Permit •
CITY OF. TIGARD • PLUMBING PERMIT
,, 1 DEVELOPMENT SERVICES PERMIT #: PLM2000 -00429
'`�'�" ., 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/27/00
SITE ADDRESS: 10620 SW WALNUT ST PARCEL: 2S102BC -02005
SUBDIVISION: NO. TIGARDVILLE ADDITION • ZONING: R -4.5
BLOCK: LOT: 024 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 sanitary sewer line. Sewer connection will be done under separate plumbing permit by a licensed
plumbing contractor.
FEES
Owner:
Type By Date Amount Receipt
FRISBIE, OWEN P JR AND PRMT CTR 11/27/00 $72.50 27200000000
E L 5PCT CTR 11/27/00 $5.80 27200000000
10620 S
10620 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: Permittee Signature. '
all (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
4 Plumbing Permit Application
Date received: /07 /or) Permitno.:AifZnp -co yz
--, Tigard
City of Ti d
ti ` City ► Sewer permit no.:a� 3t j 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 .faJQ2pan - i3O 3 /-3 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
r ❑mew construction ❑ Addition/alteration/replacement ❑Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address:
1 CD • ).,0 �W Q\1' Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
Tax map /tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: ° 1 - ') (-4.h 4,b I ZIP: Each additional bath/kitchen
Description and location of w rk on p emises: C twom t c Siteutiiities:
'A tk941 - / 5 - p c hsKili. P ss. o 1 Catch basin/area drain
Est. date of completion/inspection: , S 0 • Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business named ti i u ri ‘.k. , c: 4' A _ • Manholes
Address: y 7+7( ' S T V t ,- Rain drain connector
City: k yT I State:(" )� I ZIP: 9 Sanitary sewer (no. lin. ft.) j WO'
Phone:AT-0-(`) L ` 7 ) C I Fax: .3ptE -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: ` -,__1 Absorption valve
Back flow preventer — Print name: elik L k E C\„ • Date: 1 ) I Backwater valve •
CONTACT PERSON Basins/lavatory
Name: �� �� fir- Dishw washer Clothe
Address: c 3 .4 Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: • I - , 4 6 Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): /O X ,9 vn/g /---2e/S6/&---- Floor drains/floor sinks/hub
address: Garbage disposal
Mailing / /(0 2p S� Lileg zA/u % Hose bibb
City: I 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
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 mote information. Minimum fee $ 7..2 . SC)
Notice: This permit application Plan review (at _ %) $
O Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 5 r (PD
Expires accepted as complete. TOTAL $ 7tr' 3 0
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4616 (6/00 /COM)
/' 7Af , AfS T, i3- /y
G j/z.c. /f4' cr �e-n-i-rte" � /0/5/
. / f /T /a/ ee-Ai ✓ e 1 149-/Z. - /149-/Z.
PLUMBING PERMIT FEES:
�. -`; dPRICE� TOTAL Ngyatgndg2 famlly ,k,1"
k,
FIXTURES °(individual) " QTY, . ::46) �. mss • ;AMOUNT (includes ' u ' 'res�I n PRICE .. TOTAL
Sink 16.60 ;the dweliingi d', he fist i ft. QTY -(ea)- .l- AMOUNT
16.60 i orr eeachA ,
Lavatory 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:
16
3" 16.60 60
4" 16.60
tiF: `., dE d_" ' '. ",'r FQiiaritifybyW „oriCPerforine"d; .,:.
Water Heater 0 conversion 0 like kind 16.60 W
Gas piping requires a separate mechanical fixture T�y . 'New ' lc:V:4, Replac :1A Re ole
permit. Mel > • . _ .s' sd .. Capged,.
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
16.60 Urinal
Other Fixtures (Specify) Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' / 55.00 .s S 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
t a
Isometric or riser diagram Is required if
Quantity Total is > 9 ct:T ` -. •� .
*SUBTOTAL � Jo 2 • Sa
8% STATE SURCHARGE ffi , , r v
''*PLAN REVIEW 25% OF SUBTOTAL
only if fixture qty. total is > 9 (:at"
TOTAL fr i, 4 1C, $ ? �r 3d
M =.
* 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.
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... GRIFF'S SEPTIC SERVICE, .INC. -
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Name • � � � � (J �- Date ` — ',27 —
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SJ A Phone
City / Initial • On Acct.
State a Zip Code 47
Price Amount
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NOT RESPONSIBLE FOR LANDSCAPING
A service' charge of 1.5 %:perntonth will be charged on all past due accounts. Tot :d
Not responsible for attorney's fees.
A fee of $15.00 ill be charged on II retur ed checks.
Appr val '
C ustomer Signature •
•
'Zan '2,u P.O. BOX 1244. t Canby, OR 97013 . • DEQ# 36912
(503)'632 -6138 CCB# 104320 •
CITY OF TIGARD' BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP.w, -tea
Date Requested /1- CI AM BLD
Location / OC 2// Suite MEC
•
Contact Person Ph r3:- «t PLM c/ L�
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall • - \ ELR
Footing Access:
Foundation / 11 O� 3 FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT .
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear • V
Framing _
Insulation
Drywall Nailing .
Firewall
. Fire Sprinkler
Fire Alarm
.. Susp'd Ceiling
Roof
Misc:
Final
PASS . PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
anitary Sewer
Rain Drains / / � L/t ` / /L� / -
Fi- / -- /or/
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
Other fl Date / Inspector Ext dy
Final
PASS PART FAIL.. DO NOT REMOVE this inspection record from the job site.. .