11370 SW NORTH DAKOTA STREET 1S V IO)ldO H1NON MS OL£L l
1
F-
00
Q
H
O
Q
cc
0
Z
3
co
O
T
T
11370 SW NORTH DAKOTA ST
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00239
13125 SW Hall Blvd.,Tigard, OR 97723 (503) 6394171 DATE ISSUED: 6/12/01
SITE ADDRESS: 11310 SW NORTH DAKOTA ST PARCEL: 1S134DB-02400
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUE/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Replace kitchen fixtures. (remodel)
FEES
Owner: _
-- Type By Date Amount Receipt
TERETERESA SCOTT —
A WYNWOOD PRMT CTR 6/12./01 $72.50 2.7200100000
TIGARD, OR 97223 SPCT CTR 6/12/01 $5.80 27200100000
Total $78.30
Phone 1: 503-639-4396 ~
Contractor:
IVO SKORA PLUMBING
1820 SW WYNWOOD
PORTLAND, OR 97225 REQUIRED INSPECTIONS
Phone 1: 503-644-7373 Rough-in Insp
Rea#:
Final Inspection
4.
1K
F-
N
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
JSpecialty 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:X" Permittee Signatu r
roll(503)639-4175 by 7:00 P.M.for an Inspection needed the next business day
Wj
Plumbing Permit App " n
Date received:b Q i Permit no.T
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,
City of Tigard Phone: (.503) 639-4171 PmjecUappl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type.
ily dwelling or access otv U Commerci trial U Multi-family U Tenant improvement
;JoLbaddress:
struction .f,L Additiodalteration/re lacement U Food service U Other:
Q S�. y � Fee a. Total
Bldg.no.: Suite no.: New I-and 2-9mily dwellbW only:
(laclades 100 It.for each rdilky comsedlon)
Tax map/tax lot/account no.: SFR(1)bath _
Lot: Block: Subdivision: SFR(2)bath
Project name: SFR(3)bath
City/county: T� ./� ZIP: Each additional bath/kitchen
Description and location of work on premises: ' Sheutilklea:
Catch basin/arca drain
Est.date of completion/inspection: DrywcIlstleach line/trench drain
Footing drain(no.lin.ft.)
Manufactured home utilities
Business name: i _S;� .a ! ' ,�'//1/ -_ _ Manholes
Address: 'y/I/" �/ Rain drain connector
City: . ------- 1 State: ZIP: 6 Sanitary sewer(no.lin.ft.)
Phone: h _� Fax: — — E-mail: Storm sewer(no.lin.ft.)
CCB no.: y lumh.bus.re,-.no: 3 - - - water service(no.lin.ft.)
City/metro lic.na /� �/ Fixture or hem:
Abso tion valve
Contractor's represrntative signature _ Back flow preventer
Print name; Date: /Z-� Backwater valve
Basins/lavalo
Name: f/_- Clothes washer
Dis washer _
Address: Drinking fountain(s)
City: State,: ZIP_ E'ectors/sump
Phone: Fax: E-mail: Expansion tank
Fixture/sewer cap
Name(print): / Floor drains/floor sinks/hub -A
_ Garbage disposal
Mailing address: !f1 L ' Hose bibb
City: -j�'/a StateZIP: . lcc maker
IL Phon - Fax: — E-mail: - Interce or/ ase trap -1-- _
Owner instal lation/residential maintenance only: The actual installation Primer(s)
f will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
U) —
} employee on the property I own as per ORS Chapter 447. Sin (s),basin(s),lays(s)_
Owrer's si n,dure: Date: Sum
.-� Tubs/shower/shower pan _
m Urinal
j Name:_ Water closet
W Address: _ Water heater
J —
City: State: Z1P: Other:
Phone: _ �•tx: E-mail: Total
M all jurisdictions accept credit trade,pkw call jurisdiction fa man infarrration. Plan
evict fee............ ) $
NrL_
Notice:This permit application
Cl visa U MasterCard Plan review(At — �
expires if a permit is not obtained
Credit card rumba:_ / / within IRO days after it Itas been State surcharge(8%).. .$
TOTAL ........................$ I t Clt'�'
Nine d carAtolrler u attown on cExpires rd't card accepted as complete.
S
Cwdbolder sipisawe Amount 44(-1616(6R)WOM)
PLUMBING PERMIT FEES: '
PRICE TOTAL Now 1 and 24amlly dwellinga only: —
FIXTURES (Individual) QTYea AMOUNT pncludes all plumbing fbdurM In PRICE TOTAL
Sink 16.60 the dwelling and the flnt100 R QTY (M) AMOUNT
dllt
16.So for each u �ccannait
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 Garbage TOTAL
REVIEW 25%OF SUBTOTAL
—
Gaage Disposal --- ---
Laundry Tray 16.80
Washing Ma(;hir 16.60 --
Fkror Drain/Fioor Sink ? - N16.
PLEASE COMPLETE:
3"
4-Water Heater O conversionO like kind Quantity Om►ed
Gas piping requires a separate mechanical Fixtum Type: New Moved Rsplaned Removed!
Capped
permit. _ — —
MFG Home New Water Serv" 46.40 Sink
MFG Nome New SaNStorm Sewer 46.40 Lavat _
_ Tubof Tub/Shower
Hose Bibs 16.130 C40fibinaltion
Roof Drains 16.60 hower Only —
Drinking Fountain 16.60 Water Closet —
Urinal
Other Fixtures(Specify) 16.60 Dishwasher
Garbage Disposal
un r r Room Tra
shin Machine __—
_ _ FI Drain/Sink: 2"
Sewer-1 st 100' 5 3"
Sewer-each addHional 100' 48.40 4"
Water Service-let 100' 55.00 Water H ter _
Other Flxt s
Water Service-each additional 200' 46.40 S
Stone&Rain Drain-1st 10055.00 _V _—
Storm b Rain Drain-each bnal 100' 46.40 —_
Commercial Back Flow Prevention Device 46.40 —
Residenlial Backflow Prev;ntion Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Spet sally 72.50
Re uested Inspections _ per/hr_ COMMENTS REGARDING A VE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60 —
QUANTITY TOTAL
IL Isometric or riser diagram Is requir d If _
_
QuantityTotal Ii >9
� 'SUBTOTAL _
U) _ — —
8'/e STATE SURCHARGE --
J '"PLAN REVIEW 25%OF SUBTOTAL
m Re uired o_nI ly f flxturo qty.1Wal le>0 _
FD TOTAL1— I s
°Minimum permit hs Is$72.50+e%Mate surcharge,except Resklenlial Backflow
Prevention Device,which Is$:re 25+e%slate surcharge
All New Commercial Buildings require plans with isometric or riser diagram and
plan review
I:\dsts\forms\plm-fees.doc 10/10/00
CITY OF TIGARD BUILDING INSPECTION DIVISION v `
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST
/ SUP
Date Requested__ AM PM _. BLD
Location a3 96 '5 w Suite MEC
Contact Person Ph 70 Ir-GU PLM 23
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation Fps
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab _ 81T
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
FramingI1>: 4 L -t,�G I t,r r �y 414L,
Insulation
Drywall Nailing _
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PAIJ PART FAIL ---
ZQAL&Deam
Under Slab
Top Cut —
Water Service
Sanitary Sewer
Rain Drains
Fi
PART FAIL
MECHANICAL
Post R Beam
Rough In
Gas Line --- _
Smoke Dampers
Final —
PASS PART FAIL
ELECTRICAL
Service _
Rough In -
UG/Slab
Low Voltage t
Fire Alarm
Final
PASS PART FAIL _
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee a,$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ 1 Please call for reinspection RE: [ ]Unable to inspect-no access
ADA
Approach/Sidewalk rO InsIntor, ►// /t_Otheuate � Ex
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the fob site.