Permit •
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES
PERMIT #: PLM2001 -00062
-
il 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/2/01
SITE ADDRESS: 12536 SW QUAIL CREEK LN PARCEL: 2S104DA -00700
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 044 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: Back Flow Preventor
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT CTR 3/2/01 $36.25 27200100000
4230 GALEWOOD STREET 5PCT CTR 3/2/01 $2.90 27200100000
SUITE 100
LAKE OSWEGO, OR 97035 Total $39.15
Phone 1: 274 -5223
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 (503)63 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
. . i, An
Date received: Permit no.((j t / —o ob 62
? City of Tigard - ry..: 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 � r _ , , , Da issu B y: I Receipt no,:
Land use approval: Cas Payment type: .
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
3 iew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: /a.53 " 61 -t C- k (jr a 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.: (o 55 84 SFR (1) bath
Lot: 4 LP 'Block: I Subdivision: (_l,.c i_Q, 1D LUDO SFR (2) bath
Project name: ( J. CLi I N0 u 1(5 U) L/L SFR (3) bath
City /county:111LLAC,l f U) )45 &d .1 ZIP: q7 �"� Each additional bath/kitchen
Description ovation of work on premises: Site utilities:
PAck, cu.) d t ' . Catch basin /area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: p rtGrass thdiciscct Manholes
Address: a9 8•q S cl.(-) lit ) SM'Y) an 2D Rain drain connector •
City:w, LgUn I )111f, I Stat:0K -- I ZIP: 97 O'7 1 Storm Sanitary sewer (no. lin. ft.)
Phone,—(O7, (u Fax: ( & - 9e' mail: - • sewer (no. lin. ft.)
CCB no.: to 13 Co I Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: 003cD4 Fixture or item:
valve
Contractor's representative signature Back flow preventer / a'7. 55 a
Print name: . ('O -up Date: - O Backwater valve
CONTACT PERSON Basins/lavatory
Name: Ellen S P rrnru0 Clothes washer —
Address:29e?5 A-0 fCv) CU'L K0
Dishwasher
Drinking fountain(s) •
City: LU i ( l'U I 1e.) I StateOl2 I ZIP:Q'167 0) Ejectors/sump
Phone:(n8Q — 607; 2 i 7 I Fax: • .4 — 987 r mail: Expansion tank
OWNER Fixture/sewer cap .
Name (print): Dm m oy 7 sS ea-7C /*roes Floor drains /floor sinks/hub
Garbage disposal
Mailing address:9Q30 &CO /e.C..tJOt Lai) ei___, - Hose bibb
City: Lez e, O () I StateO2I ZIP: q 703 y — Ice maker
Phone: I 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
Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: 'State: 'ZIP: Other.
Phone: 'Fax: 1E-mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction information. iction for more infoation. Notice: This permit application Minimum fee $ =
l] Visa ❑ MasterCard Plan review (at _ %) $
expires if a permit is not obtained State surcharge (8 %) $ q o
Credit card number: .... within 180 days after it has been 349. ! S
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature ■ Amount 440.1614 (6r00/COM)
PLUMBING PERMIT FEES:
• j t :TOTAL''°' New'1 and 2- family',d ont ;;:,:... =_ . ".w-�.y. �
.:,.� _.i Y ._ a ,,;;,< :��- 4 -� ,: ,PRICE � _ .� r , j �. . P . . . :, ., .... . -�.� Y� ° : , •'� : ri ��•'sd °�: �:x
_1 ^� T y' 7 ,:..� jt.�1�.1� -:a i • , 'M1 � e� .va��. , fit T.'.� - •y
�` ti` `'` r,;< '�, .AMOUNT, : ,(incle
uds all;plurn ing i tu In ' ; _ ;PRIC i ; TOTAL`':;:
Sink IXTURE .pndivldtialj�� ?�. ..._ ._.'= � =,,:. ::�1TY.�, =a(ea) ... , - .� - �. - : .: ,,.• ... ,� ,.' a�� ..,..
16.60 ;the dwelling and the flist1,00 ft.- '' ' .' ,QTY; ; (ea ) ' ! -*AMOUNT 'fa each utility connection) �- • ,- ` -: rc -,.. ° ' ".. ' ='°�, ■
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
TOTAL
Garbage Disposal 16.60
Laundry Tray 16.60
Washing Machine .16.60
Floor Drain/Floor Sink. 2" 16.60
3° 16.60 PLEASE COMPLETE: • 4" 16.60
: -- '; : • t::r' =:4'Quaritity by Work Performed r;.: : ; :
Water Heater 0 conversion 0 like kind 16.60 + = ` c
Gas piping requires a separate mechanical Fixture :1
Gas New) . Moved -' Replaced,,, :Removed/
Z. ::Capped
permit.
MFG Home New Water Service 46.40 Sink
46.40 Lavatory
MFG Home New San/Storm Sewer Tub or Tub /Shower . -
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
16.60 Water Closet
• Drinking Fountain _ 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 "
55.00 Water Heater .
Water Service - 1st 100' Other Fixtures •
Water Service -each additional 200' 46 (Specify) .
Storm & Rain Drain - 1st 100' 55.00 -
Storm & Rain Drain - each additional 100' 46.40 RAC/tiP2tYLO I
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' / 27.55 _ c p_7 55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.5 COMMENTS REGARDING ABOVE:
Requested Inspections
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL ,1 `., ' ` ' `• `r :,•:=-4. '`:
Isometric or riser diagram is required if / 7:'J S e2
-� 76
Quantity Total is > 9 z ` ; . t• 4, •,- .
*SUBTOTAL
8% STATE SURCHARGE .
"*PLAN REVIEW 25% OF SUBTOTAL
Required only If fixture qty. total is > g
TOTAL 317' is- $
° r airy r e, except Residential Backflow * Minimum pe rmit fee i h 1 8 638 ° e
Prevention Device, which I E36.25 + % state surcharg
' New Commercial Buildings require plans with sometnc or riser diagram and
plan review.
is \dsts \forms\pim- 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 — / 7 AM PM BLD
Location / Z > 3 tr 5 w Oct A t / ( . - e k Suite MEC
Contact Person Ph GSZ —Ga7 2vv / — G Z
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR W - C4AL--
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
Post & Bea
Under Slab
Top Out
Water Service
Sanitary Sewer
Brains
•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 D ki' � Inspector
(((
Other Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.