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Permit CITY TIGARD PLUMBING PERMIT r, DEVELOPMENT SERVICES PERMIT #: PLM2001 -00173 DATE ISSUED: 6/29/01 $ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112CD -00200 SITE ADDRESS: 15685 SW 76TH AVE SUBDIVISION: DURHAM ACRES ZONING: R -4.5 BLOCK: LOT: 015 JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: 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: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 150 ft WATER CLOSETS: • WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Connect existing house to newly installed sewer lateral. Line work of approximately 150', no reverse plumbing required. Double fees for working without a permit. FEES Owner: Type By Date Amount Receipt CHRISTENSEN, PHILLIP E AND PRMT CTR 4/27/01 $202.80 27200100000 SALLY C 5PCT CTR 4/27/01 $16.22 27200100000 15685 SW 76TH AVE TIGARD, OR 97224 Total $219.02 Phone .,1 Contractor: MIKE MOORE & SONS EXCAVATING 2500 SW 178TH ALOHA, OR 97006 REQUIRED INSPECTIONS Sewer Inspection Phone 1: 503 - 519 -9182 Final Inspection Reg #: LIC 110863 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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued By Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day 4 , _- -' c_v Pao/ -co /sue Plumbing Permit Application Date received: `/ a!e °! Permit no.: PcJYa'e0i-e4/ f : ti' = r its City of Tigard ,� �� `J g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) J Job address: /56 N s 5 Gam � 7 Description Qty. Fee (ea.) Total New 1- and 2- family dwellings only: /` Bldg. no.: Suite no.: - (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: - SFR (1) bath Lot: I Block: 'Subdivision: _ SFR (2) bath Project name: _SFR (3) bath - City /county: 42,fo� I ZIP: 9- 22 2 9 Each additional bath/kitchen . Description and location of work on premises: Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells /leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities B usiness name: ��j ,a �7def,e/' ('' .50 S .)! CB . Manholes Address: c 25 - Up 5 c i7Jr' Rain drain connector City: /5742x,, I State: O iC I ZIP: S' > ( - +Sanitary sewer (no. lin. ft.) /5r; ' Phone: , j 9- S /gr Fax: 1E-mail: Storm sewer (no. lin. ft.) CCB no.: //U 263 'Plumb. bus. reg. no: _Water service (no. lin. ft.) City/metro lic. no.: Fixture or item: Contractors representative signature: .�� Absorption valve Back flow preventer • Print name: Date: - - - e , / Backwater valve • _ CONTACT PERSON Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: [ State: I ZIP: Ejectors /sump Phone: Fax: E -mail: Expansion tank ' OWNER Fixture /sewer cap Name (print): F if t L/_ / 1 d 4 f 4 � 6)111 L/67 - E06 l67-E06 g (0 Floor drains/floor sinks/hub Garbage disposal Mailing address: 1S (p 6 5 7W - • Hose bibb City: --ri 6.,4; -Q. t I State: a 4.1 ZIP: 7A, 7 3 Ice maker Phone: I Fax: 1E-mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual 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 IIIIIIIIIIIIIIIIIIMIEZEEEMIIIIIIMIMIIIIIIIIIII Tubs /shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: ZIP: Other: Phone: I Fax: 1E-mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ v � D � Plan review (at _ %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained � � j Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires TOTAL $ I o9 ,..51 Name of cardholder as shown on credit card accepted as complete. $ � 22 Cardholder signature Amount �� d d S 440 -4616 (6/00 /COM) / -ice- 44 3 - 7 38 ( 6f L - a / V95 ' . PLUMBING PERMIT FEES: _- -, •• ' : 5 PRICE TOTAL -: -;New 1 and 2 family dwellings only • ; ` ,FIXTURESA;(tndlvidual). , , QTY (ea). AMOUNT (Includes all plumbing ures g fixt in • PRICE T OTAL r the d Sink 16.60 tw and the first1 00rft. QTY (ea) AMOUNT.' Lavatory 16.60 <for�each- utility,.connection) -: ; ,:, „ . .. ' L 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 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE ' , Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL . . Garbage Disposal 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 Heater 0 conversion 0 like kind 16.60 Quantity by Work'Performe'd Gas piping requires a separate mechanical .Fixture Type: ^° - New _Moved • . Replaced Removed/ permit. _ ` = ;;Capped .. MFG Home New Water Service 46.40 Sink. MFG Home New San/Storm Sewer 46.40 Lavatory • 16.60 Tub or Tub /Shower Hose Bibs Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3 " Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL ;, - I Q� , YO 8% ` STATE SURCHARGE ' ,„ : :`. l **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 0 o TOTAL $ ( 0 / • / t n * Minimum permit fee is $72.50 + 8 % state surcharge, except Residential Backflow ///;;; Prevention Device, which is $36.25 + 8% state surcharge. C/1 * * All New Commercial Buildings require plans with isometric or riser diagram and 1 ( l plan review. l ,....... 4. (..., - 2--- --- -77 ., i i:\dsts \forms \P Im- fees.doc 10/10/00 9" 5-15 CITY TIGARD PLUMBING PERMIT i DEVELOPMENT SERVICES PERMIT #: PLM2001 -00173 I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/01 SITE ADDRESS: 15685 SW 76TH AVE PARCEL: 2S112CD -00200 SUBDIVISION: DURHAM ACRES ZONING: R -4.5 BLOCK: LOT: 015 JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: 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: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 150 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Connect existing house to newly installed sewer lateral. Line work of approximately 150', no reverse plumbing required. Double fees for working without a permit. FEES Owner: Type By Date Amount Receipt CHRISTENSEN, PHILLIP E AND PRMT CTR 4/27/01 $202.80 27200100000 SALLY C 5PCT CTR 4/27/01 $16.22 27200100000 15685 SW 76TH AVE TIGARD, OR 97224 Total $219.02 Phone ,1: Contractor: MIKE MOORE & SONS EXCAVATING 2500 SW 178TH ALOHA,.OR 97006 REQUIRED INSPECTIONS Phone 1: 503 - 519 -9182 Sewer Inspection Final Inspection Reg #: LIC 110863 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. Thispe'rmit 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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued By s or Av e", ittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 7 AM PM BLD Location / b vL' '7(f% 7 .2 1 Suite MEC Contact Person I rr� Ph 675 337/ PLM p3Z20`jD0/7' Contractor Ph SWR 'BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Ll Foundation /a / , eg(h FPS Ftg 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'd Ceiling Roof Misc: Final PASS PART FAIL Post & Beam Under Slab e•-• Top Out may* ���✓ s� /4 la Rain ;rains 'ASS PART FAIL 4 ANICAL' Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL" Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS. PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA 4V L / S/ o Approach /Sidewalk Date 7 ` O/ Inspector - Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.