Permit CITY OF TIGARD PLUMBING PERMIT
1 DEVELOPMENT SERVICES PERMIT #: PLM2002 -00359
491 . ,� I I DATE ISSUED: 9/10/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12830 SW PACIFIC HWY PARCEL: 2S1026D -01701
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: OOA JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 4
OCCUPANCY GRP: M 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 (4) commercial backflow devices.
FEES
Owner:
Type By Date Amount Receipt
DAVIDSON, WILLIAM G + DIXIE L PRMT CTR 9/10/02 $185.60 27200200000
8915 SW COMMERCIAL 5PCT CTR 9/10/02 $14.85 27200200000
TIGARD, OR 97223
Total $200.45
Phone 1:
Contractor:
AMERICAN PLUMBING SERVICES INC
5905 N INTERSTATE AVE
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone 1: 289 -6498 RP /Backflow Preventer
Reg #: LIC 151062 Final Inspection
PLM 26 -567PB
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 ay obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Iss ed By: 1� �` �/ �/�///1' ' Permittee Signature:
Call (503 • - ' -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
• Plumbing Permit Application OFFICE USE ONLY +-�
Date received: 9/0 9-- Permit no.: l ' 5
,,„. City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PER1IIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: / 2 e .30 S . I.J, 1 f'• C. t si t Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New I- 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 premises: Fa4 r Site utilities:
3 ..c. x. (Jo w v / U d 5 Catch basin/area drain
Est. date of completion/inspection: , s C '/uledi •+ . . .jWV Drywells /leach line /trench drain
PLUMID'ING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: _ ; , . - _ At Manholes
Address: A 9 PS' N. .2 • S JJd' qvd Rain drain connector
City: "1.1' Age, el State:-.• ..j ZIP: 9 7, 7 Sanitary sewer (no. lin. ft.)
Phone:- a, y9i'ax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Pl,bus. reg. no: Aeg - 147 Water service (no. lin. ft.) City/metro lic. no.: /5 / 000 ( 60 94 ,30/0 `y
Fixture or item:
Absorption valve
Contractor's representative signature: �� MA S Back flow preventer /5;-'4°f)
Print name: Date: Backwater valve
CONTACT PERSON Basins /lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E - mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): 6 re . i ✓
i Floor drains /floor sinks /hub
Mailing address: I 2 >� ;p .r. &J. AweiijC y Garbage disposal
Hose bibb
City: Tt` fc. o'd I Stateai ZIP: 972 2 3 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 J
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other: ,
Phone: Fax: E -mail: Total
Minimum fee $ q . #0
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at u %) $
Credit card number: _ / / within 180 days after it has been State surcharge (8%) .... $ 1 {' 7
Expires TOTAL $ � 1.
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
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 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 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
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 2 sets of plans with isometric or riser
diagram for plan review.
l: \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 Requeste // / AM PM BUP
Location 1 R3 Suite MEC
Contact Person Ph ( ) c.Co D —1 T7J PLM
Contractor Ph ( ) SWR
pa BUILDING Tenant/Owner / 4 —COP) S 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
Drywall Nailing
Firewall
Fire Sprinkle
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 ,
Oth: •
4 0? PART FAIL
CHANICAL
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: El Unable to inspect — no access
Fire Supply Line
ADA •
Approach/Sidewalk Date Inspector Ext
Other: l am°
Final 0 NOT REMOVE this inspection record from the job site.
PASS PART FAIL