8855 SW MCDONALD STREET cI
C
8855 SW McDonald Street
I CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002-00210
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/11/02
SITE ADDRESS: 08855 SW MCDONALD ST PARCEL: 2S102DC-0130
SUBDIVISION: EDGEWOOD ZONING: R-4.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME GPACES:
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: ii s URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER, LINE: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace approximately 50'of water service
Owner: FEES
– —
---- Type By Date Amount Receipt
LUNG, DAVID W PPMT CTR 6/11/02 $72.50 27200200000
8855 SW MCDONALD ST 5PCT CTR 6/11/02 $5.80 27200200000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
FULLMAN SERVICE CO LLC
5221 SW CORBETT
PORTLAND, OR 97201-3716 REQUIRED INSPECTIONS
Phone 1: 224-5221 Water Service Insp
Reg #: LIG 122310 Final Inspection
PLM 26-443PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is riot started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or o„ect questions to OUNC by Calling (503) 246-1987.
s
Issued By: ^� _ Permittee Signature:
Call (503) 619-4175 by 7:00 P.M for an inspection needed the next business day
Plumbing Permit Application
Date received: Perr•citna:
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,'rigard,OR 97223
City of Tigard Phone: (503) 639-4171 l'roject/appl.no. Cxpiredate:
Fax: (503)598-1960 Date issued: By: Receipt no.:
Land use approval: —_-- Care file no.: l'aytnent type:
slid 1
I &2 fancily dwelling or accessory U Commercial/industrial L!Multi-family U Tenant improvement
U New ccrostructiun U Adclitioti/al(cratiolt/replacement U Food service U Other:.1011 SI FE INFORMATION FEE SCIIEDULE(for special
hiforniation use checklist)
Job address: leg-le-S, J`I.J /r'Ic ,S�, Ucwrri(ttiot 411Y. 1'ee(ca.) T01al
Bldg.no.; Suite no.: i NeK 1- and 2-family dnellings only:
(Ineludd 1100 ft.for each utility connection►
Tax map/tax lot/accourlt no.: SFR(1)bath
Let: Block: Subdivision: SFR(2)bath
Project name: J,n 'l` 6o,iiGe ; SFR(3)bath
City/county: ZIP: a Each additional bath/kitchen
Desch tion andlocation of work on premises: Sheutililles:
_fir -7p �' O' l✓.c�� .$'C/Y/r.e T;p;ng� Catch basin/area drain
Est.date of completion/inspection: Q,�- urywells/leach line/trench drain
Footin drain(no.lin.ft.)
PLUMBING(TON URAUI OR Manufactured hop.utilities
Business name: �ti//�ry�-�;r/� ic$ .>�L'/�/i�e- Manholes
Address: S 2' ► S/.v 6/4RIr Rain drain connector
City: /���>' �iy(_ State:OA 'LIP: 7��/ Sanitary sewer(no.lin.ft.)
Phone S`o1,2/ Fax: 9/J /�3Z� Email: Storm sewer(no.lin. ft.)
CCB no.: .3,Z.3 5-� Fix
Plumb.bus.reg.no: ?�, t/'/3 ('j ter service(nn, lin.ft.)
City/metro lic.no.: //e/7 Fixture or item:
Contractor's representative signature: Absorption valve
3B III
preventer
Print name: -_ a ��111 r Hale: /�- Backwater valve _
Basins/lavatory
Name: Clothes washer —!
-- -- ---- Dishwasher
Address: __ — Drinking fotmtain(s) — —
City: - State: ZIP: _-- Ejectors/sump-- — -
Phone: Fax: E-mail Expansion tank
Fixture/sewer cap
�p i Floor drains/floor sinks/hub
Name(punt): R l/r^ �..,ter rr ' _ Garbage dislx�sal
Mailing address: • 54,Mf hose aged
City: _ State: ZIP: _ M Ice maker
Phone: .3 Z Fax: E-mail: Interceptor/grease trap
(Avner installation/residential maintenance only: The actual instalktion Primer(s) —
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on die property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's si nature: _ _ _ I�cle ..___ Sum
Tubs/shower/shower pan _
Uri nal —_
Nene: -- ---- — _ _ Water closet _
Address: Water heater
City. _ — State_ Z,IPVOther: - -
Phone: Fax: TE-mail: Total
Minimum fee................$ 7,2•Sl
Not all Jurisdictions wcgw cmdn earls,please can jurisdiction for more information Notice:'nis permit application r
Plan review(at _ 96)
U visa ❑MasterCard expires if a permit is not obtainco
credit card number. _—_-_—__�_� —.�� within 180 days alter it has been State surcharge(896)....$ s _
Expires accepted 7 '3
- - - accepted as complete. TOTAL .......................
Name a ctudholder u shown on credit card
S
'nlholder xiputure --- - Amount, 440.1616(69aK.•OM)
PLUMBING PERMIT FEES:
--- ----- PRICE TOTAL —New-1 andfa
2- mily dwellings only: --
FIXTURES IndivldualL__ QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink- 16 60 a the dwelling and the flrst100 ft. QTY (ea) AMOUNT
_ for each utility connection
16.60
Lavatory _ _ One(1)bath $249.20
Tub or Tub/Shov.er Comb _ 16,60 Two(2)bath 3350.00
_-"—
Shower Only 16.60- - -- Three(3)bath $399.00
- -
Water C osel 16.60 SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE
PLAN REVIEW 25%.OF SUBTOTAL
Dishwasher 16.60 _ - -;---
Garbage Disposal
16.60 ------ -- TOTAL
Laundry Tray -� 16.60 -
Washing Machine 1660 --
Floor=- uantit
2- 16, - PLEASE COMPLETE:
3" 16.60 -
4" 16.60 _- -- —
--- b_Work Performed
Water Heater O conversion O like kind 1660 Fixture Type: New Moved Replaced Removed/
Gas piping requires a separate mechanical _ Capped
ermir -
MFG Home New Water Service 46.40 Sink -..--
46.40 -- La rator� _-- -- --- -
MFG Home New San/Storm Sewer - Tub or Tub/Shower
Hose Bibs 16.60 Combination
Root Drains 16.60 Shower Only
16.60 Water Closet
Drinking Fountain Urinal _
Other Fixtures(Specify) 1660 _ Dishwasher
Garba a DIs osal
-- - Laundry Room Tra -
Washin Machine ---__
_ Floor Drain/Sink: 2" _
Sewnr-1st 100' 55.00 3" _
Sewer-each additional 100' 46.40 4"
Water Heater
rvl
Water Se .+•1st 100' 55.00 S.$� Cther Fixtures
Water Servict.r-each additional 200' 4640 (.Specify)
Storin 8 Rain Drain-1st 100' :)5A0 _ -
S1orm 8 Rain Draln-each additional 100' 46.40 - --
Commercial Back Glow Prevention Device 45.40 - - �-
Residential Backflow Prevention Device- 27.55
Catch Basin - 16.60
inspection of Existing Plumbing or Specially 72.50
Requested Inspectionspar/hr COMMENTS REGARDING ABOVE: -
Rain Drdin,single family dwelling 6525 _ -----
Grease 16.60 -- - —�-_-- ---- —
QUANTITY TOTAL -
isometric or riser diagram Is required it —
Quantfty
"SUBTOTAL ---- -
8%STATE SURCHARGE
••PLAN REVIEW 250/.OF SUBTOTAI-
Required only tl fixture qty total is_1 9
-- TOTAL
"Minimum permit fee is S72 50•8%slate surcharge,except Residential BackBow
Prevention Devire,which is$36 25+a%state surcharge
'All New Commercial Buildings require plans with Isometric or riser diagram and
plan review
1:\dstn\forms\plm-fees.doc 10/10/00
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4;75
MST
INSPECTION DIVISION Business Line: (503)639-417'
BUP
Received v Date Requested . - __ /`2.- AM _ - __ PM BLIP
Locationi� _ suite_----
- - -- — MEC - - -- -
Contact Person z sf,vt-4 Ph(_ ) A- ZZ PLM
Contractor Ph(.-------) _ SWR
BUILDING Tenant/Owner __--- - _- ---_- _---- ------- . _ ELC _-- -
Footing ELt;
Foundation ACce,s.
Fig Drain ELR ---- - _-
Crawl Drain
Slab Inspection Notes. SIT
Post& Beam
Shear Anchors _
Ext Sheath/Shear
Int Sheath/Shear
Framing - - -- - -
Insulation
Drywall Nailing - -- -
Firewall
Fire Sprinkler L /V
Fire Alarm
Susp'd Ceiling -- - ----
Roof
Other: --
Final
PASS PART FAIL — --�
Post S Beam
Under Slab
Rough-In
a er rvi� ---
San�ary-ewer
Rain Drains - -
Catch Basin/Manhole
Storm Drain -
Shower Pan
ftPA
PART FAIL
kWtHANICAL -
Post& Beam
Rough-In --
Gas Line
Smoke Dampers - --
Final
PASS PART FAIL - - -- ------ —
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage -
Fire Alarm
Final Reinspection fee of$— _. __required before next inspection. Pay at City Hell, 13125 SW Hall Blvd.
PASS PART FAIL
SITE [� Please call for reinspection RE: __ _ Unable to inspect-no access
FireSupply Line 1' / I
ADA
Approach/Sidewalk
Date -----1 �llspsalor—__ Ext__--
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL