Permit CITY TIGARD PLUMBING PERMIT
• DEVELOPMENT SERVICES PERMIT #: PLM2002 -00083
I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/22/02
SITE ADDRESS: 12450 SW WALNUT ST PARCEL: 2S103BC -03900
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 940 ft
Remarks: Installation of (2) catch basins and 940' of private storm sewer line.
FEES
Owner:
Type By Date Amount Receipt
WINDWOOD CONSTRUCTION INC PRMT CTR 3/7/02 $320.20 27200200000
12655 SW NORTH DAKOTA 5PCT CTR 3/7/02 $25.62 27200200000
TIGARD, OR 97223
Total $345.82
Phone 1: 503 - 625 -6526
Contractor:
NEW WEST CONSTRUCTORS INC
PO BOX 19588
PORTLAND, OR 97280 -2909 REQUIRED INSPECTIONS
503 - 977 -2909 Storm Drain Insp Storm Drain Insp
Phone 1:
Reg #: 503-977-2909 -2909 Storm Drain Insp Final Inspection
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
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.
•
Iss ed By: I 1: �,L� AA / I Permittee Signature:
Call (503 ;39 -4175 by 7:00 P.M. for an inspection needed the next business day
y ,
Plumbing Permit Application OFFICE USE ONLY
Date received .5 7 D'.t Permit no u marob d j' -OOj)U
\_, r}3 City of Tigard
- � Sewer permit no. Building permit no \
Address 13125 SW Hall Blvd, Tigard, OR 97223
(in of Third Phone (503) 639 -4171 Project/appl no Expire date.
Fax (503) 598 -1960 R Date issued. By Receipt no 1`'
Land use approval: _b / �( / Case file no Payment type
TYPE OF PERMIT
D I & 2 family dwelling or accessory 3 Commercial/industrial D Multi- family ❑ Tenant improvement
1K ew construction D Addition/alteration/replacement 0 Food service 3 Other
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address /2 tiro (,04LeV"rs 1 . "\--,',:1-20 Description Qty. Fee(ea.) Total
Bldg no.: Suite no '
New 1- and 2- family dwellings only:
Tax map /tax lot /account no (includes 100 ft. for each utility connection)
SFR (I) bath
Lot Block Subdivision. SFR (2) bath
Pioject name 6 L () r pi i O s$ IN 21.L SFR (3) bath
Cuy county �;Net 0 C01,,tQg ZIP Each additional bath /kitchen
Description and location of work on premises Site utilities:
Catch basin /area drain 2
Est date of completion /mspecuon Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no lin ft.)
Manufactured home utilities
Business name. IS tx ) L Z S T- Co 505 21JC..'To2S Manholes
Address t?O, Gt„ (9s Rain drain connectot
City Qt`j2:TL4010 Statc.CA ZIP: 92z_8 Sanitary sewer (no lin ft.) (�
Phone 9)7 Z.9 9 Fax977Z9Or) E -mail Storm sewer (no lin ft.) ' ejyQ C
CCB no /Qs7,42— Plumb bus reg no
Water service (no lin ft )
Cltv/mctrollc no Fixture or item:
Absorption valve
Contractor's representative signature l - - --------(— Back flow preventer
Print name: /66_0 (24:711.4A- •11.0 Date. Backwater valve
CONTACT PERSON Basins /lavatory
Name /L✓14) �Ie,JZ,..I4ryV6 Clothes washer
Address Dishwasher
City State: ZIP: Drinking fountain(s)
Ejectors /sump
Phone . - . I' Fax E -mail. Expansion tank
OWNER Fixture /sewer cap
7
Floor drains/floor sinks/hub
\ame (prim) t A� U)006 Lpi,U 1 , ►0L ^ • Garbage disposal •
Mailing address )2,65 S% It11y(Z -ZVI 'l A4 L o 4- Hose bibb
C it■ i t 5 1 4e,c, StateO (Z- ZIP 0j 7ZZ 3 _ Ice maker
Phone 6L s C Fax E-mail I 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 I LPN, t- A) Water
Watercloset
Address y 600 S t_) O 4-i _ # Z-30 Water heater
City. y r i L44Q State Q(L ZIP97Z -3 Other:
Phone, 445 Fax.y5L_,y3 E -mail Total ,
UI all I UIhl d tion, auept weds card,. plead call junsdnuon lot 11101C mlbnna Minimum fee S alon
Notice This permit application
Plan review (at %) S
/ ° e\plres If a pennu is not obtained
do ...rd nnmh`' State surcharge (8 %) . S
within ISO days aftei it has been
t\p�rc, TOTAL ..... . . . S ,T1 57,2
N.,,,,,,.. or ,d r dholdct as ,hown on c/cdu ddnl aCcepied is complete.
S
Cardholder ,i n.au« Amount 441i -46is 10 011 CO \11
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
for each utility connection)
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
8% SUBTOTAL
Urinal 16 60
8 /oSTATESURCHARGE
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 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
Hose Bibs 16 60 Tub or Tub /Shower
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"
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 SS-ct.,
Storm & Rain Drain - each additional 100' 46.40 2Y1.00
Commercial Back Flow Prevention Device 46 40
Residential Backflow Prevention Device" 27 55
Catch Basin .2 16 60 3)i 20
Inspection of Existing Plumbing or Specially 62 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: ?ZO • Lo
8% STATE SURCHARGE: Zs. 62
* *PLAN REVIEW 25% OF
SUBTOTAL:
Required only if fixture qty total is > 9
TOTAL PERMIT FEE: $.1f1•5:82
*Minimum permit fee is S72 50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is S36 25 + 8% state surcharge
* * All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review
i \dsts \forms \plm -fees doc 02/05/02