8925 SW PINEBROOK COURT cD
0
8925 SW Pinebrook Court
n CITY ®F' TIGARD
RD PLUMBING PERMIT
/ T t /�
PERMIT#: 8/27/0PLM2002-00333
DEVELOPMENT SERVICES
DATE ISSUED: 8/27/02
13125 SW Ha,l Blvd., Tigard, OR 97223 (503) 639-4171
^..^.RCEL: 2S111 AQ-J:51 UG
SITE ADDRESS: 08925 SV/ PINEBROOK CT
SUBDIVISION: PINEBRC,OK 'TERRACE ZONING: R-4.5
BLOCK: LOT: 028 ,JURISDICTION_TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME Sr'ACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PP.EVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES _ LAUNDRY TRAYS: SF RAIV DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
'TUBISHOWERS: SEWER LINE: 60 ft
WATER CLOSETS: WATER LWE: ft
DISHWASHERS: RAIN DRAIN: ft
Rr narks: Replace approximately 60'of sewer line from lateral to house.
FEES
OvA ier: -- Type By Date Amount Receipt
PAULAT, DEANNA K P„i,AT CTR 8/27/02 $72.50 272.00200000
8925 SW PINEBROOK COURT 5PCT CTR 4/27/02 $5.80 27200200000
TIGARD, OR 97224
Total $78.30
Phone 1:
Contractor: —
LOVETT EXCAVATING INC
17385 SE TODD LN
GLADSTONE,OR 97027 REQUIRED INSPECTIO14S
Sewer Inspection
Phone 1: 503-504-2847 Final Inspection
Reg #:
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 -lork 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 th Oregon Utility
Notification Center. Those rules are set frit'I in OAR 952-0001-0010 through OAR 9 2-0001-0080.
YolaJ0
fray obtain copies of these rules or direct questiors to OUNC by c84ng- 3) 4 -1987.
l
I ued By: \ �L_ Permittee Signaturrv: yLl
'!:Vi (503)639-4175 by 7:00 P.M. for an ii • ;section needed the next business day
Permit A + OR
iii ^ A1C�ltiOi1 Received j�' a� Plumbing
no
— Date/BY: PermitNo.: e,r �-oo335
+ Planning Approval Sewer
city Qf rigard Test h 01'111 Plan R OthePermr No.:
Plan Review Other
13125 SW Hall Blvd. Date/l : Permit
Tigard,Oregon 97223 Post-Revicw Land Usc
Phone: 503-639-4171 Fax: 503-598-tn;0 Date/By: ease No.: —
u ' .
Internet: ww'w.CL � See Page 2 for
tigaid.Or,us Contact Supplemental Information.
24-hour Inspection Request: 503-639-4175 Name/Method: /
TYPE OF WORK _ Description To
FEE*SCHEDULE(forspecial Information use checklist)
— Demolition
Qty. Fcc(ca.)
New construction tal
New 1-& 2-fantlly dwellings
Addition/alteration/replaccment Other Includes 100 ft.for each u(ilit connectlon
CATEGORY OF CONSTRUCTION SFR I Dail) 249.20
1 &2-Family dwelling ❑Commercial/Industrial SFR 2 bath 350.00
Multi-Famil SFR(3)bath 399.00
_ Ac_cessory Building —
Master Builder Other: Each additional bath/kitchen 45.00
Fire sprinkler-s . R.: Pae 2
JOB SITE INFORMATION and )CATION Site Utilities
.rob site address: W tr LIG.6o
$ld r./A Catch basin/area drain
Suite#: Dr well/leach line/trench drain 16.62
Project Name: _ ___— — Footin drain no.linear ft. Pa c 2
Cross strect/Dircetions to ob site: {- Manufactured home utilities 1 1610.016.60
0
�� cS C) ',Q/ t t') �jv C'GF� (T Manholes _ .6O
Rain drain connector 16 fie.
Sanitar sewer nn.linear ft. Pa'c 2
St'irm sewer(no.lin(:'tr R.) Pa is 2
Subdivisiots. _ Lot#: V ater service(no.linear it,) Pa c2
Tax ma parcel#: __ Fixture or Item.
DESCRIPTION OF F WORK Absor.tion valve Iti.GU
VBackflow rcventer Pa e 2 _
R
_ Backwater valve 16.60
JL— �'" Clothes washer 16.60
Dishwasher 16.60
Drinkin fountain 16.60
PROPERTY UWNER 'ENANT _ E'ectors/suin W60
Name: Ex tunsion tank 16.60
---
Fixture/sewer ca 16.60
Address: — Floor drain/floor sink/hub 16.00
Cit /State/Zip: — -- Garba a dis oral 16.60 _
Fax: [lose bib 16.60
Phone:
APPLICANT CONTACT PERSON Ice maker 1 G.6o
Interce tor/ rcase tra 16.60
Name: _ _ — v-- Medical as-value: $ Pa c2
Address:__ Primci 16.60
Cit /State/Zi : Rriofdrain(commerc)al�_ 16.60 _
Fax: Sink/basin/lavato 16
Phone: 16,6
0
U
Tub/shower/shower an
E-mail: Urinal — IG.GO
_ CONTRACTOR Water closet 16.60
Business Nam —� E= v� Water he;.tcr 16.60
Address: S e Other. --
Cilty/State/Zir, off (C Diner
RyPlumbing Permit Nees*
Phone: 5a3 5 Fax: subtotal $ 7" •''
CCB Lic. #: 12 0 Plumb. Lic.#: Minimum Permit Fee$72.50 $
Residential Backflow Minimum Fee$36.25
Authorized pate: ��-nv Plan Revicw(25"/0 of Permit Fee) $
Signature: -- '— State Surcher a S%of Permit Fce) $
IPA V) TOTAL PERMIT
- (Please rint nanx) — Notice: This permit application expires If a permit is not obtained within
IAO days after It has been accepted n complete.
All new('ommercial building require 2 sets of plans Kith isometric or *Fee methodology set by Tri-County Building Industry Service hoard.
riser diagram for plan review.
Plumbing Permit Application - City A''Figard
Pale 2 - Supplemental information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footaae� Permit Fee;
Footing drain-I°100' 55.M 0 to 2,00 __. $115.00
Footing drain-tach additional 100' 46.40 2,001 to 3,600 $160.00 _
3 601 to 7,200 __- S220.00
Scwer-I st 100' 55.00 7,201 and reatr.r $309,00
Sewer-each aMlional I W' 46.40
Water Service-Ist 100' 55.00 Medical Gas S stems:
Water Service-each additional 100' 46.40 Valuation: Permit Fee:
Storm&Rain Drain-I st 100' 55,00 $1.00 to$5 000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional SIOUX)or fraction thereof,to and
Fixture or Item Qty. Fee(ea) I Total including$10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Devine _ each additional$100.00 or fraction thercof,to
(minimum permit fcc$36.25) -27.55 and includinst$25 OOOAO.
Rain Drain,single family dwelling 65.25 $25,001.00 to$5'1,000.00 $379.50 for the first$2J,000.00 and$1.45 for
each additional$100.00 or fraction thereof,to
Inspection of existinl:plumbing or and includi $50,000.00.
specially requested ir: cetiims erhour _ 72.50 _- L�5_0,001.00 and up $742.00 for.ne first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes",please indicate work perforated by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
uantity b Flxtarc Work 11 rfornted COmtnet,t i regarding fixture work:
Fixture Type' Replace
New Nlovtd Fxlstla Ca i icd
Ba list /Font
Bath -Tub/Shower _
-Jacuzzi/Whirlpool --------- — .--_ ---- -—.___-
Car Wnsh -Tach Sall
-Drive fhru _
Cuspidor/Water Aspirator
Dishwasher -Commercial -
-Domestic
Drinkintt Fnuntain
_L115 Wash_
Floor Drain/sink -2"
-3„ _-4" _
Car Wash Drain _ ----- *Note: If the fixture work under this perntit results in alt
Garbage -Domestic _
Disposal -Commercial increase of sewer E DUs,n sever permit till be issued and
-Industrial fees assessed for the sewer increase must be pail:%efore the
Ice Much./RS!h .Drains plumbing pertnit can be Issued.
Oil Separator Gas Station
Rec.Vehicle Durnp Station —
Shower -Gang
-Stall
Sink -Bar/lova6xy _-
-Hindley
-Commercial _
-Service
Swimming fool Filter
Washer-Clothes
Water Extractor
Water Closet-'toilet
Urinal -
Other Fixtures:
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 539-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP .
Received —____----_-._ Date Requested�–� AM lam_ PM BUP _—
Loccoion ?uJr� //� Suite MEC
Contact Person _ —_ _121—�1 . Ph( s ) Ll S_ PLM
Contractor _-- --------__--- __-- Ph( —) _ --- SWR --
BUI'.DING Tenant/Owner ELC _—
Footing - ELC
Foundation Access:
Ftg Drain ELR —
Crawl Drain
Slab ;nsperJonNotes: SIT —
Post&Beam --- / —/—/-
Shear Anchors --
Ext Sheath/Shear
Int Sheath/Shear
Framing ---- -
Insulation
Drywall Nailing --- �-
Firewall
Fire Sprinkler ------------- - — ------ ---- -
Fire Alarm
Susp'd Ceiling -- - -- -- ---------- - ---
Roof
Other -�._------ -----_-_-_ .—__— _-- ----�
Final -- ------ �._,
PASS PARI FAIL ,.--------------- ------ _ _
Post&Beam
Under Slab — -
Rough-In
Water Service -
Rain Drains --
Catch Basin/Menhole
Storm Drain -.-_—_--
Shower Pan
Other:
A PART FAIL-
-
MECHANICAL—_
Post& Beam
Rough-In -- --- -- .. ------ -
Gas Line
Smoke Dampers -
Final
PASS PART FAIL --- - - -- _
ELECTRICAL
Service
Rough-In —
UG/3Iab
Low Voltage — _ __----._r.__---- ------- —
Fire Alarm
Final Reinspection fee of$r_ —required bef e n inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ [� Please call for reinspection RE: __ _ -- Unable to inspect-no access
sire Supply Line
ADA Date_ Z Inspector --.-- Ext---
Approach/Sidewalk
Other:
Final GAO NOT REMOVE this Insp 1 record from the Job slue.
PASS PART FPIL