Permit ,I
•
\ CITY OF TIGARD PLUMBING PERMIT
I& DEVELOPMENT SERVICES PERMIT #: PLM2003 -00437
�" r ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/15/03
SITE ADDRESS: 15671 SW SUMMERFIELD LN PARCEL: 2S111DC -05000
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 350 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocate washer, water heater and sink to garage.
FEES
Owner:
Description Date Amount
NELSON, GARY /SANDRA
15671 SW SUMMERFIELD LN [PLUMB] Permit Fee . 8/15/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Tax 8/15/03 $5.80
Total $78.30
Phone : 503 639 - 9539
Contractor:
3 MOUNTAINS PLUMBING
PO BOX 386
SHERWOOD, OR 97140
REQUIRED INSPECTIONS
Phone : 503 - 925 - 1342 Rough -in Insp
Final Inspection
Reg #: LIC 141187
PLM 34 -368PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699. /
Issued By: ` , %i , I , _ _,` Permittee Signature. 0 .. 7ZE= (Yv
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
h City RECEIVED Date received /9U 3 Permit no. 0-3-0U�e3 7
4i- '� l Cit of Tigard ,� � � � `J g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Ti&arck Uk O 1 [� (2 97223
City of Tigard Phone: (503) 639-4171 A Project/appl.no.: Expire date:
Fax: (503) 598-1960 CITY OF TIGARD Date issued: By:$'/y I Receipt no.:
Land use approval: BUILDING DIVISION Case file no.: 77 Payment type:
TYPE OF PERMIT
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: /S/'7/ 5 ' sere, - Description Qty. Fee(ea.) Total
1
Bldg. no.: 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: IBlock: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: 4 " y/ f-727 I ZIP: Each additional bath/kitchen
Description and l tt�� ork on premise: Site utilities:
g er /, /1,1 di,o Catch basin/area drain
Est. date of completion inspection:
Drywells/leach line /trench drain
/�`� Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: i; , ,- ` , �� Manholes
Address: , 0. y /C ��
� , Rain drain connector
City: 44r6&L I Stated, I ZIP: ' 7//.7-6 Sanitary sewer (no. lin. ft.)
Phone: !93 "S 72 ax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: / I Plumb. bus. reg. no: gv54. �'r Water service (no. lin. ft.)
City /metro lr no.: 1 f 5 / 0 Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: )3R// i ° i 1) Date: , ,- / -Q Backwater valve
CONTACT PERSON Basins/lavatory
Name: 8,0 51rnoqb Clothes washer /-
Dishwasher
Address: p0, dep,z_ Drinking fountain(s)
City: �tvlaxekl. I Stag I ZIP: -7/ Zed Ejectors/sump
Phone: jbf -0 =/ Fax 603 Qs-Y1 -mail: Expansion tank
OWNER a'i % Fixture/sewer cap
Name (print): ../ Floor drains/floor sinks/hub
r Garbage disposal
Mailing address: / '7/ S ���� Hose bibb
City: 7 I State I ZIP: fly: 7- 4, Ice maker
Phone:51) - 9 - fs"slit Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me o i e maintenance and repair made by my regular Roof drain (commercial)
employee on the pro y I own as pe O S Chapter 447. , / Sink(s), basin(s), lays(s) / ii.
Owner's signature., 4 5 '( Date: �/ y' 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 •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at %) $
O Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been TOTAL $ J lJ
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
Lavato 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 3" 16.60 PLEASE COMPLETE:
3" 16.60
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
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"
Water Service - 1st 100' 55.00 Water Heater
Water Service - ch additional 200' 46.40 ' Other Fixtures
ea
(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 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
•
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 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 3 7 MST
INSPECTION ' Business Line: (503 -4171
�j BUP
Received 11/20 -RI Date Requested 1 / 2- /A3 AM /
PM BUP
Location 1 5 _ . � ►�►'I e '' e�-4 _ ite 00-3--#)‘-° -
n
3
Contact Person .1,(/' (� /11-e -'T5 dip ` 06 c.f3 7
Contractor '4( l ) 7/-2 9& SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Insp Notes: SIT
Post & Beam // C aS 7 4 S -Iri
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear VV� .
Framing r " 1 G�x
Insulation T /Z-2 5 3 /� p
Drywall Nailing /
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
=ART FAIL
Post & Beam
Under Slab \ d
Rough -In I l
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole , y
Storm Drain V
Shower Pan
Other:
PART FAIL
MECHANICAL
Post & Beam
Rou • h -In
.mpers
PASS PART FAIL
- ' RICAL
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 ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA r
Approach/Sidewalk Date V1.10 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL