Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2001 -00597
jl DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 11/16/01
SITE ADDRESS: 08060 SW PFAFFLE ST PARCEL: 1 S136CD -00600
SUBDIVISION: SPRINT PCS WIRELESS MONOPOLE ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW • GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 4
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 7
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 700 ft
Remarks: Site plumbing utilities, Other fixtures are 6ea roof drains and lea manhole
FEES
Owner:
Type By Date Amount Receipt
EEI SOLUTIONS PRMT CTR 11/16/01 $571.00 27200100000
5665 SW MEADOWS RD, SUITE 300 PLCK CTR 11/16/01 $142.75 27200100000
LAKE OSWEGO, OR 97035 5PCT CTR 11/16/01 $45.68 27200100000
•
Phone 1: 503 - 294 -2150 Total $759.43
Contractor:
CR WOODS TRUCKING INC.
P.O. BOX 1488
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 503 - 625 -5242 Sewer Inspection
Reg #: LIC 123973 Sewer Inspection
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Final Inspection
•
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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
AkX.
i
Issued By: I "L Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
. 6-f f- iAtiw 7 .
Plumbing Permit Application 1111.111M1111.1111111.1= ,
1 g Date received: // $ D/ Permit no.: Wa2)/ -c 5 7
�• City of Tigard ° i `J 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: I Receipt no.:
Land use approval: Case file no.: Payment type:
C�
.�
❑ 1 & 2 family dwelling or accessory ommercial/industrial 0 Multi- family 0 Tenant improvement
A New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inform ation use checklist)
Job address: 80(00 SO QFPI FLEE -, Description Qty. Fee(ea.) Total
Bldg. no.: 1 Suite no.: New 1- and 2- family dwellings only:
Tax map/tax lot/account no.: 151 3(4 C.P (o � (includes bath foreachutilityconnection)
SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: G o ,J 9L,A2A Cirrf tCE LOG SFR (3) bath
City /county: IAe I ZIP: 9'122'3 Each additional bath/kitchen
Description and location of work on premises: _ Site utilities: '
S lire t 1T MAI' 1 DES - Catch basin/area drain
/- - — Drywells/leach line/trench drain
Est. date of completion/inspection:
Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: 02_ tococ, s Tau GK.1 x.16,_ I N G . Manholes
Address: PO etoX 4 4 9, is Rain drain connector
City: Slkti 12.1X101 I State: OR I ZIP: q f 1 4. Sanitary sewer (no. lin. ft.)
Phone: 5v'� -(a25 -52,4 ax: 351 -05 E -mail: Storm sewer (no. lin. ft.)
CCB no.: 123 Ii ' '' I Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lie. no.: Fixture or Item:
Contractor's representative signature: Absorption valve
C Date: 1. 5 tJ t Back flow p alve r
Print name:
�J¢.tCi M E7v1�1S Backwater valve
Basins/lavatory
Name: EQtG 1�tecuv.LSE� _Clothes washer
Address: ( 400 stn) fi Fiji • %t0 Dishwasher
City: P o't'Ct_ pc,.., I State: of_ I ZIP C112,01 ��IIg umptains)
S ' Ejectors/sump
P own Fax: 2 4-9115 E -mail: Expansion tank . dV Fixture/sewer cap
Name (print): C, tEti.O4 et°par" D" erAQ‘r Floor Garfiage s sinks/hub
Mailing address: $(0(05 SO EA - 'W 11-6 l' Hose disposal osal
e bibb
City: 05 V•1€ State:OQ, I ZIP: 4'103 S Ice maker
Phone: 2cti - moo I Fax: 2(1 - ¶((. ,1 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
Tubs/shower /shower pan - ,
Name: �Eti ti. ENGI�It'E21h(4 - E� CNKl�t,�l�'I•lSEh1 Urinal
Water closet
Address: pjOOO $W PGA t.� ST Water heater
City: Qo�.„ J L 0 I Sue:02. (ZIP:. 91223 Other.
Phone: 17S. ew I Fax:Gg8.( tAE -mail: Total
Not all jurisdictions accept credit cards, please cam jurisdiction for more information Notice: This permit application Minimum fee $
Plan review (at _ %) $
Cl Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit cans Expires accepted as complete. TOTAL. $
$
Cardholder signature Amount .. t,p. P 1PC C^�. \ C:rtY _ i 4 0 -4616 (600✓COM)
9 50.1-Ca 42 2- ? � ► 1 a 5 r � nr E R € Po+�alc_& i; 5 10
6-2)3 - 44,2 22t t-k tu_S Qo fl-o • 0 g- 111.2-4- A14 ; RQSS VCoS1 -
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
16.60 for each utility connection)
Lavatory 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 9 4 i Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal .
Dishwasher
� '61- fid Le f(o 19.-7 Garbage Disposal
'� Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' , 55.00 sc 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 Ss
Storm & Rain Drain - each additional 100' �e
4 6.40 a
Commercial Back Flow Prevention Device 46.40 •
Residential Backflow Prevention Device' 27.55
Catch Basin 4/ 16.60 !o 4ii -
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 / q
Quantity Total is > 9
*SUBTOTAL C7)
8% STATE SURCHARGE � (9b'
**PLAN REVIEW 25% OF SUBTOTAL /1 2 75
Required only if fixture qty. total is > 9
TOTAL $ 71 -1 7 , i/3 `
* 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.
i:\dsts \forms\plm- fees.doc 10/10/00
CITY OF TIGARD 24 -Hour
BUILDING . Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Dato�e ed 5��� AM PM BUP
Location �l�l� f'�l71� Suite MEC
Contact Person Ph ( ) S, 1J/ (pun 2apd/ 79 O ,5 q7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam Wig ` A/ 5
Ext Shear ea Anchors
fM Z-I-- ,1171 AL10 -Dos +®
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P S PART FA
LU BIN
Post & eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Show er
Pan
411F EIP PART FAIL
r 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 LI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /� .,.�/
ADA
Approach/Sidewalk Date 5;-- �� _ � Inspector /.W C; "t Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL