Permit CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2000 -00390
.= `�' 'Y'I� DEVE H O B MEN 9 S
) 639 -4171 DATE ISSUED:
13125 SITE ADDRESS: 10685 SW PARK ST PARCEL: 2S103DA -03300
SUBDIVISION: DERRY DELL PLAT 2 ZONING: R -3.5
BLOCK: LOT: 036 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: •
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 50' of water service.
FEES •
Owner:
Type By Date . Amount Receipt
FURRER, ROSMARIE PRMT CTR 10/17/00 • $72.50 27200000000
10685 SW PARK 5PCT CTR 10/17/00 $5.80 27200000000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
MICHAEL + CO PLUMBING
P 0 BOX 23008
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone 1: 639 -3189 Water Service Insp
Reg #: LIC 000678 Final Inspection
•
PLM 26 -333PB
•
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 m obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issu B i Permittee Signature: J�
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day
"� Plumbing Permit Application
Date received: /0 "///% Permit no.: L.112000 -003 90
'''f 1 ; City C of Tigard
n.. `•t b Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expir ate:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
•
Land use approval: Case file no.: ment type:
TYPE OF PERMIT
ca I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction %I Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special inform ation use checklist)
Job address: 1 IS ( S Sk..73 •c \` gT Description Qty. Fee(ea.) Total
Bldg. no.: 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: I ZIP: Each additional bath/kitchen
Descciptioni and location of work on premises: Site utilities:
K tO W cA SAL" Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: (1(\ tuna • 4 CD 4 ww.. w - c ` Manholes
d
Address: -VD atif. a 3 DO E. Rain drain connector
City: - `j "i te I State:e i I ZIP: C7 / Sanitary sewer (no. lin. ft.)
Phone: (p i t -3 I eS I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: Lii x'1`1 I Plumb. bus. reg. no: 0 2 b -333 D 8 Water service (no. lin. ft.) SD 74.Cli•
City/metro lic. no.: 1a-$'S - Fixture or item:
Contractor's representative signature: I <10-....--e=0 Absorption valve
Date: / — i 7 — OD Back flow preventer
•
Print name:
1DG4 O t1 es 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): }2 pSQ YV1S - I - F -- -- 'r - 2� Floor drains/floor sinks/hub
Mailing address: / bb $3 Sv) Garbage disposal
Hose bibb
City: - CI:I A 0, 4. !State: 0 I ZIP: 4 ? Zz3 Ice maker
Phone: 1o35 Sha8 '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
Name: Urinal
Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ °�'
Notice: This permit application at %
0 Visa 0 MasterCard expires if a permit is not obtained Plan review ( %) $ tD
within 180 days after it has been
credit card number: / / State surcharge (8 %) .... $ S
Name of cardholder as shown on credit card Ex p fires accepted as complete. TOTAL $ . 3 O
$
Cardholder signature Amount 440 -4616. (6/00/COI4)
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
for each utility connection)
Lavatory 16.60 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
• 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.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm - fees.doc 10/10/00
CITY TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 - ,
/ J BUP
Date Requested /0 - (0 AM PM BLD
Location / b G 8 . Ar , 5 Suite MEC
Contact Person Ph 09 - PLM 7,gr GU,3r
Contractor Ph SWR
•
BUILDING 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
• :eam
Under Slab
Top Out
e er ervice
Sanifary Sewer
Rain Drains
Final
42 AS PART FAIL
ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
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
•
Approach /Sidewalk
Other Date / � l Inspector ExY "
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.