Permit r� CITY OF TIGARD PLUMBING PERMIT
l
DEVELOPMENT SERVICES PERMIT #:. PLM2000 -00422
„ 13125 SW Hall Blvd.; Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/17/00
SITE ADDRESS: 10640 SW WALNUT ST PARCEL: 2S102BC -02002
SUBDIVISION:. NO. TIGARDVILLE ADDITION ZONING: R-4.5
BLOCK: LOT: 024 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing residence to newly installed sewer lateral. No reverse plumbing, running less than 100' of
sanitary sewer line. Reimbursement District #14 fee paid on this date.
FEES
Owner:
Type By Date Amount Receipt
OLSEN, KENNETH E PRMT CTR 11/17/00 $72.50 27200000000
SANDRA L 5PCT CTR 11/17/00 $5.80 27200000000
10640 SW SW WALNUT
TIGARD, OR 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 B I C C.dll / ,f Permittee Signature:
Call (503) .39 -4175 by 7:00 P.M. for an inspection needed the next business day
f' 4 ,. Plumbing Permit Application
Date received: /k / 74V Permitno.:Ny Cl of Ti and SBuilding permit no.:
;� s
, ,. - g Sewer 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 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family 0 Tenant improvement
0 New construction ❑ Addition/alteration/replacement 0 Food service ❑ Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist)
Job address: I (-)(.0 d t (�,ct{,.3 Lk.-r— Description I . Fee(ea.) Total
Bldg. no.: 11 Suite no.: New I- and 2- family dwellings only:
Tax map /tax lot/account no.:
(includes (1 100 ft.
h
Lot: (Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: (bt42 pp_ I ZIP: 97 .9-3 Each additional bath/kitchen
Description and location of work on premises: C EY, &Ti>.* Site utilities:
ty 6 o .'r I..L t-Y /1.1 Sr/tt.l,f,b Ao w>=/2_ . 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: C)().3 4_(2, Manholes
Address: Rain drain connector
City: I State: I ZIP: • Sanitary sewer (no. lin. ft.) >. /po/ / 57'1 c '
Phone: 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 •
Basins/lavatory
Name: Clothes washer
Dishwasher -`
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
y Name (print): /. /1 MM /£ ?H ({ _ pi__ 1/f Floor drains /floor sinks/hub
Garbage disposal
Mailing address: / 06 (16 sw w 4144 u T Hose bibb
City: I' / Gm 2 () I State: O 2I ZIP: q 7 2. 22 Ice maker
Phone4u3/ 6t: 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 pro rty I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
... Owner's signature: (6. Q2iet.. Date: / /-/ 7- 2.(. O 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 � 9°�
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 7 7�!
No This permit application ✓
expires a o • o
O Visa asterCard i if permit is not obtained Plan review (at _ %) $
Credit card number: / / p P State surcharge (8 %) .... $ • G
O
Expires within 180 days after it has been TOTAL $ 7 r 7S • 5(
Name of cardho shown on credit card accepted as complete.
$
`'"Cardholder signature Amount , 440 -4616 (6/00/COM)
,
PLUMBING PERMIT FEES:
-,,,,_,$.;, ;,-,;,, ? ,, : •. • ; ''''; -11,131; :Jo:JAL : :Nokeval - TA.,;24arnitsPrdivoiliiltis'vedy: ,..,.
FIXTURES (individual) ' ' ' QTY ; . .;,(ea) . w; :AMOUNT ' iinCliicle:r r-111,Arniiiiidginges in , PRICE ' TOTAL
.,
Sink 16.60 AtiiliVelliriciraliafinirstipkft. QTY (ea) , AMOUNT
$249
Lavato 16.60 ''Icii.TCrkiitilitirediineciltni
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 - - - 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 , f-.::: . :'2 , 4:::...:::'4Qiiiritity
Gas piping requires a separate mechanical Flitti.ifel --' 4 INe145 f,Moire'd;i A .:
, . .: 4.....„,... . i ew.oe- ... zi■ .:. r 0 -,, f ; itiaviti-4K. ,
permit. , .7:•/ , ,2, ,,., ,, .,,, .•..: .. .1 ,• .. ,.t t:•.,'' :-:1. &tapped
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
Other Fixtures (Specify) - 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sevier :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 :. 1' -.'?..--i-.:. • t'Zi;;.,-
*SUBTOTAL
. .
8% STATE SURCHARGE M ,, 7
,- - r,...V . F,,i,
. 44'.-' .
**PLAN REVIEW 25% OF SUBTOTAL : •:'
Required only if fixture qty total is > 9 : 41*,..kV ,!+'L i' F ,,
TOTAL '', Ti $
* Minimum permit tee 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 •
invoice MUFF'S SEPTIC SERVICE, 'Mil.
Name Jr Rdo" cAt " Date )1--3/ 66 -9
Address - R6).S: Le rl Phone V (0 P
City �NI Initial On Acct.
State L Zip Code qr)0.ss
ikryi b J) L1211\ui' Price Amount
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4 D3('.1, /
NOT RESPONSIBLE FOR LANDSCAPING
A service charge of 1.5% per month will be charged on all past due accounts. Total: //
Not responsible for attorney's fees.
A fee of $15.00 will be charged on all returned c ecks.
Approv
By: P
Customer Signature
TlQh011 P.O. BOX 1244. • oanby, 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
Date Requested //— A M - PM BLD
Location /O VC S w &- ti k..1S f Suite MEC
Contact Person ' • • • Ph , c -- o3 6 51 PLM Ao&v - 0(1 t// Z Z-
. Contractor Ph 5 7 y SWR
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 J
. Susp'd Ceiling
Mi c f . J ' /0�� . /t_ . _
Final '%111-
/ PASS PART FAIL
LUMB --
os eam
Under Slab
Top Out
Water Service •
Sanitary Sewer
Rain Drains
Final
PART FAIL
4115111
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
Otheoach /Sidewalk Date Inspector .( Ext,-
Final
- PASS PART ' FAIL D NOT REMOVE this inspection record the job site. .