Permit •
A ' CITY OF TIGARD PLUMBING PERMIT
�1i DEVELOPMENT SERVICES PERMIT #: PLM2001 -00069
- ''" �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/9/01
SITE ADDRESS: 09702 SW LONDON. CT PARCEL: 1 S135CD -05600
SUBDIVISION: LONDON SQUARE NO.2 ZONING: R -25
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 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: Replace gas water heater.
FEES
Owner:
Type By Date Amount Receipt
SHANNON, ARLEEN M PRMT CTR 3/9/01 $72.50 27200100000
9702 SW LONDON CT 5PCT CTR 3/9/01 $5.80 27200100000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
WRIGHTS PLUMBING
3725 SE OLSEN ST
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Phone 1: 503 - 449 -8418 Final Inspection
Reg #: LIC 129671
PLM 26 -645PB
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 - 008
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: J Permittee Signature: W
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b ness day
, • Plumbing Permit Application
� , Datereceived: /9 /p/ Permit no. "01.200/ -7nU6 9
City of Tigard Sewer permit no.: Building permit no.:
I I! Address: 13125 SW Hall Blvd, Tigard, OR 97223 gPe
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 /I C" Date issued: By.:4)9• I Receipt no.:
Land use approval: 11 E -OO7 — eoo.57 Case file no.: Payment type:
T\'PF OF PERMIT
)iir 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other.
3011 SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: et 70 a 6(,...) L ys. 0lo1 CT. Description Qty (ea.) Total
Bldg. no.: l 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: I Block: I Subdivision: SFR (2) bath .
Project name: SFR (3) bath
City /county: Ti c ' L I ZIP: q 12 3 Each additional bath/kitchen
Description and locion of work on premises: Site utilities:
. _ ■ . _ . fo 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: Lr) p., i e, N r S Pl�w..1n i Manholes
Address: 3'7 a s sr c I se Rain drain connector
m
City: It,,i _ I S tate• 3I�I Znx ,Z (7 2 .2 Sanitary sewer (no. lin. ft.)
Phone: '503 -74 y-f3Bli Fax: I -mail: Storm sewer (no. lin. ft.)
CCB no.: i 29 (p 1 Plumb. bus. reg. no: Q4,,,_ ( S p service (no. lin. ft.)
City/metro lic. no.:1 NO r 9rLnJE ep y op 3 D/ Absorption or ein:
Contractors representative signature: b oon
valve
� �/ Back flow preventer
Print name: 4 A ; , ` U.)1(.1 e. I D • ` • 3 - • _C' Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Name (print): 4 i t e - sH4 N AID
Floor drains/floor sinks/hub
Garbage disposal
Mailing address: . Soj — q -i oa 5(.0 Icm cr. Hose bibb
City: ^'f- l 9'*4,.. cA Stater, f I DP: et -00.A 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
ENG I N EER Tubs/shower /shower pan .
Urinal
Name: Water closet
Address: Water heater i ----
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: Total
Not all accept cept credit cards, please call jurisdiction for more information Notice: This permit application Minimum fee $ / ° • 5 <_7
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $ 5 Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ , PO
Expires Name of cardholder as shown on credit card
accepted as complete. TOTAL $ - 2 P, 2 O
$
Cardholder signature Amount 440 -4616 (6r00VCOM)
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
Lavatory 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
3" 16.60 PLEASE COMPLETE:
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
16.60 Urinal
Other Fixtures (Specify) 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 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.
** Ali New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:\dsts \forms\plm- fees.doc 10/10/00
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
P i s BUP
V1i g Date Requested — 3 f t AM PM l g
Location qlO 2 X6 r Suite M �1 lee ( — ma'gl
Contact Person I I C \ 4i1. Ph 3 -( D e 1d 5 4 0 -17
Contractor " " vUC�b ` c� 1 p qZ 2 - c1 Z.? SWR
BUILDING Tenant/Owner • LA) 0 ' — ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection •tes: n SGN
Slab �/ SIT
Post & Beam
Ext Sheath /Shear G-61.._•
•
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
P FAIL C
PLU I Try9.....,c '
'Pos & Beam
Under Slab /I_
Top Out
Water Service;
Sanitary Sewer' .
• I Drains
. tom `
FAIL 9 viy
: NIC: 1
Post : Beam v
Rough In ` ;"" -' - 1
. p■ Gas Line ,:'
Sm. ampers
, PAS •• PART FAIL
CTRICAL • ' •
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA , '3/ Approach /Sidewalk Date `9 ‘C 0 1 InS e cto r - E Xt 3 i
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.