Permit A CITY OF TIGARD PLUMBING PERMIT
YID DEVELOPMENT SERVICES PERMIT #: PLM2000 -00413
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/7/00
SITE ADDRESS: 12541 SW QUAIL CREEK LN PARCEL: 2S104DA -00200
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 039 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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 a back flow preventer
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 11/7/00 $36.25 27200000000
4230 SW GALEWOOD ST 5PCT CTR 11/7/00 $2.90 27200000000
STE 100
LAKE OSWEGO, OR 97035 Total $39.15
Phone 1: 503 - 387 -7538
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 6136
PLM 11558
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.
Issued By: Permittee Signature:
Call ( 03 639 - 4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit A anon
Date received: Permit no. ? - 0 I
a.ot - � ^ City of Tigard
,All NOV 6 2000 Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 '00fWMIINIT f ,DEVELOPMENT Project/appl.no.: Expire date:
Fax: (503) 598 - 1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
•
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
NI New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: /aS'f / .S(,(-3 (..t(Lia_L/ G'1°t -.e Canc., 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.: LO r 39 &,SS 8 S SFR (1) bath
Lot: I Block: I Subdivision:d(,l_QLL //p //6u) SFR (2) bath
Project name: ( LLc I I f //Mk) LIT 39 SFR (3) bath
City /county: rjq a d, i WASP- I ZIP: 9 J .-a-3 Each additional bath/kitchen
Description an ation of work on premises: Site utilities:
8 A-C d w / `e_ Catch basin/area drain
Est. date of completion/inspection: I■)011 " Th.,. Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: Pro& Kt1SS Landscape _ - Manholes
Address: ,29K9 S St.4) kII)SIn GLIL., r2-D Rain drain connector •
City: W i /.S rnt) //(. I I Sanitary sewer (no. lin. ft.)
Sta[efll� ZIP:990 ?d �'
( ( t ;,� -y g7(E -mail: Storm sewer (no. lin. ft.)
Phon�g�, [081- loo7t<I Water service (no. lin. ft.)
CCB no.: ,434 - 3 I : & —
City /metro lic. no.: 003 Fixture or item:
Absorption valve
Contractor's representative signature: F�C-L.,t__- LoC-c.. Back flow preventer / =27 S5 .27 s
Print name: E P/1 S A-rr- Date: / -, Backwater valve
CONTACT. PERSON . Basins/lavatory
Name: 6'.I �p �``crui _Clothes wash
Address: asrcfS K
SLO ln� 2.,b u/l D Dishwasher
Drinking fountain(s)
City: LO i (Sonu / / Ie, I State: 6R , I ZIP: ej'/( 70 Ejectors/sump
Phone: /p $a - (c07 , Fax: (Ra - .' g ,, -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): 1D61'1 1110 SS e,•Fkr /-�t}m e Floor drains/floor sinks/hub
Garbage disposal
Mailing address:Lfd30 St-u 6a /ett7064 ST 1 - 1 - ` - /0 Hose bibb
City: L t)G O.Lt.e C) I State:d,e---- I ZIP:`1 r] p 3 C1 Ice maker
Phone: I ax: 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
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total / .a.7.55 a-7. Sl
Minimum fee $ 3G., • aS
Not all jurisdictions accept credit cards, please call Jurisdiction for more information. Notice: This permit application
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ a , 5'0
Expires TOTAL $ 39+ l S
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
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
Quantity by Work Performed
Water Heater 0 conversion 0 like kind 16.60
. Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
Capped
permit.
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 RI= 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
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00 _
Storm & Rain Drain - each additional 100' 46.40 //Z >u
Commercial Back Flow Prevention Device 46.40
GL2UeGt')
Residential Backflow Prevention Device' / 27.55 .29, S5
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 36 ,a•
•
8% STATE SURCHARGE - 70
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL 3T. 6 $
* Minimum permit fee is $72.50 + 8% state sutcharge, except Residential Backflow
Prevention Device, which6 5 + 8% state surcharge.
** All New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
l: \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 •
BUP
Date Requested 2 -7 AM PM BLD
Location /1Y4'( S61, Q,,_ A �� / Gte if. 4 -ti Suite MEC
Contact Person 1 I 14 S> Ph 53 5D3 7 s% PLM Zew -G o Y( 3
Contractor Ph Jx -,7/ 7 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 7 v U Z4*
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 Cer:
PASS PART FAIL
PLUMB
Post & Beam
Under Slab �
Top Out
Water Service
Sanitary Sewer
Rain Dr . s
Fin
ASS ART FAIL
HANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
c tLECTRICAt)
Service
Rough In
UG /Slab
/Cow Volta
3 4 4 ) S ART FAIL
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 1
Approach /Sidewalk / ! ig �'� Insp ector /ii`'I! .i
Other Date �Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.