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�AI2TQ CIN`d'IHOIH MS 09901
CITYOF TIGARD _ PLUMBING PERMIT _
DEVELOPMENT '%ERVICES PERMIT#: PLM2001-00279
13125 SW Hail Blv4 , Tigard, OR 37223 (503) 639-4171 DATE ISSUED: 6/29/01
SITE ADDRESS: 10660.SW HIGHLAND DR
PARCEL- 2S110DD-05700
SUBDIVISION: SUMMERFIE:LD NOA ZONING: R-7
BLOCK: LOT: 157 JJRISDICTION: TIG
LASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOI PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
TORIES: WATER HEATERS: CATCH BASINS:
FIXTURES — LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE 'RAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: PAIN DRAIN: 100 ft
Remarks: Rain Drain installation.
_
Owner: — --FEES
— --
-" Type By Data Amount Receipt
SCHEID, JAMES H + JACKIE C TRS --- ------ —
10660 SW HIGHLAND PRMT CTR 6/29/01 $72.50 27200100000
TIGARD, OR 97224 5PCT CTR 6/29/01 $5.80 27200100000
Total $79.30
Phone 1: --
Contractor:
LARSON & SON
7800 SW 36
PORTLAND, OR 97279 REQUIRED INSPECTIONS
Phony Rain Drain Insp 1: 503-246-7004 Final Inspection
Reg #:
-Chis 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 we rk is suspended for more
than 180 days ATTENTIONOregon law requires you to follow rules adopted by the Oregoll Utility
Notification Center. Those rules are set forth in OAC', 952-0001-0010 through OAR 9�-J%-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1981.
Issued By: r _1l ��� '� Permittee Signatures
Call (503) 639-4'15 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application NA,
, Permit y /_ Datereceried:f'
City of
f T 1fga�Ct[ �C� Sewer permit no.: Building permit no.:
Address: 13125 SW Mall Blvd,Tigard,OR�9;73 -- - -
Cirynrl'i�nrrl Phone: (503) 639-4171 Project/arpl.no.. - Expire date:
Fax: (503) 598-1960 Date issv'd: B Rceeipt no.:
Land use approval: _ v, Case file no.: Payment type:
U 1 &2 family dwelling or accessory U CommerciaVirdustrial U Multi-family U Tenant improvement
U New construction U Add ition.ialteration/replacr,men t U Food service U Other:
.1011 MY E INFORMAT roll ,
Job address: _.l�Q� GC/ �/ �(/ Desc_ t _or. QI I�ee(ea.) 'l'or'd
New 1-and 2---ffornfly dwellings only:
Bldg.no.: Suiff no.: (includes 100 It.foreach utility connection)
Tax map/tax lot/account no.: _ — SFR(I)bath
Lor. Btcx k: Suhdivision: _ Sf R(2)bath --__----__- __- --- ._--_--
Project name: �^ SFR (3)bath
City/county: Each additional bath/kitchen --
Description and location of work on premises: SiteuNlities:
Y,2AZ' ZO';t/ __ Catchbasin/areadrain
_
Est.date of completiori/inspcctiow Drywells/leach line/Dench drain„
Footing drain(no,lin.ft.) _
Manafactured home utilities _
Business Warne: J/ Manholes _
Address: 2 lL Rain drain connector
City: d d State: a`L ZIP: Sanitary sewer(no.lin.ft.) --
Phone oc)J1 Fax: I E-mail: Storm sewer(no.lin. ft.) -
CCB no.: 17h d Plumb.bus.reg.nom W^te"cr rvice(no.lin.ft.) - -
City/metro lic.no.: � ) ;_ Fixture or Item:
Contractor's representative signature: Absorption valve
Bacflow preventer
_-
Print name: k -
p ice/ ,� ' ' Date: v Backwater valve
Basins/lavatory
Name: Clothes washer
Addn ss - Dishwasher
Drinking fountain(s) _
City: State: ZIP: Ejectors/sum
Phone. Fax: I:maul: I Expansion tank
Fixture/sewer cap _
N.roic(print,): , Floor drains/floor sinks/hub
_ _P _ � ic.i G =J C —`-_ Garbage disix)sal
Mail ng address: Hose bibb
~City: _ State: Z1P_ Ice maker
Phone: ,� �;�,�- 1 /I Fax:. F-mail Interceptor/greas_e trap ---
Owner installation/residential maintenance only: The actu... 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 _
Tubs/shower/shower pan
_Name: Urinal -
�- ----
Water close,
Address: Water tomer
-City: _ � - State: ZIP: Other: -
Phone: _ — Fax: ---l-E-mail: �-- — Total r.
Not NI jurisdictions accept credit cardr,please call jutisdicrion ror nine inroctnadon. Minimum fee.... ..........$ _- T
Notice:'Ibis permit applicat on
U Visa U MasterCard expires if a permit is not obtoined Plan review(at _ %) $ c��--t---
Credit card number: r _ _ within 180 days atter it has i-cr State surcharge(8%) ....$r'x
- --- - accepted%s complete. --.� - -
Netnr of c older m shown on credit card' p p p TOTAL .......................$ 3
S
a tre +� Amount 440-4616(6RDCOM)
i
PLUMBING PERMIT FEES:
PRICE TOTAL New-1 and 2-famlly swellings only:- -
FIXTURES (individual) Q1Y ea AMOUNT (Includes all plur,ning fixtures In PRICE TOTAL
Sink 16.60 the dwelling?nd the find100 ft. QTY (ea) AMOUNT
16.6° fur each I,!' V connegtl Ln
Lavatory_ _ - _ --- bath - $_249.20_
Tub or Tub/ShOvr3r Comb. 16.60 fwo(2)bath — $350.00
S! r only Three 3 bath _ $399.00
Jo 16.60 �__�—
Water Closnl 16,60 — - _ SUBTOTAL
_
Urinal — — 16.60 -' 8%STATE SURCHARGE _
Disherashel - 16.60 PLAN REVIEW 25%OF SUBTOTAI.
Garbeje Di,posal _— i6 60 - TOTAL _—
Laundry Tray _ 16.60
Washtnq Machine — 16.60
Floor Drain/Floor Sink 2° ,6.6° -_ PLEASE COMPLETE:
3„ -- --- 16.60
q" 6.60
Water Heator O conversion O like kind 16 t+0 Quantic b Work Performed
Gas pining requires a separate mechanical Fixture Type: New Moved Replaced RWm dl
s pi _ -------Capped
MFG Home New Water Service 46.40 Sink
MFG Home New SaNStorm Sewer _ T 46.40 Lavato
Tub or Tub/Shower
Hose`ribs 16.60 Combination
Roof Dr,`ns - - - 1Sh
6 60 ------ ower Only
DrinRing Fountain i 16.60- v i Water Closet
-- - -Ifi&OT -' Urinal
Other Fixtures(Specify) _ - Dishwasher
—� Garba a Disposal_
- --� _ Laundry oo-n Tray
Washing Aachine
_ - — ----- Floor Drain/Sink: 2" --
Sewer-1 st 100' 55.00 -- 3"
Sewer-each additional 100 46.40 4"
Water Srrvirp-1st 100' _ - 55.00 Waler Heater
_ -- Other Fixtures
`Nater Service-each additional 200' 46.40
Storm&Rain Drain-1st 10t15500
Storm&Rain Drain-each additional 100' 4640
Comrnercial Back Flow Prevention Device 4E 40 -
Residenlial R3ckllow Prevention Device' 27.55 --- --
Catch Basin t6.60 --
Inspection of Existing Plumbing or Specially 71,50
Reuesled Inspections _ er/hr - -_ COMMENTS REGARDING AB,'.VE:
Rain Drain,singie family dwelling 6525
Grease Traps- - - 16.60 --- --- --
QUANTITY TOTAL
Isometric or riser diagram Is required;f - _ -
Quantity Total is >g
'S1IRTOTAL --�
3%STATE SURCHARGE --
'"PLAN REVIEW 25%OF SUBTOTAL
Required only it fixv,,-qty total Is>11
TOTAL $
'Minimum p+rmlt fee is$7:50•8%state surcharge.except Residential Back'low
Prevention Device,which is$36 25+8%,tale surcharge
"Ari New Commercial Buildings require pians with Isometric or riser diagram and
plan review
lAdsLrtforms\plm-tees doc 10/10.x00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Litene: 6 9-4174v. -
DaRequested AM PM
rr _ _ _ BLD
Location /G �i ro S w �4r1�_ v_ _ Suite _ MEC
Co,tdct Persnn Ph (PLM
Contractor Ph _ SWR
BUILDING v Tenant/Owner �• 1% _ ELC
Retaining Wall ELR _
Footing Access:
Foundation FPS
Fig Drain SGN —.—`^---
Crawl Drain Inspection Notes: --------- —
Slab -_ —__ ---- SIT
Post&Beam —- —
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation - ----_�.—__—._---------------__—_—
Drywall Nailing
Firewall ---
Fire Sprinkler
Fire Alarm
Susp'r.Ceding
Roof ---
Misc __--
Final
PASS PART FAIL ---- - - -_----
Post& Beam -- - -- - -- -
14
Uoder Slab ,
Top Out
Water Service
sanitary Sewer
? 'SS j PART FAIL
NICAL �—
ast& Hewn - --
Rough In
Gas Line
Smoke Dampers
Final -- -- -
PASS PART FAIL
ELECTRICAL ----- ---
Seivice
Rough In
UG/Slab
-_Low Voltage
Voltage
Fire Alarm
Final T
PASS PART FAIL
SITE
Backfill/Grading --- ------ - — ---.-- --_ __ _ __
Sanitary Sewer
Stirm Drain ( ]Reinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd
::etch Basin RE:reinspection Please call for reins
(Fire Supply Line j p j Unable to inspect-no access
ADA I�'
Approach/Sidewalk
Other Date _ Inspector _-_ �, __ _Ext
Final
PASS PART FAIL__ DO NOT REMOVE this inspection record from the job site.
r,