Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2001 -00177
DEVELOPMENT SERVICES DATE ISSUED: 4/30/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12492 SW QUAIL CREEK LN PARCEL: 2S103CB -08900
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 047 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: Install back flow preventor
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 4/30/01 $36.25 27200100000
4230 GALEWOOD ST 5PCT CTR 4/30/01 $2.90 27200100000
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 952-00014)010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by 'ng (5• 246 -1987.
Issued By: l / Permittee Signature:
Call (50 ' 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Date received: 1/-30 "D / Permit no.eina(,)//0/ .e p 7
a ; Cit* of Tigard and
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 Receiptno.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement
New construction ❑ Addition/alteration/replacement ❑ Food service 0 Other: Q
JOB SITE INFORMATION FEE SCIIEDULE (for special infort ation use checklist)
ft
Job address: f .4t 9' ,,;,_ Sip QLLI Gti✓e e- Lai) br Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
s ,
Tax map /tax lot/account no.: &S AS SFR (1) bath
Lot: 1.-r I Block: I Subdivision:CILLL kg- WO (( SFR (2) bath
Project name: (_4_4(,. H.-p i jau; '_e'' SFR (3) bath
City /county: .netaAr4 1 11) Y4' yt-Ori I ZIP: 97 a}3 Each additional bath/kitchen
Description andsiocAtion of work on premises: Site utilities:
61 k_f1(M) a60(c.c., Catch basin/area drain
Est. date of completion/inspection: y 30 0 Drywells/leach line/trench drain
PLUMBING CONTRACTOR Manufactured drain (no. lin. ft.)
Manufactured home utilities
Business name: p,Oo,o5 S Land L 0 Z4G Manholes
Address: o29?g s g kIf) S'7fatit R,40 Rain drain connector
City: (,(); / C r YI Ul / (? I State: d #I ZIP: q 76 7e) _Sanitary sewer (no. lin. ft.)
P - 6 I Fax4-a- 9S '7,( E -mail: Storm sewer (no. lin. ft.)
CCB CB no.: no.: (/943((j Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: 00 3 c-/ Fixture or item:
Contractor's representative signature e-ei) G (/LtAz0 Absorption valve
Back flow preventer /
Print name: ? /dr) _ Date: £ -D-/ - di Backwater valve
CONTACT PERSON Basins/lavatory
Name: 0l et) -L.4'1TV.) Clothes washer
Address:agg S g(3 lLn SIIYI.fL /2.03 Dishwasher •
City: J b Y) U L L, { C�1 I 7 0 -7 Drinking fountain(s)
y (�) / State ZIP: C Ejectors/sump
Phone: , „ -6670? • Fax: ,8; '-7E7 -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): ni Q-ri $, L7/-� -C, / L J1Y1 6 s Garbage disposal
Mailing address> 30 Oute_t o ofa,�r .. Hose bibb
City: f J) o ( � U () I State: (31/ I ZIP: `7 7b3 t-/ Ice maker
Phone: Iax: 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
] p least call jurisdiction for more information. Minimum fee $ ,60 ta5
Not all jurisdictions accept credit cards, p N otice: This permit application Plan review (at _ %) $
O Visa 0 MasterCard expires if a permit is not obtained (70 credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $ 39. / S
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 410-4616 (6/00/COM)
PLUMBING PERMIT FEES:
,..„.,_.,:-.••••::..-:..-,-,:- PRICE , TOTAL New 1 and 2- family dwellings, only: _ • • .;t - . : `' � '
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 , Lavatory 16.60 One (1) utility connection) $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 3" 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
16.60 Urinal
Other Fixtures (Specify) Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
1 • 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 Ol /ChM°
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' / 27.55 2.7 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 - , , 7
Isometric or riser diagram Is required if 07. t5
Quantity Total Is > 9
*SUBTOTAL - 3 ,S
8% STATE SURCHARGE
R. go
'*PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9 '
TOTAL ' • $3
* Minimum permit fee is $72.50 + : ^...: - I - esidential Backflow
Prevention Device, which : 6.25 + 8% state surcharge.
** All New Commercial But . , :. , .r nser diagram and
plan review.
i:\dsts \forms\plm- fees.doc 10/10/00 .
3�z
CITY OF TIGARD BUILDING INSPECTION DIVISION T
•
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
UP
Date Requested 5%3 AM PM BLD
Location / Z ` f 9 Z S w at. 4 r 1 C Suite M
Contact Person py-o J - elf Ph (off Z- 7 a , , ?.l�v/ — 6 0/ 7 7
Contractor Ph x 2- 17 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 j5L,
Roof
Misc:
Final
PASS PART FAIL
c/7:
o
Post & Bea /
Under SI
Top Out
Water Servi
Sanitary Sew
Rain Drains
in
ASS 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
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 Si jg 1
Other Date Inspector Ex-t3 t
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.