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CITY OF 1 IGAR D _ PLUMBING
PERMIT
DEVELOPMENT SERVICES E #: r'LM2002 00435
13125 SW Hall Blvd., Tigard, OR 97223 (503) 539-4171 DATEE ISSUED: 11/13!02
SITE ADDRESS: 11940 SW BURLCREST DR PARCEL: 1S134CA-02500
SUBDIVISION: BONING:
aLOCK: LOT: JURISDICTION:
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOPIE SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: T LAPS:
STORIES: WATER HEATERS: CATCH B) SINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
�— SINKS: UR,NALS: GREASE TRAPS:
LAVATOi?IES: OTHER FIXTURES:
TUB/SHOWERS: S1--WER LINE: 50 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace approximately 50 feet of sanitary sewer service.
- ---FEES
Owner:
---� - -- --
CASTRO, EDUARDO E KAREN A Description Date-- Amount
--
11940 SW BURLCREST DR II'LUMI1I I'crmit Fee 11/13/02 $7250
TIGARD, OR 97223 II'LLJMBI Permit Fee 11"13/02 $0.00
1TAX) 8'%,State Tax 11/13/02 $5.80
TAXI 8 State Tax 11/13/02 $0.00
Phone 1: ---- — — --
Total $78.30
Contractor: ---
APOLLO DRAIN * ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
REQUIRED INSF-_CTIONS
Phone 1: 239-8801 Sewer Inspection —
Final Inspection
Reg#: MET 00003082
LIC 00049418
PLM 26-533PB
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 to 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
r,
Issue B Permittee Signature:
Call (503) 639- 75 by 7:00 P.M. for an Inspection needed the next business day
Building Fixtures
Plumbing Permit Application
Date received: Ol Permit no.: L-
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Rhvd,'l igard,OR 97223
Ciro of'/'igp,rd phone: (503) 639-4171 Project/applno.: a date:_
Fax: (503) 598-1960 Date issued: B I Receipt no.:
Land use approval: Case file no.: Payment type:
YVPE 01F PfRMIT
J k& 2 family dwelling or accessory UCommercial/industral U Multi-family U Tenant imprm:.mcnt
J New consuurtion U Addition/alteration/replacement U Food service U Other
.10111 SITEIINFO911JLEinformation '
Job address: _-5�„� �tPS{ p r Description Qty.I Fee ea. Tutal
Bldg. no.: Suite no.: New 1-an 2-family dwellings only.
(includes 100 ft.for earh utility connection)
T ax map!tax lot/account no.: SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath
Project name: _ SFR(3)bath
Cit /county: ZIP: '/ -7.2;;2 5 Each additional bath/kitchen
Description andocatiot of work on premises: Site utilities:
Elie l;ire QQb�t•�r. Catch:.asimlarea drain
Est.date of completion/inspection: Drywells/leach line/trench drain
111111111 Footing drain(no. lin.ft.)
Manufactured home utilities
Business name: ���n Manholes
Address: —N��,r < jf, Rain drbin connector
City: G en L State:e)f, I ZIP: Sanitary sewer(no.lin.It.)
Phone: gyju Fax: I E-mail. Storm sewer(no.lin. ft.)
CCB no.: Plumb.bus.reg,no: . 6• Water service no.lin I",,)
City/metrolic.no.: 3o6g, fie•j1_o� Fixture or item:
Contractor's representative signature: BacAbso tion valve
Print name: f t sYs e. bate: r Back flow presenter
"/ -"Z Backwater valve
PERSONBasins/lavatory
Name: Clot es washer
Address: _— Dishwasher
Cit State: ZIP: Drinking fountain(s)
Ejectors/sump
Phone: Fax: E-mail: Expansion tan
Fixture/sewer cap
Name(print): ['�`4 r p Floor drains/floor sinks/hub
Garbage disposal
Mailingaddress: ll9q0 .,r (.rC —_� use bibb
City: State: o fL 1 ZIP: Ice maker
Phone: M- 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 rain(commercial)
employee on the property I own as per CIRS Chapter 447. Sink(s),basin(s),lays(s)
Owner's si mature: _ _ Date _ Sump
Tu7shower/s ower pan
Urinal
ne: Water closet -----
Address: _ Water eater
City: �i r4Iate: ZiP: Other:
Phone: Fax: E-mail: Tobd
Not 11 Jurisdictions accept credit cae
cards,please drm
l Junsdidbn for more infoation. Minimum fee................$
Nodce: This permit application plan review at
O Visa U MasterOwd ( ) S
exl,ircs if a permit is not obtained ° �,
Credit can,wmbet: —L�__ State surcharge(9%) $ '
Expires within 180 days after it has beets "" —�' .
accepted as complete. TOTAL........................ S
Name n ser older u a-{awe on i— terse—card —— � p
--Cardhollet signature Amount _� 110.1616(6OYMM)
PLUMBING PERMIT FEES:
v~ PRICE TOTAL ( New 1 and 2-faraliy dwellings only: -�
FIXTURES individual QTY ea AMOUNT (Includes all plumbing fixtures inPRICE TOTAL
Sink 16.60 the dwelling and the firs000 ft. QTY (ea) AMOUNT
Lavatory - 16.60 for each utility connectionZ __
One1)bath 5249.20
rub or Tub/Shower Comb. 16.60 Two 2 bath _ $350.00
Shower Only 16.60 Three(3)bath $399.00 _
Wl.ter Closet 16.60 V
Urinal 16.60 SUBTOTAL
8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 23%OF BUBTOTAL
Garbage Disposal 16.60 TOTAL _
Laundry Tray 16.60
Washinp Machine 16.60
Floor r ain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater O conversion O like kind 16.60 uantity b Work Ferformed
Gas piping o4quires a separate mechanical Fixture Type: New Moved Replaced Removed/
ermit Capped
MFG Horne 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(Shicify) 16.60 Urinal
Dishwasher _
Garbage Disposal _
Laundry Room Tray
Washing Machine
Sewer-1st 100' 55.00 Floor Drain/Sink: 2"3" --
Sewer-each additional 100' 46.40 4"
Water Service• 1 a 100' 55.00 Water Heater
Water SW ce-each additional 200' 46.40 Other Fixtures
Storm&Rain Drain-1 at 100' 55.00 (Sped
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 Spedally 62.50
RequestedRequestt!j Ins ecUoneper/hr COMMENTS REGARDING ABOVE:
Rain Drain,sirigle family dwelling 65.25
Grease Traps 16.60 -- - --- - ---- --
QUANTITY TOTAL ---
Isometric or riser diagram Is required if ----�
QuantPy Total Is >g
'SUBTOTAL
8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Required only H fixture qty.total Is>9
TOTAL f
"Minimum peril fen ;$7;50•a%state surcharge,except Residential Backflow
Prrvention Device,which is$afi 75-8%state surcharge
""All New Commercial Buildings require 2 sats of plans with Isometric or firer
diagram for plan review
I:\dstslformslpim-fees.doc 12/26/01
i
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISICM Business Line: (503)1639-4171 MST -- --
/ / BUFF
Received __-----.-----__- Date Reouested- -
Location l y * t- -
-�---�- url�Y yY .` -----Suite _— fadcC -
Contact Person .. - ----- Ph( —) - y ------ -
Contractor -- PLM �i�Z�a✓ .)--
-- -- - -- --- - Ph (- R
-
BUILDING ---
Tenant/Owner - ELC
Footing --___ - --' - - — -- -- ---
Foundatioi i
Ftg Drain Access: ELC —
Crawl Drain _ ELR
Slab Inspection Notes: `-` ----___ - -- ---
Post& Beam SIT
Shear Anchors - - -
Ext Sheath'Shear
Int Sheattv'Shear ""'------
Framing --
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -
Fire Alarm fr
Susp'd Ceiling -
-- i -
Roof -------...-----
Other:
Final ---
pA—PART FAIT. -- —
c L - - �.-
Post t Beam
Under Slab ---
Rough-!n
Water Service
Rain Drains
Catch Basin i Manhole -- - -
Storm Drain
Shower Pan - -
Other:
AS PART FAIL - -
ANICAL
Post&Beam —_— ___ -------- — ---
Rough-In _
Gas Line ------- --- - -—---
Smoke Dampers -----------
Final ----- -- — ---- -- ---
PASS PART FAIL —
�LECTRICAL - ----- ---- -- ---
SerVlCe --- — ------- ------
Rough-In — ------ —
UGiSlab -- - --_— _—_.--------____
Low VoltageFire Alarm ----- --, _
Final
PASS PART_ FAIL Relnspectlon fee of$ requirsd before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Phase call for reinspection RE:-
Fire Supply Line —-- Unable to inspect-•no access
ADA
Approach/Sidewalk D _ Inspector fp")110
Cit' Ext
Final DO NOT REMOVE this inspection record from th4;ole site.
PASS PART FAIL