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12155 SW I ippitt Place
�\ PLUMBING PERMIT
i CITY OF TIGARD _-- ---
DEVELOPMENT SERVICES PERMIT #: PLM2002-00218
13125 SW Hall Blvd.,Tigard, OR 97223 (5(�3) 619-4171 DATE I iSUED: 6/14/02
PAPCEL: 2S10313C-05200
SITE ADDRESS: 12155 SW TIPPITT PL
SUBDIVISION: '�IPPITT PL/,CE ZONING: R-4 5
BLOCK. _ - LOT: 002 JURISDICTION: TIG _
CLASS OF WORK. Al T GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WA':
Plumbing Permit Application
---- Date rec:ived: Permit no.:,;0L41 i"C) -0'.;i
Citi' of Tigard -
Sewer permit no.: Building permit no.:
Address: 13125 SW Holl Plvd,Tigard,OR 972223
City of Tigard Phone: (503) 639-4171 Project/appl.no.: Expiredatc:
Fax: (503)598-10:;'O Date issued: By: I Receipt no..-
Land
o.:Land use approval: —_ - Case file no.: Payment type:
I
I t. 2 family d xrllurk of ;r c o-ry J C nninctcialhlidustnal U Multi-family U Tenant improvement
U Ncw construction U Addttlon/alteration/4laccment U Food service U Other:
.1011 SI-I V.I`NFORNI t
Job address: Z /�� S(,t� r F/ar t Description (lt 1 ee(Qa.) 'iota!
Bldg.no.: Suite no.: New 1-and 2-family dwellings only: �
(Includes 100 ft.foreach utility connection)
Tax mapttax lot/nccount no.: SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath
Project name: SFR(3)bath
City/county: Zip: 9 7223 Each additional bath/kitchen
�scription and 1"ocatio. of work n premises:l I�L/.�l�'.L a Site udi ties:
tfi JAa , ✓,r r rI /A-,- �,A/.-1 Catch hasin/area drain -
test.date of complelion/inspection: Drywells/leach line/trench drain _
Furling drain(no. lin.ft.)
M,tnufacturcd home Llilities
Business name: I-),J v.• Manholes _
Address: Rain drain connector
City: I State: ZIP: 7/ h Sanitary sewer(no. lir..ft.) _
Phone: Fax: E-mail: Storm sewer(no. lin. ft.)
CCB no.: 3 ;7( Plumb,bus.reg.no:,t)l (J _ Water service(no.lin.ft.)
City/metro lic.no.:1.-7 41,-n --t) 'Tfr — Fixture or Item:
Contractor's repres ntative stbneture: � Absorption valve
Back flow prevcnter
Print name: vi,Q �� r Date: w - : Backwater valve Z"_ut
�JJMMUM146 11- Basins/lavnto�r
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: --- State: ZIP: Ejectors/sum
Phone: Fax: I E-mail: Expansion tart:
Fixture/sewer cats
Floor drains/floor sin',,/hub
Name(print): 12 &2of — rarba a alis tsar _
Mailing address: �_ S '1..J i ,w Hose bibh
City: State: A ZIP:_S'72 2 3 Ice maker
Phone:ISM `t cf- (,09 Fax: IE-mail: nterce tp or/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will he made by me or the maintenance and repair made by my regu:a.r Roof dra;n(commercial) _
employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _
Owner's --i-nature:_,,_ _ 1)atc: ___ Sump
Tubs/shower/shower -�-
Urinal
Name:------------_ - --- - --- Water:oset - --- - --
Address: Water heater
I City: v — State: ZIP:`- 96)-Other:
Phone: Fax: E-mail: Tont
Not all puidicum oaaept credit Cada,plow call)"Tidictk,n(I more ill n"01. Notice:This permit application Minimum fee............ ) $ _ =�� ��
U Visa U MasterCard expires if a permit is not obtained Plan review(at .r $ — 2O
CredU card numter —Ewithin ISO days after it has been State surcharge(896)....$ �' I
accepted as complete. "~
TOTAL .......................$Name d c I u rhnwn nn credit cad
S
Cadlwrder signature _ - Amomt 410-4616(NOWOM)
r�!
PLUMBING PERMIT FEES:
- V PRICE TOTAL rNew 1 and 2-famlly 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 -- -
16.60 --o-"
SUBTOTAL
Urinal
_ 8/.STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposil 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 Healer O conversion O like kind 18.60 Quantity b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Ca ed
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 Shuwer Oni _
Drinking Fountain 16.60 Water Closet _
Other Fixtures(Specify) 16.60 Urinal
- Dishwasher
Garbage Disposal
Laundry Room Tr.3
Washing Machine
-_- A Floo•Drain/Sink: 2"
Sewer-1 at 100' 5500 3"
Sewer-each additional 100' 46.40 d"
Water Service-1st 100' 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
oeG
Storm,) Rain Drain-1st 100' 55.00
Storni 8 Rain Drain-each additional 100' 46.40 _
Commercial Back Flow Prever tion Device 40.40
Residential BacMlow Prevention Device- 27.55
Catch Basin 16.60 -
Inspection of Existing Plumbing or Specially 62.50 -
Rec Tested Inspections ermr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60 - -
QUANTITY TOTAL _
Isometric or riser diagram Is reqs Ired if
Quantity Total is >9 -• -
*SUBTOTAL - -- - ---�
8%STATE SURCHARGE
PLAN REVIEW 25%OF SUBTOTAL
_ Required only If fixture qty.total Is;,9 _
TOTAL 5
"Mlnirnum permit fee Is$77.50•8%state surcharge,except Restrientlal Bac48uw
Prevention Uevice,which is S.M 25+8%elate surcharge
""Ali New Comm:•clal Buildings requiry 2 sets of plans with Isometric or riser
diagram for plan nwlew.
i d9ts\forrns\plm-fees.doc 12;2o/01
CITY OF TIGAkO 24-Hour `� s
BUIL Inspection Line: (603)639-4175 MST s �-
INSPECTION UVISION Business Line: (503)639-4171 -
BUP
Received -Date Requested— ��_ AM PM BUP
Location Tt- Suite--- MEC -�
Contact Person --_____� ,e�a.� �/ Ph ,yU PLM
Contractor - -- ----.---___._-- Ph(----) - - SWR
BUILDING Tenant/Owner _ ELC
F-aoting ELC
Foundation Access:
Ftg Drain G /� ELR -
Crawl Drain l
Slab Inspecti n totes: SIT _
Post&Beam -_ -
IShear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing - --- — ------ — -
Firewall
Fire Sprinkler --- ---- --- - ---
Fire Alarm
Susp'dCeiling ---- ---- --- -
Roof
Other: -._- -- ------ ------- •-----
Final ---- -------
PASS_ PART FAIL -------- - - --- -----
PLUMBING -- -- — - -- ---._..--- --
Post& Beam
Under Slab ----- — -
Rough-In ,
Water Service -- - -
Sanitary Sewer
Rain Drains --- - �,
Catch Basin/Manhole
Storm Drain --- -L--- /-
Shower Pan
Other:
,Fin L
SS PART FAIL
ANICAL
Post& Beam
Rough-In -�_ _...- --------- --------- -�
Gas Line
Smoke Dampers - --- - -
Final
PASS PART FAIL
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final E] Reinspection tee of$ ---_-_--required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect-no acc,c ss
Fire Supply Line
ADA Date ! Inspector i1Bxt--_
Approach/Sidewalk
Other-
Final — - DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL