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Permit j a CITY OF TIGARD PLUMBING PERMIT ° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00123 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/5/2007 PARCEL: 2S 101 AC - 01900 SITE ADDRESS: 12615 SW 72ND AVE ZONING: C - SUBDIVISION: LOWE'S HIW, INC LOT: JURISDICTION: TIG PROJECT: LOWE'S Project Description: Relocate (1) catch basin CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: 1 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES LOWE'S HIW, INC HWY 268 EAST Description Date Amount NORTH WILKESBORO, NC 98055 [PLUMB] Permit Fee 9/5/2007 $72.50 [TAX] 8% State Surcha 9/5/2007 $5.80 Phone : 336- 658 -7519 [PLMPLN] Plan Review 9/5/2007 $18.13 Total $96.43 Contractor: ARRIS CONSTRUCTION 5155 BAINS GAP RD. ANNISTON, AL 36205 REQUIRED ITEMS AND REPORTS Contact # : PRI 256- 237 -1601 Reg #: LIC 172662 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 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. 7 1 / Issued B / Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 14 6 l3 $ 14 1) Plumb ne Permit Apolica lf'C \/ _�J i l Ht Ot 4 Site Utilities i r)It ()Frick 1 isr r►Nl,i City of Tigard MAR 2007 Received Date/By • a, 07 i p.„,0 4..: oty#07'61406a3 :� a 13125 SW Hall Blvd., Tigard, QIji'f 2 ;` l :vARD Plan Review Phone: 503.639.4171 Fax :BW�5�8f 0D' �,isi��. B , f � / 0 l Other Permit No.: Inspection Line: 503.639.4175 r 3 7 V T A It U I Internet: www.tigard- or.gov i ® See Page 2 for h a��7 t (', SupplementalInformation TYPE OF WORK IA / j4 FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist ' i ppp���ppp I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: ew 1- 2- family dwellings (includes 100 ft. for each utility connection) • . - CATEGORY OF C s NSTRUCTION SFR (1) bath 249/0 ❑ 1- and 2- family dwelling FA 11._. 4 mmercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑� Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: j = ARIA) Zz Catch basin or area drain 1 16.60 /4 66 City/State/GTT0 1 , . Drywell, leach line, or trench drain 16.60 l Footing drain (no. linear ft.: Page 2 Suite/bldg. /apt. no I 1 Project name: 01/4-)t � . Gs �` '- Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _J Page 2 Storm sewer (no. linear ft: _J Page 2 Subdivision: Lot no.: Water service (no. linear ft.: _) Page 2 Fixture or item Tax map/parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Badtfow preventer Page 2 ____I___. P� -*NV -4 i Backwater valve 16.60 Clothes washer 16.60 1441. Dishwasher 16.60 PROPERTY, OWNER • I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name. i • •i • ti , i . A / _ d` ■ • / Expansion tank 16.60 Addrss: (7 . e I '2 tO Fixture/sewer cap 16.60 City/State/27 n4 j e Floor drain/ floor sink/hub 16.60 Phone: ( ) t Fax: ( - ) Garbage disposal 16.60 Hose bib 16.60 APPLICANT ❑ CONTACT PERSON . , vvv Ice maker 16.60 Business name: J ; "'" i � o � ' ; �(�k0 t i Interceptor /grease trap 16.60 Contact name: ® ( tS , Medical gas (value: S ) Page 2 Address: r_ /__ • " "� _ °Ier �� ± I -!-. i _ Prima 16.60 City/StateJZl - . ., -- r Ai. Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: , � 4. j _ i a, -" Tub/shower/shower pan 16.60 E-mail: Urinal 16.60 . - • . CONTRACTOR Water closet 16.60 Business na (3 / t,' /S eel / V, / /C-7 • Water heater 16.60 Address: ,�,4, •., P other: City/State/ZIP: • NNE s 1 e / t/ A L r- subtotal ,3�zo Minimum permit fee: $72.50 -1 Phone: , g, 23 . / , Fax: ( ) Residential badtflow minimum permit fee: $36.25 �i _ " � I/ Plan review (25% of permit fee) f % F 3 ©t V j u . m Lic. J. / , State surcharge (8°/* of permit fee) .5 Authorized signature: 1. ,�._ „,11 / TOTAL PERMIT FEE 94, 4 Print name: e. �w �r Da / 14 This permit application expires if a permit is not obtained withi ISO days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. eAa,iwmswamltAPLMU- vamnApp.doc 0676/06 440 .461611 1W02/COM/WPB) • Plumbing Permit Application - City of T . Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1' 100' 55.00 0 to 2,000 $ 115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greats $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 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 Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and 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 Device each additional $100.00 or fraction thereof to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof to Inspection of existing plumbing or and including din $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for _ each additional $100.00 or fraction thereof Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and Quandtz by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Caned Added Flirting ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780-0040. Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash - Each Stall - ❑ Any complex structure as defined in OAR918- 780-0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher -Commercial -Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial -Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rea Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory • - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and -Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: is\&dWing\PetmiuTL M- Pe+mitApp.doc 09/22/16 CITY OF TIGARD _ BUILDING DIVISION PERMIT #: PLM2007 -00 1 23 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 96/2007 Phone: (503) 639 -4171 • A o Inspection Requests (24 Hrs.): (503) 639 -4175 "'I I .. ' -- INSPECTION WORKSHEET FOR DATE: 9/6/2007 TIME: 7 :00AM PAGE: 56 SITE ADDRESS: 12615 SW 72ND AVE CLASS OF WORK: SUBDIVISION: LOWE'S HIW, INC LOT #: TYPE OF USE: PROJECT NAME: LOWE'S DESCRIPTION: Relocate (1) catch basin PHONE #: OWNER: LOWE'S HIW INC, 336.658 -7519 CONTRACTOR: ARRIS CONSTRUCTION PHONE #: 256-237 -1601 Inspection Request Scheduled For: Date: 9/6/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 055219 -02 256-343-2294 N Corrections /Comments / Instructions: C A it- 'Et t.- LA )" N A PASS ❑ PARTIAL APPROVAL I CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1 1 J > > I, tu— Date: (9 J (, J 0) Phone #: (503) 718- CITY OF TIGARD ' BUILDING DIVISION PERMIT #: PLM2007 -00123 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2007 Phone: (503) 639 -4171 . 4 ' m Inspection Requests (24 Hrs.): (503) 639 -4175 III.. INSPECTION WORKSHEET FOR DATE: 9/612007 TIME: 7:00AM PAGE: 57 SITE ADDRESS: 12615 SW 72ND AVE CLASS OF WORK: SUBDIVISION: LOWE'S HIW, INC LOT #: TYPE OF USE: PROJECT NAME: t -OWE'S DESCRIPTION: Relocate (1) catch basin I OWNER: LOWE'S HIW, INC, PHONE #: 336- 658.7519 CONTRACTOR: ARRIS CONSTRUCTION PHONE #: 256.237 -1601 Inspection Request Scheduled For: Date: 9/6/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 345 Culvert/catch basin 055219 -01 256-343-2294 N Corrections /Comments /Instructions: NC PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C5 I o-1.J i i \b Date: 6 416I -0 7 Phone #: (503) 718- •