Permit •
CITY OF TIGARD
PLUMBING PERMIT
" DEVELOPMENT SERVICES PERMIT #: PLM2001 -00253
' 11-. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/15/01
`�"
SITE ADDRESS: 12320 SW TIEDEMAN AVE PARCEL: 2S103AA -01906
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 009 ,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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 80' of new sewer line for connection.
FEES
Owner:
Type By Date Amount Receipt
MARTIN, RICHARD E PRMT CTR 6/15/01 $72.50 27200100000
12320 SW AVE 5PCT CTR 6/15/01 $5.80 27200100000
TIGARD, OR R 97223 97223
Total $78.30
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: Sewer Inspection
Reg #: Final Inspection
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: 4 _ , �`� /r Permittee Signature: ��
I? Ajt4er aLVA,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
e11 NAME k a %IA ■ IA L
_ DATE 9
1 MAILING ADDRESS l i s-
n
*1:p ` � ' CITY ` ' NEXT PUMPING
S- . ' .�D�
JOS ADDRESS 9W® �'"' 1 L��b� DATE
Phone: (503) 648 -8246
2575 NE Kathryn St. #28
Hillsboro, OR. 97124
SEPTIC PUMP: t ) (/ ``' \( - I I1 ��1,� _._-
DIG & LOCATE: Ca J`� l N, �\
FIEL INSTALLED: ��
TANK &DRAIN D NSTALLED: tx G3 `),,. x --
MISC: C , .
b� 0
` \` TOTAL$
PUMPING CHART
Household Size 1 2 3 4 5 6 7 8 9 10
(Number of People)
500 5.8 2.6 1.5' 1.0 0.7 0.4 0.3 0.2 0.1 --
750 9.1 4.2 2.6 1.8 1.3 1.0 0.7 0.6 0.4 0.3
1 000 12.4 5.9 3.7 2.6 2.0 1.5 1.2 1.0 0.8 0.7
Tank 1250 15.6 7.5 4.8 3.4 2.6 2.0 1.7 1.4 1.2 1.0
Size 1500 18.9 9.1 5.9 4.2 3.3 2.6 2.1 1.8 1.5 1.3
(gal) 1750 22.1 10.7 6.9 5.0 3.9 3.1 2.6 2.2 1.9 1.6
2000 25.4 12.4 8.0 5.9 4.5 3.7 3.1 2.6 2.2 2.0
2250 28.6 14.0 9.1 6.7 5.2 4.2 3.5 3.0 2.6 2.3
2500 31.9 15.6 10.2 7.5 5.9 4.8 4.0 4.0 3.0 2.6
Note: Mom frequent pumping needed It garbage dispose/ is used.
aN - o0,Q 1
.0* h Plumbing Permit Applicati l i
Date received: 6/4 / Penultno.:T , _au53
' «,. Ci of Tigard
i b Sewer permit no.: Building permit no.:
.4.14; - Address: 13125 SW Hall Blvd, Tigard, OR 9722
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction O Addition/alteration /replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
7C Job address: tg go 5 . Gy.,, °r; e !414 rt 4 j/' 1)escri lion 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.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: O F►r I ZIP: Q 7 3 Each additional bath/kitchen
Description andlocation of work on premises: Site utilities:
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: Q bt/,(/�_ Manholes
Address: Rain drain connector
City: I State: I ZIP: Sanitary sewer (no. lin. ft.) ea
I Fax: I E mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: Date: Backwater valve •
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Name (print): 1 t I f_ A r M ar T7 n Floor drains /floor sinks/hub
Mailing address: (a 3 0 5. L- , r of e ,,, � Ate HHose bibb
disposal
ose bibb
City: r a ,2 I State:Or I ZIP: q 7 ,,23 Ice maker
Phone: 5:, ? p6 g,$,lx: 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 9wn 6 per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: /( ,t t ,1'1o'-4& Date: Sump
MIIIMIIIIIMIFI 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. Notice: This permit application Minimum fee $ 7.2 , SD
O 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%) .... $ S , '
Expires TOTAL $ .7 ' , 3 D
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-0616 (6100/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)
ry 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:
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 S $ . 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 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 $38 25 + 8% state surcharge
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts\forms\plm- fees.doc 10/10/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
4-Hour . pection Line: 639 -4175 Business Line: 639 -4171 MST
` BUP
Date Requested / 3 AM PM BLD
Location ) 3 Z c c-'vt- Suite MEC
Contact Person Ph f (o gZZ(p PLM ,&'/ aU a,5
Contractor Ph SWR CYO ( -00 l ‘if
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Slab
Crawl Drain Inspection Notes: • 77)
Post & Beam SIT
Ext Sheath /Shear r - '
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
ant ary ewe
Rain grains
Final /�
PASS FAIL t'Q. S 'L fT r -ed 7 F v l
MECHA L (,,4
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 Date /O/2 / Inspector 1)/I 71/r Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1111111Y OF TIGARD 24 -Hour .
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION - Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM M BUP
Location I 3-1.0 Suite MEC
Contact Person hick_
Ph ( ) 9 8= ? PLM OD/ °S -
Contractor Ph ( ) SWR ?io / —a0 (
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: gy p - • L � SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART AIL
PLUMBING
Post & Beam
Under Slab
Rough -In $�
Water Service
'am II rains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
gir: di-t 4 PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date g////g — Inspector / / ors/ - Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL