Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 -00477
' .. � I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/10/02
SITE ADDRESS: 13680 SW SANDRIDGE DR
PARCEL: 2S 105D D -04900
SUBDIVISION: PACIFIC CREST ZONING: R -7
BLOCK: LOT: 025 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: Install backflow preventer.
FEES
Owner:
Description Date Amount
D R HORTON HOMES 5125 SW MACADAM AVE STE 145 [PLUMB] Permit Fee 12/10/02 $36.25
PORTLAND, OR 97201 [TAX] 8% State Tax 12/10/02 $2.90
Total $39.15
Phone : 503 - 222 - 4151
Contractor:
TRADEMARK LANDSCAPES, INC.
18478W WALKER RD.
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone : 503 - 631 - 3890 Final Inspection
Reg #: PLM 6796
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
Issued By: /,//t/ Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1 r Building Fixtures
PlumbingPermitApplication OFFICE USE ONLY
Date received: p /O -O 2-- Permit no.: knogeo -G2 7
t �1 - City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW HaRE ti)? . ; Its 97 2D
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval:
DEC 10 2002 Case file no.: Payment type:
• 1 :s
TITIT OF PERMIT
0 1 & 2 family dwelling or accessory 0 CommerciaUindustrial 0 Multi - family 0 Tenant improvement
y l,New construction 0 Addition/alteration/replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use chec list 4
Job address: t' t ,,2Q 5. W 60 r t d Description 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: 26 (Block: I Subdivision: Vc c,4 ;c. Cs.e--sT SFR (2) bath
Project name: SFR (3) bath
City/county: I ZIP: Each additional bath/kitchen
D ription and location of work on premises: 13. cc.Kflux) 'ti✓L Site utilities:
i:)n.t k s b' SlaxetAcs1 k o..d tMiz er- 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: VRAVEVV Let.r.inSeaDQ Manholes
Address: % 9it S, - Je. \ (car '(Q\ Rain drain connector
Ci tY: Ov 4 I State: Ore I ZIP: S'7095 Sanitary sewer (no. lin. ft.)
c
Phone:� 504_�,p I Fax: 451 -y131 I E -mail: Storm sewer (no. lin. ft.)
CCB no.: 1 1 35 I Plumb. bus. reg. no: Water service (no. lin. ft.)
Fixture or item:
City/metro lic. no.: 3
c
Absorption valve
Contractor's representative signature: S Back flow preventer I
Print name: S rE.o€ ELLI S ' Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: 51 Eve. EL L 15 Clothes washer
Dishwasher
Address:
tv-c As /4- v< Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
12 Floor drains /floor sinks/hub
Name (print):
�'z-TV�I Garbage disposal
Mailing address: L j3. 5, („ 144..,c,1 N , 5.,, -k 102_ Hose bibb
City: PorLT(.c,,. 4 I State: 0,4. I ZIP: 91 2.A1 Ice maker
Phone: '2.22_— 4 % 5I 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
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
credit cards, please call jurisdiction for more information. Minimum fee $ __ . g.") Not all jurisdictions ace
P i N otice: This permit application %) $
O Visa 0 MasterCard Plan review (at _ /o)
expires i f a permit is not obtained
Credit card number: Expir/ State surcharge (8 %) $ within 180 days after it has been TOTAL $ .c � . r `
/ S
Name of cardholder as shown on credit card accepted as complete.
Cardholder signature Amount 440 -4616 (6/o0 /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
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
Hose Bibs 16.60 Tub or Tub /Shower
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal
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 Backiow
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. •
i:\dsts \forms\plm - fees.doc 12/26/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Ube: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location _ _ . �� � —, - .uit MEC
Contact Person Ph ( ) PLM ^ CG 4l 7
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 C
Fire Alarm
R Ceiling
Roof
Other: /
Othe ,
Final
PAS T FAIL
MBI
eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
r
\PASS ,ART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage, U , F V P
Fire Alarm
Final D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line /
ADA
Approach/Sidewalk Date J ` / � 7 InspeCr Ext
Other:
Final DO NOT REMOVE this Inspection record fr m the job site.
PASS PART FAIL