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Permit 'I CITY OF TIGARD PLUMBING PERMIT Tj I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00072 I 13125 SW 1 Hall Blvd., Tigard, OR 97223 503 - 639 -417 DATE ISSUED: 8/30/2005 PARCEL: 1 S 135AA -AC001 SITE ADDRESS: 10390 SW 90TH AVE ZONING: R -4.5 SUBDIVISION: ASHBROOK CONDOMINIUMS LOT: 001 JURISDICTION: TIG Project Description: Site utilities. Other items: (1) manhole, (4) raindrain connectors. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: 3 WATER HEATERS: CATCH BASINS: 5 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 0 TUB /SHOWERS: SEWER LINE: 268 ft WATER CLOSETS: WATER LINE: 200 ft DISHWASHERS: RAIN DRAIN: 400 ft Owner: FEES MATRIX DEVELOPMENT Description Date Amount 12755 SW 69TH AVE, SUITE 100 TIGARD, OR 97223 [PLUMB] Permit Fee 8/30/2005 $609.40 [PLMPLN] Plan Review 8/30/2005 $152.35 Phone : 503 [TAX] 8% State Surcharl 8/30/2005 $48.75 Total $810.50 Contractor: BRIAN CLOPTON EXCAVATft1G INC PO BOX 509 REQUIRED ITEMS AND REPORTS Phone : 503 682 - 0420 Reg #: LIC 50337 PLM 3 - 5I7PB 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 -66 9 or 1- 800 -332 -2344. Issued By: ti � Permittee Signature: 7)2 �'p� (l "�� 2 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. Site Utilities R EC E I V E I 4 . � ,.( «) p b y_ Plumbing Permit Application A ® FOR OFFICE USE ONLY Y g �Alr 2 2oOJ DateB e •�" ��►r� auo5 oO(. 7 Cit of Ti and / `� Permit No.: � , 13125 SW Hall Blvd., Tigard, OR 97223 lan Review /� Phone: 503.639.4171 Fax: 503.598.1960 A n Other Permit No.: - 24- Hour Inspection Line: 503.639.4175 SV'..l' T, � � S'Q G ti� - to Ready/By: Juris y: ry � a See Page 2 for rn Inteet: www.m /„r .tlgard.or.us Notified/Method: / ( Supplementallnformation / 5 () � . rz. *¢^ Ja. , -�5 ;•r>: l ;;` r e TYPEOFWOTLK r F 'x k.` ' ro .' , FEE* SCHEDULE �Iew construction ❑ Demolition For special information use checklist. Description Qty. I Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection) L. �' GATGORY OF'CONSTRUCTIOit a3� a r SFR(1)bath 249.20 [I i- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 SFR (3) bath 399.00 J ❑ Accessory building [-ti-family eoN001�N�U�S Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: . z° _.;,1 Fre sprinkler ( sq. ft.) - Page 2 � `'"�� STTFsINFORIV [`ATxION�AfDtI;OCA�TIONI ��, ^`f .� _ � ...,,��w�o-,� �� c _...�,xwc g� .��. ,�.._ - � - �,� ,,t����m�� Site utilities Job site address: 1O 3RD+ I o4Zo.i I o'14 1 &4 &0 s\/ D q Catch basin or area drain 5 16.60 �/�, Cij City/State/ZIP: r� / « . S Drywell, leach line, or trench drain = 16.60 ..- Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 A $}F�2GO�L C Or oO7 4ii a4ti5 Manufactured home utilities - 110.00 Cross street/directions to job site: r Manholes 16.60 S / C At)E114UE .4' �wdA . �J1Q. T Rain drain connector y 16.60 Sanitary sewer (no. linear ft.ZC .8) Page 2 ,J y 7, 'O Storm sewer (no. linear ft. Opp ) Page 2 / q y. Z a (' Subdivision: Lot no.: - Water service (no. linear ft.:'I.oO) Page 2 / 4/ y6 Fixture or item Tax map/p arcel no s' ( 35AA LdI O q-z Absorpdon valve 16.60 ��x DE5CRItP +TTONOP�ORK ��. C.= Backflowpreventer Paget ' NEw Co ��1> ..'..cx'io ._ Q- I s��,r - Backwater valve 16.60 1 `� Clothes washer 16.60 ��,.. Qz��•��n� - rvu�►�.sE" sy�E �wrs �Q Dishwasher 16.60 �- ,�?� > %.�,a?'�„" t-�' " Ejectors /sump 16.60 Name: M Q R.l,x IE L) I OPt-A..IT t C t� _ Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: P`'SL [sw ) Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: ( ) /// Garbage disposal 16.60 fi.AP'LIT.,�. r ® R59N Ice maker ] 6.60 Business name: J.A' 21x 3 /eLOPI.4- ,.,rr c2c p. Interceptor /grease trap 16.60 Contact name: M . r AUdy �uTH�_l Medical gas (value: $ ) Page 2 Address: Z� 55 Sw •µ A -EPt4E ' �� t1 � j oo Primer 16.60 City /State /ZIP: � C�Z Roof drain (commercial) 16.60 Sink /basin/lavatory 16.60 Phone: o3) reZO - goeo tL Fax:: (503) 598- Tub /shower /shower pan 16.60 E -mail: -. Urinal 16.60 `•�•` "�f�; -_` �� w CON "CTOIt ��'�'s� �- :�:;:� "s:.'" Business name: G 1 � e(a Water heater 16.60 Address: o -� �l'• SD�i Other: Cit p \J Subtotal ty w1 S v \ \ ' Q� 1 0 `. ) Minimum permit fee: $72.50 / Phone: ( 7 ) Fax: ( ) Residential backflow minimum permit fee: $36.25 6 Q 9. y CCB Lic.: Plumbing Lic o.: 7 y / 7 ' 3 Plan review (25% of permit fee) J5.35 Authorized signature: �_ State surcharge (8% of permit fee) 4 /� 75" Id TOTAL PERMIT FEE f Q, Print name? .,b " i � f _ _ ate: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tr-County Building Industry Service Board. i:\ Building \Permits\PLMU- PernitApp doe 12/03 440 -46t 6T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: �S1tiUtl htl r: .. r a Qf .: alga Clu �l a O.Ota @ pPl 1Tll>r ee 4! .. , . ,.. 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' 1 O0 55.00 /y; l 7,201 and greater $309.00 Sewer - each additional 100' 68 46.40 Gj Water Service - 1st 100' 100 55.00 S W _ io 4 Medical Gas Systems: Water Service - each additional 100' 46.40 Q ° p y y Valua=tion W_° ` , Perm j?e te • Storm & Rain Drain - 1st 100' 100 55.00 W ` `� .55: �9 Lb $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' a 46.40 /39. zd„ , , : $5,001,.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fl: tUre Or ltelitN Y s^ e ( WNW! ° ' dd udina l $10 0 00 or fraction thereof, to and 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. 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: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees 3 a � 3 § a i tz d fi� ��Qaanti. y b x � 'y�(�itture)�3'ork.performe � �txt re Type l .. ``" R epla ce w per` ` � di l ots' a RS g g Comments.re ardin fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3 -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an -Industrial increase of. sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang • -Stall Sink - Bar /Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: \Building\Pemtits\PLM- PermitApp.doc 3/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005-00072 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/30120OFF) Phone: (503) 639-4171 Ili, la APIIhl t Inspection Requests (24 Hrs.): (503) 639-4175 tl INSPECTION WORKSHEET FOR DATE: 5111/2006 TIME: 7:00AIVI PAGE: 41 SITE ADDRESS: 10390 SW 90TH AVE . CLASS OF WORK: SUBDIVISION: ASHBROOK CONDOMINIUMS LOT #: 001 TYPE OF USE: PROJECT NAME: ASHBROOK CONDOMINIUMS DESCRIPTION: eldgs 1, 2, 3 & 4: Other items: (1) manhole, (4) raindrain connectors. OWNER: MATRIX DEVELOPMENT, PHONE #: 503-6202020 CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-000 Inspection Request Scheduled For: Date: 5111/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 029709-01 503-209;7386 N Corrections/Comments/Instructions: ' PASS 0 PARTIAL APPROVAL n CANCEL I NO ACCESS FAIL fl CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: tt Date: Phone #: (503) 718- 2- Lf 2- V , . , CITY OF TIGARD fbV BUILDING DIVISION PERMIT #:p7CZ$ 7,::7)\ 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639- 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 J ��4flu °` _ mi� _.. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE � � 7 'f / ADDRESS:/0 9 fl -p l_- CLASS OF WORK: SUBDIVISION: !! LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: / P HONE #: CONTRACTOR: eery2 C� PHONE #: Inspection Request Scheduled For: Date: f/-3.r3 -45 Pour Time: Code # Inspection Description Confirm # Contact # Message 3 l'f_.5 Qa a(a,s - -a, , 09- - Corrections /Comments /Instructions: / 5 (2 6) / Or 1 0 , k- ASS [ I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: /0* Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00072 13125 SW Hall Blvd., Tigard, OR 97223 IA DATE ISSUED: 8/30/2005 • Phone: (503) 639 -4171 .. sue. i y i Inspection Requests (24 Hrs.): (503) 639 - 4175 " "' ! °`�' �. INSPECTION WORKSHEET FOR DATE: 11/16/ TIME: 7:03AM PAGE: 86 SITE ADDRESS: 10390 SW 90TH AVE CLASS OF WORK: SUBDIVISION: ASHBROOK CONDOMINIUMS LOT #: 001 TYPE OF USE: PROJECT NAME: �`S�R{.�QK OQND�2MJN1UMS._ ) DESCRIPTION: Bldgs 1, 2, 3 & 4: Site utilities. Other items: (1) manhole, (4) raindrain connectors. OWNER: MATRIX DEVELOPMENT, PHONE #: 503-620-2020 CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503 -682 -0420 Inspection Request Scheduled For: Date: 11/16/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 021384 -01 503 -206 -7386 N Corrections /Comments/ Instructions: 1 e--(-9 ,,, - 2,,,-(7,- _,,ir 67-/ . / /" i, , .PASS I I PARTIAL APPROVAL CANCEL ❑ NO ACCESS I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: l Date: i Phone #: (503) 718- CITY OF TIGARD _ BUILDING DIVISION PERMIT #: PLM2005 -00072 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/30/2005 Phone: (503) 639 -4171 � flit' Inspection Requests (24 Hrs.): (503) 639 -4175 .i "- INSPECTION WORKSHEET FOR DATE: 11/16/2005 TIME: 7:03AM Lip PAGE: 85 SITE ADDRESS: 10390 SW 90TH AVE CLASS OF WORK: SUBDIVISION: ASHBROOK COONDOIVMINIUMS LOT #: 001 TYPE OF USE: PROJECT NAME: ( OK t{7NDOMINIUhp4S DESCRIPTION: Tdgs 1, 2, 3 & 4: Site utilities. Other items: (1) manhole, (4) raindrain connectors. OWNER: MATRIX DEVELOPMENT, PHONE #: 503 -620 -2020 CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503- 682 -0420 Inspection Request Scheduled For: Date: 11/16/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 395 Misc. inspection 021384 -02 503. 206.7386 N Corrections /Comments /Instructions: • I I PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005.00072 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/30/2005 Phone: (503) 639 -4171 U 1141 �� Inspection Requests (24 Hrs.): (503) 639 -4175 ��' 'I I.. INSPECTION WORKSHEET FOR DATE: 11/10/2005 TIME: 7:02AM PAGE: 91 SITE ADDRESS: 10390 SW 90TH AVE CLASS OF WORK: SUBDIVISION: ASHBROOK CONDOMINIUMS LOT #: 001 TYPE OF USE: PROJECT NAME: ASHBROOK COOMINMUa9S DESCRIPTION: (Bldgs 1 , ?,3 -A Site utilities. Other items: (1) manhole, (4) raindrain connectors. OWNER: MATRIX DEVELOPMENT, PHONE #: 503 -620 -2020 ' CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420 Inspection Request Scheduled For: Date: 11/10/2005 Pour Time: r1 ; 0 d Code # Inspection Description Confirm # Contact # Me e d 506 Sanitary sewer 020910 -05 503-209-7386 Y CSAileS Corrections /Comments /Instructions: • `0: PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1 / OA Inspector: Date: / Phone #: (503) 718- CITY OF TIGARD BUIIDING DIVISION PERMIT #: PLM200S -00072 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/30/2005 Phone: (503) 639 -4171 Il!I Inspection Requests (24 Hrs.): (503) 639 -4175 :_.. INSPECTION WORKSHEET FOR DATE: 10/28/2005 TIME: 7:18AM PAGE: 49 SITE ADDRESS: 10390 SW 90TH AVE CLASS OF WORK: SUBDIVISION: ASHBROOK CONDOMINIUMS LOT #: 001 TYPE OF USE: PROJECT NAME: ASHBROOK CONDOMINIUMS DESCRIPTION: Bldgs 1, 2, 3 & 4: Site utilities. Other items: (1) manhole, (4) raindrain connectors. OWNER: MATRIX DEVELOPMENT, PHONE #: 503 - 620.2020 CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503 -682 -0420 Inspection Request Scheduled For: Date: 10/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 335 Rai n drain 019706 -04 503 209 -7386 N Co ctions /Comments /Instructions: • • RI PASS (l PARTIAL APPROVAL ❑ CANCEL n NO ACCESS I I FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: _ Date: k / fi e% ( P hone #: (503) 718- CITY ,OF TIGARD . BUILt)ING DIVISION PERMIT #: PLM2005-00072 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/30/2005 Phone: (503) 639-4171 ova °��' Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/26/2006 TIME: 7:07AM PAGE: 2 SITE ADDRESS: 10390 SW 90TH AVE CLASS OF WORK: SUBDIVISION: ASHBROOK CONDOMINIUMS LOT #: 001 TYPE OF USE: PROJECT NAME: ASHBROOK CONDOMINIUMS DESCRIPTION: Bldgs 1, 2, 3 & 4: Site utilities. Other items: (1) manhole, (4) raindrain connectors. OWNER: MATRIX DEVELOPMENT, • PHONE #: 503-620-2020 CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 5503.682 -0420 Inspection Request Scheduled For: Date: 10/26/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 019418-01 603- 209 -7306 Y Corrections /Comments /Instructions: -r / G - / / /`/ •k �'' 1 i ' arj A / 4 /�....(AILIA - -- L / of -' -- f9 , , % , ' ' 0-ki .„/_.,/oac i %j -ASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS • FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: /1/ U Date: 7 ' 4 ‘ J Phone #: (503) 718- 1