Permit • CITY OF TIGARD PLUMBING PERMIT .
,,.;.r. DEVELOPMENT SERVICES PERMIT #: PLM2000 -00430
° �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/27/00
SITE ADDRESS: 10625 SW WALNUT ST PARCEL: 2S103AA -01902
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 005 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: 60 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of sanitary sewer line. Scope of work is greater than 5' from house.
FEES
Owner:
Type By Date Amount Receipt
HATANAKA, BARRY PRMT CTR 11/27/00 $72.50 27200000000
RURIKO
S 5PCT CTR 11/27/00 $5.80 27200000000
10625
10625 SW WALNUT
TIGARD, OR 97223 Total $78.30
Phone 1:
Contractor: •
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone 1: 939 -5246 Sewer Inspection
Reg #: LIC 110314 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: ,d / - Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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Plumbing Permit Application
--"1 .,‘, Date received: 107/0) Permit no.:1O / Zr -DO •/&p
City of Tigard ' Sewer permit no.: Building permit no.:
! — Address: 13125 SW Hall Blvd, Tigard, OR 97223 g p
City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 /e Zoe d03 /9 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
iY 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: c ZS j-' N • Descri_i lion Fee (en.) 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: 1(1 I ZIP: �� Each additional bath/kitchen
Description and locati n of wor on premises: r Y'c'i c Site utilities:
_Sy t A7 S R A AB t'J c4 � c . Ss Catch basin/area drain
Est. date of completion/inspection: jr, ' _ Drywells/leach line trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: `r" 4 A J VAIDAMIONEM Manholes
Address: 1 i 9 2 W Ni 5 .• Y a Rain drain connector
City: State: C ' ZIP: • i Sanitary sewer (no. lin. ft.) 1 --4-01
Phone: A 5 7- Fax: .2 37 ' E -mail: Storm sewer (no. lin. ft.)
CCB no.: 1 \ i) 3 \ ti Plumb. bus. reg. no: W r se service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: \KK Absorption valve ,
Back flow preventer
Print name: 5 C Date: Crr) Backwater valve •
Basins/lavatory
Name: t }S Nk-� Clothes washer
Dishwasher
Address:
6 'r y O-k Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: 3q -52 V t I Fax: (E_mail: Expansion tank
Fixture/sewer cap
Name (print): //CA' y f�fg-r/9"/&k/. Floor drains/floor sinks/hub
Mailing address: /p ZS S &.' 4.2.9Z A/A- 7-- Hose bibb
disposal
Hose bibb
City: 'State: I ZIP: 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
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: 1E-mail: Total ,
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Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 2_2 . S C)
Notice: This permit application Plan review (at _ %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ S . kv
Expires TOTAL $ 7i 30
)
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-4616 (6100/COM)
AF- /M4.u2S l I/7 Z /ST /`/
/49 7L / d //D /off
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PLUMBING PERMIT FEES: ,
,
Topkv,-.., 1 . :-,,,;,..:::: ,
FIXTURES (individual) ;,, ., - , , l(ea).' , ..:' AMbalt "(inclildeealiiiiinibinxtures in - . - ;'POICE ,.: ' iTD,TAI:, ,
Sink / 16.60 thYaPeilictg+and.thefiEpt100 . , QTY -"(ea) , - - . '*inciuNT-
'iikaIlktitili6iconnection) . . , ..
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
Garbage Disposal ' 16.60 . TOTAL
Laundry Tray 16.60 ,
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 g1Cialititillb■McirkIReitfOrined ,',...
Gas piping requires a separate mechanical ,F‘,,,,tx.tgrelTyp`e:?,„ ,,, .' ,,.. Ne gtlpfijA Iligila illeitidved/
permit. e '.;.:';` - t41-:',. , ,: `,•-•;'- t'l.':'.71;vai ei.. ..;. Mapped .,
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 - 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 ;A-4A :'- • -,:;;', ' ' .
*SUBTOTAL Bil
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL At.!
Required only if fixture qty. total Is > 9 r- .7:',J rid600.3
TOTAL RAM r:M -4 $
asiza C.,-tIL:, 1
* 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.
hdsts\forms\plm-fees.doc 10/10/00
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—I GRUFF'S SEPTIC SERVICE, INC. _
ne`i3E-._ Date /( - ° /
• Name
Address /6 0 SZ-3 4-/ 44 4 4 . Phone 6 935 e s";2-(,,
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City / c '7A -72 Initial On Acct.
Zip Zi Code
State CDP--)
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Price Amount •
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NOT RESPONSIBLE FOR LANDSCAPING
/
A service charge of 1.5% per month will be charged on all past due accounts. Total:
Not responsible for - orney's fees.
A fee of $15.00 II be hared on all returned checks.
'4411011111, V
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e rial/tCYOU P.O. BOX 1244. • ' by, OR 97013
DEQ# 36912 •
• • f (503) 632-6138 CCB# 104320
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•CITI rOF BUILDING INSPECTION DIVISION 4 : _ •
24jlourinspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP •
Date Requested l 6 � AM PM V BLD
Location /2iC_Z S ` Suite MEC
Contact Person Ph PLM 6 ci 13 0
Contractor Ph SWR O 0 3 /?
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
Roof Nor
Misc:
Final
PASS PART FAIL
(PI
TA
Beam
Under Slab, e/
Top Out c(�jZ�
Water Service •
anita Se r
ain Drains
Fi
PART FAIL r�
' CHANICAL
0 (
Post & Beam Cam"
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
Other oach /Sidewalk Date Inspector 1177 Ext LA'
Final
PASS PART FAIL D NOT REMOVE this inspection record from the job site.