Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2002 -00231
A k a - A l DEVELOPMENT HO BMEN9 Tigard, SERVICES 639 -4171 DATE ISSUED: 6/19/02
SITE ADDRESS: 09889 SW PIHAS CT PARCEL: 1S135CD -09400
SUBDIVISION: JACOB COURT ZONING: R -12
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR 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 backflow prevention device for irrigation system.
FEES
Owner:
Type By Date Amount Receipt
TAYLOR, DONALD S + DEBORA MAE PRMT CTR 6/19/02 $36.25 27200200000
9889 SW PIHAS CT 5PCT CTR 6/19/02 $2.90 27200200000
PORTLAND, OR 97223
Total $39.15
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: RP /Backflow Preventer
Final Inspection
Reg #:
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 thr• _ .h OAR 952 - 0001 -0080.
You o IN opies of these rules or direct questions to OUNC by ' ailing 503 246 -1987.
Af .
Issu B ! �� / / d e Permittee Signature: A 111
Call (503 639 -4175 by 7:00 P.M. for an inspection needed the next business day 1
o..
PlumbingPermit Application
Date received: , /�Jd� Permit no. i , X 23
4•"#. =- i , City of Tigard
- A � City Sewer pem»t no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: 4 e date:
Fax: (503) 598 -1960 Date issued: 1 % 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 ❑ Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: (1/58/ 5 ; q s G Descrt'tion 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: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: "ti fy4 fA I ZIP: 17)43 Each additional bath/kitchen
Description and location of r on r ises: Site utilities: -
l'l Sta l I APS(4Q/1+ill w I f()7a !6A Catch basin/area drain
` Est. date of completion/inspection: -, 1 n Drywells /leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: ,l Manholes
Address: Q 60 /V - Rain drain connector
City: I State: I ZIP: Sanitary sewer (no. lin. ft.)
Phone: I Fax: 1E-mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer .
Address: Dishwasher
: State: ZIP: Drinking fountain(s)
City: I I Ejectors/sump
Phone: Fax: E -mail: Expansion tank .
OWNER Fixture/sewer cap
T (gy Floor drains/floor sinks/hub
Name (print): Dena 11 Garbage disposal
Mailing address: q �(q St-) p�haic Hose bibb
a
City: Tl jc � r c !State: p& I ZIP: 4 ? S 3 , maker
Phone: S3 JJ -(,off T Fax: I E -mail: Ot ireloq O�jdtftl II nterceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me 0 ,n aintenance and repair made by my reg lar Roof drain (commercial)
employee on the pro o , s r - • RS 1 apter 447. ' Sink(s), basin(s), lays(s)
Owner's signature: .A4 • / : 11 ate: 6 r . • Sump
ENGINEER Tubs/shower /shower pan
Name: Urinal
ame:
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. Notice: This permit application Minimum fee $ C 10 •as
❑ Visa CI MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / State surcharge (8 %) .... $ A . 90
Expires within 180 days after it has been
TOTAL $ 0 5 . J
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
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
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.
** All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
is \dsts \forms\plm - fees.doc 12/26/01
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
•
INSPECTION DIVISIQN Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1 o Z AM PM BUP
Location 9'5??? g -aGr;GQO Suite MEC
Contact Person Ph ( ) 6 d 3 PLM v —00 , 3
Contractor Ph ( ) SWR
BUILDING • Tenant/Owner ELC
Footing
Foundation Access: ELC
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 Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Othe 7 /
Final
PASS PART FAIL
PLUMBING
•
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan t
Other: •
n
PART FAIL
7a" ANICAL
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 reinspectio RE: Unable to inspect — no access
Fire Supply Line C
ADA /
Approach/Sidewalk Date l Inspector Ext
Other:
Final DO NOT EMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour ,
BUILDING Inspection Line:; (503)639 -4175
INSPECTION DIVISI9N Business Line: (503) 639 - 4171 ST
BUP
Received Date Requested 7 / � AM �s PM BUP
Location g $1 f c � .[ ✓� Cy,- Suite MEC
Contact Person Ph ( ) O 3 9 3. pLM
Contractor Ph ( - 6 SWR
BUILDING Tenant/Owner ELC
•
Footing
Foundation ELC
Ate
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear 5Z(Q 1'( `-
Framing T `
Insulation
Drywall Z4
Drywalwall Nailing
Firewall
Fire Sprinkler
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 i3 F.-
Other
PASS PART F L
MECHANICAL
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: [] Unable to inspect - no access
Fire Supply Line
ADA / ' </ d "//- � //
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL