Permit CITY OF TIGARD PLUMBING PERMIT
AIWA tiO1 4 ' DEVELOPMENT SERVICES PERMIT #: PLM2000 -00456
f ! 13125 SW Hall Blvd.,'Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/15/00
SITE ADDRESS: 11545 SW WALNUT ST PARCEL: 2S103BA -00201
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 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: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Moving (1) clothes washer, (1) sink and (1) water heater.
FEES
Owner:
Type By Date Amount Receipt
NIHILL, GERALD T + DEANNA LYN PRMT CTR 12/15/00 $72.50 27200000000
11545 SW WALNUT ST 5PCT CTR 12/15/00 $5.80 27200000000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor: •
ADVANCED PLUMBING
CHUCK MCALLISTER
PO BOX 593 REQUIRED INSPECTIONS
PORTLAND, OR 97207
Phone 1: 503 - 478 -9735 Top -out Insp
Reg #: LIC 140302 Final Inspection
PLM 37 -477PB
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 " ay obtain , sies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Iss - d By: • .: ;j',_�a ! 1L4 Jo_ Permittee Signature: . `V
Call (503) : 9 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Date received: /'�/5 -O(/ Permit no.: porn —an � V5
off A-',___. ; Tigard
City of Tigard
_ `J Sewer permit no.: 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 - Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
n 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: ' U .L{ 5 St,� GL PtL(i 5T Descri'tion Qty. Fee(ea.) Total
Bldg. no.: I 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 (6 -K1(?D OR ZIP: q Each 0 Each additional bath/kitchen
Description and location 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: Pt1) kl rt Mc _ED PLO m a ! , C. Manholes I
Address: PO 600_ 3 Rain drain connector •
City: 'a0 r tt I State: Ot? ZIP:' gej Sanitary sewer (no. lin. ft.)
Phone: 3p3 ing 1735 Fax: 66b E- mail:tj c A(rynbi!l Storm sewer (no. lin. ft.)
CCB no.: 140RO a I Plumb. bus. reg. no:37- 4/77,D c (.4tt A Water service (no. lin. ft.) MN
City /metro lie. no.: 0.0c3o �o 4/65 l r
y_ ,_a Fixture or item: ■ -.
Contractor's representative signature: ="i/' Absorption valve
Back flow preventer —
Print name: J c• ._ ' / /Sole, Date: /,,I -/ _OD Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap _
(p g E /A W (tl ✓1 n I ( HILL_ Floor drains/floor sinks/hub . _
Name (print): F'l lv Garbage disposal _
Mailing address: 1 i 5 45 5ct.) (ii At NU r ST, Hose bibb
City: —1-16- i j) I State:6Q I ZIP: 9 7 2 � a � 3 Ice maker NM
Phone: . .. .1_6 .. Fax: 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)
I
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Name: Urinal
ame:
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 infommtion Minimum fee $ 7a
N otice: This permit application Plan review (at %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days State surcharge (8 %) .... $ '.7 , 13
Expires ays after it has been TOTAL $ 715 . 'Zbv
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
Lavatory 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 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 h
fi' 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
Other Fixtures
Water Service - each additional 200' 46.40 (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 nser diagram and
plan review
is \dsts \forms \plm- fees.doc 10/10/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
t ';' 24 Inspection Line: 639 -4175 Business Line: 639 -4171 MST -,
BUP II A'.`
Date Requested / 2 v AM PM BLD
Location // 7 g c 5 (Ai Cualk J- S r Suite MEC
Contact Person Ph ' - /z5:5' PLM -C qi G
Contractor Ph 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
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
'RLI.L01
Post & Beam fc6
•
op 0_411i
� va er Service
Sanitary Sewer
Rain Drains -
Fi
PART FAIL
NICAL
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 f,
Approach /Sidewalk D ate V
Other / P Inspector i Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
i• 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
•
Date Requested it AM PM BLD
•
Location //S V) Scv GL/ h Suite MEC
Contact Person Ph .5 - 9f 1 z s> PLM 2tA0 6 V 5-4
Contractor Ph 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
Susp'd Ceiling .
Roof
Misc:
Final
PASS . PART FAIL
<PLUMBI
Post & Beam '
Under Slab
Top Out "
Water Service
Sanitary Sewer
� .: sins
rii. "
PART FAIL
•HANICAL •
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 Date , Inspector Ext
I
Final
PASS PART FAIL D • NOT R MOVE this inspection record from.-the job site.