•
/ 3
- Service 3 •
Swimming Pool Filter 1
Washer - Clothes 6 •
Water Extractor
• 6 i.
•
•
Water Closet - Toilet 6
Urinal 6
TOTALS
3 Z-
Total fixture values: 3 divided by 16 = 4P.O0 EDU g
HISTORY E� ` S ,a 0 _ � /. _ hr) �v',d _ �C
W # PLM# EDU# S R#
PLM# EDU# S R
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:\dsts\swrtaly.doc
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP i t #
Date Requested �Z-- 2--e) AM PM BLD
Location 9 CI'S 5 w GGC u 5 Suite MEC
Contact Person v /d Ph j03 2- (-1- 37 ') PLM '/3S
•
Contractor Ph SWR
`BUILDING•= Z1 Tenant/Owner ELC
•
Retaining Wall 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
Firewall
Fire Sprinkler .
Fire Alarm
•
Susp'd Ceiling
Roof
Misc: .
Final
PASS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
PART FAIL
•
Post & Beam
Rough In
Gas Line • • -
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL,; „” u °:
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 Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date /.2 /
O OC1 Inspector V Ext
Other
Final
PASS PART FAIL DO NOT REMOVE -this inspection record from the job site. •