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Permit CITY OF TIGARD PLUMBING PERMIT PERMIT 10 DEVELOPMENT SERVICES DATE ISSUED: 7 31/02 2 -00300 =' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15285 SW 94TH AVE PARCEL: 2S111DB-12500 SUBDIVISION: SUMMERFIELD NO.12 ZONING: R -7 BLOCK: LOT: 652 JURISDICTION: TIG CLASS OF WORK: OTR 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: n SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install line to ice maker. FEES Owner: Type By Date Amount Receipt CAMELL THOMPSON PRMT CTR 7/31/02 $72.50 27200200000 15285 SW 94TH 5PCT CTR 7/31/02 $5.80 27200200000 TIGARD, OR 97224 Total $78.30 Phone 1: 503 - 620 -4741 Contractor: CROWN PLUMBING 5429 SE FRANCIS PORTLAND, OR 97206 REQUIRED INSPECTIONS Phone 1: 503 - 771 -9449 Final Inspection Reg #: LIC 42671 PLM 34 -70PB 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: 6, L Permittee Signature: , Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • , .. • - . , • Plumbineermit Application . .. - - • - ._.- • . _ • , ,. ... „ r • „, ,,,t..„.„ , !..----,,,;7.. Date receivedg &I - Of5-;.-- "Permit no.: • '- . ' _ g.• -OP' :JO City of iTigard'i h s , ., .. ......: ewer pernu t no... • - . .. Building permit no:: • * - -- Address: i13125 SW kall.,131Socl; Ti gaid, OR' 97223 •. - - - CityofTigard,-;- P . F e: (503) 639-4i7' •-•*'-''''''4.-=':- - — Project/appl.no.: • ' • - Expiredate:. • - .. , , . - ' ..;'= -:-.• Fax (503) 598-1960 - 4 . . • - Date issued: : - ' -- 1 CM Receipt no.: - - - ..,_ Lind approval: ' * - Cdse file no.: 1 Payment type: • _ . .. _ • .. • ' - ' . - '-' •' - -, - - • . ' 'TYPE OE 'PERMIT li(1 & 2 family dwelling or accessory ---- '''CI CommerciiVindu .... ., , .1, „,itl Multi-family. 0 Tenant improvement . _. .._. 'CI New construction - - - • • ' , —' IlkItclditiordalteratiOn/replacement I p Food service! 0 Other ., , '• .. • • - • • JOB SITE INFORMATION ' - • .. _ % ,,. - . FEE 'S( HEDULE (for special information use checklist) Job address: 5 ?5 St4) 9 • . .- .- .... ' - Descriltion 02I Fee(ea.) Total Bid New 1- and 2-family dwellings only: g. no.: •. .-:.; ' ; ':- ".: -. 'Suite no.: - • . .- - •,, , i - ' • • • • - (includes 100 ft. for each utility connection) Tax map/tax lot/account no.: . . - • - • SFR (1) bath: ' 1 Lot: I '...:•-' ' '' Block: ''''.. • ' r Subdivision: ' SFR (2) bath ! .- ill Project name: - 1 ', _ • O'y • ' -•• - i ' - .- h. ' '. • SFR (3) bath IIII City/county: . '' -; ' ( .1 ' - el' - 0',' ZIP 4'72 , • - • -.-- - i . - Each additional bath/lcitchen = . . Description and • ation f work,on premises; • -• , '- -• - Siteutilities: - r tks.--, v...i.J...6 ...t..2....1;y1..0...Q.A_Nr -..-c -•.j. , . , . . Catch basin/area drain III • , . . Est. date Of completion/inspection: -------1L- .--. -- tt,''.5: . - .. I _ Drywells/leach line/trench drain I= Footing drain (no. lin. ft.) • MI '' '-'• ."--.. - • - -- PLUMBING CONTRACTOR -. - , ' Manufactured home utilities IIM Business name: -avl -1,... --1A,1,4;,10 , ...._ ,,, .--:i - Manholes . ; - NM ' ' Address: -5 • --_. - -- -I A:K - • - -I-. ' " - :. ' 7 Rain drain connector ISM., 1-0..m1 • [MYRA ZIP: • - A , Sanitary sewer (no. lin. ft.) NM Phone: - _ el Fax: /-9 ,--, E-mail: '. . .. Storm sewer (no: lin. ft.) MIll CCB no.: 26 • . • v 41 Plumb..bus. reg..no: .s - !... • Water service (no. lin. ft.) I= • City/metro lic. no.: ' - - 6 - - , — '- -a- - - - , .: 4 - Fixture or item: ., t) 1 ' . • Absorption valve II Contractor's representative signature: IMANLXII111111/111 Back flow preventer MI . • Print name: - ...Xr. . ! - r'.. Date: • ".- - .0: - .2 ., -- •- - Backwater valve MI , 1- -• .'' , . - .. CONTACT PERSON .. . • . ' . , - Basins/lavatory • =I Name: _ ! -!' - - • - i ' . ' •-• -- ' - -- -- -- • 0 i — - Clothes washer, , _ „ . . .. . _ . ,. . - Addre .Dishwasher ss: - - : -- - • - - - - - - ---■-• - ----4- - • - - -- -- • - ! ' Drinking fountain(s) ' MIN • - City: . Ejectors/sump , I= . ... . . _ . • . _ Phone: . Fax: 1 1 E-mail: ; • Expansion tank • • =I . . OWNER : ... . Fixture/sewer cap MN . , -• • -- Floor drains/floor sinks/hub Name (print):. _ • e_ .211-■ 0 50,1 • • Garbage dis . • sal - r:P'Mt'llIllrjll Hose bibb -': • • City: ' — "— •:-- "-- -'- - - - - ----- State:-- - ZIP: • -- - Ice maker - ME . ..so Mal Phone: (p.20- iy * * Fax: - ----=- ' ' • - E-mail: ---- ' ' • Interce stod:rease tra 9 ME Owner installation/residential maintenance . only: The actual installation - Primer(s) - •' MI • will be made by me or the maintenance and repair made by my regular Roof drain (commercial) IIM employee on the property I own as per ORS Chapter_447. _. _. ' • Sink(s), basin(s), lays(s) MI Owner's signature: 1 • Sum . Ili • • • • • • ' • • ' ENGINEER. - • .' • . _. • Tubs/shower/shower 'an • IIII • • • 1 .. _ _. Urinal NM Name: Water closet • • • Ili • Address: • • Water heater City: State: ZIP: Other • NM Phone: Fax: E-mail: • Total . , . . ( Na all jurisdictions accopt crozlit cards .1casC call jurisdiction fot more information. Notice: This permit application Minimum fee $ '7 7 St) Pit-Visa 0 MasterCard Plan review (at %) $ — expires if a permit is not obtained c-redu " - ' " ' - • ' ' I ' - C • --- . ' - ' ' - .. 1( / I 1).Z within 180 days after it has been State surcharge (8%) $ Sc .1971%.. i' Expires TOTAL $ '7 8' , 3 0 accepted as complete. Will I 11 ..411_ . 1 / 1 - 1 .a?A!.0114- : 30 Cardhol 7 si tp. uie-- • 4404616 (600/COM) 6P)?L pAK vb i o-c pc va vv.. k :.0,_e...4.._ o.s Sc-. ccs rss; 1514., .t cJL,Sf ill -, . PLUMBING PERMIT FEES: . „ , , ... :! t ,.,::„. • , ., .. AP . ,c11:91:641w; illeVtandl ,.. t 4 FIXTI1RES4iitiNiiiiiilYAMWV.Mt 'Ng ;' ii.greaai, riAmoUNTiA glif_:„ c10.4.*Ittilumpitiii**1,4,W h;Wt, RR'!" TOTA Sink 16.60 -5 11P zAtg 1 "'" - A ' citnetd..elliiititand,thelirst, 0 L ft,c q z ' - .,,Cin ti4...da)w =, ., NT tfdritrAhlifil I Itjaanf '..-4W:n 6,:',6:%,a4 MI,4i.=':'; Lavatory .16.60 • One (1) bath • • $249.20 Tub or Tub/Shower Comb. , 16.60 Two (2) bath , . $350.00 Shower Only . 16.60 • Three (3) bath . Water Closet 16.60 - ' - . , SUBTOTAL UrinaI • , 16.60 '--- ' :' i ::: , -, ^. - • 8% STATE SURCHARGE r.*,,l''i Mgiox4y • Dishwasher 16.60 ' PLAN REVIEW 25% OF SUBTOTAL - • . - • t. - Ni.W6';1 if:W , Garbage Disposal 16.60 TOTAL Laundry Tray t Washing Machine . 16.60 ' , ' • Floor Drain/Floor Sink 2" . 16.60 • 3" ,. . 16.60. , -. ' ,,,!, '. PLEASE COMPLETE: --- 4" 16.60 .c. _ ' ..... .. .. Water Heater 0 conversion 0 like kind 16.60 • . it 7 --. 04.,d,,QuantityrbyiWo .P,e orrne ,.;?.1-i , Gas piping requires a separate mechanical .- F,biterrearriier.--.Or' 7 ' , •New X 4 MitiVedZ' Replaced fa t Removed! permit . `e.44,11:460414N-v: [f,, 4,-.0 raw .1.C5jiea' MFG Home New Water Service 46.40 , • . Sink MFG Home New San/Storm Sewer 46.40 Lavatory . _ Tub or Tub/Shower • Hose Bibs 16.60 ... . Combination . Roof Drains 16.60 Shower Only , Drinking Fountain , 16.60 . , •,, . -.. Water Closet;. , - . .. :.• , 4. Urinal Other Fixtures (Specify) . 16.60 • - r .. . ... - Dishwasher . . - Garbage Disposal . - -, Laundry Room Tray . Washing Machine• , Floor Drain/Sink: 2" .. : ... .. , Sewer - 1st 100' 55.00 3" _ Sr-each additional 100' .46.40 - , , . - . Water Service - 1st 100' 55.00 : ..., .. :1 • Water Heater - ...... . . . Water Service - each additional 200' 46.40 Other Fixtures '''''' :. -% *.ir • (Specify) - -:-'A ze.c "-% 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 , ' t' ' COMMENTS REGARDING ABOVE: ,'-' - :' . -- Rain Drain, single family dwelling 65.25 . . . Grease Traps 16.60 1 r QUANTITY TOTAL 0,4!--, ,ivi: fr.Aaik.g.e.v.wt g,•: 1-.4zicro - .• - . ' Isometric or riser diagram is required if Quantity Total is >9 fro& :,..Temt *SUBTOTAL - • 8% STATE SURCHARGE Few IN7-0. Ad , • c ... ' ' . **PLAN REVIEW 25% OF SUBTOTAL k *,,,`:%„%4 .,.... &,. : : .):-:,‘,,,,-..., : _ .: ,,,:,, , k ,;,,,, i ,., .,,..",. .., 1.. ;:. t , - ,.. Required only If fixture qty. total is > 9 rAket: .,,V* _47412 :.,:: , ,,, = -•%•:*-;:, - •P.:...:.. _ , .' I;t.,.,,, . : -, •-,- .'. • . . , , ; - .. TOTAL V:42,. , $ , . - • ay..ft 6•: hY. _ ..._ ..... . _ . < - • , _ - . " •.: . • ..:,- • , , . • ° Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow ... ., . , . .._ . . - • Prevention Device; which Is $38.25 + 8% state surcharge. - , .. ,... , .. , _ - .., .. **All New Commercial Buildings require plans with isometric or riser diagram and. - - . .. plan review. .. . • - , , ,. * • • " ' . . . , . • - , . - iAcIsts \forms\plm-fees.doc 10/10/00 - - - -• , ' CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST / BUP Received Date Requested FG 7 AM PM BUP Location / 6,7\g MEC Contact Person Ph ( ) PLM ! ! e; e Contractor Ph ( ) 77/-74/L11 SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL i PLUMBING Post & Beam Under Slab Rough-1n 1 ' Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: PART FAIL HANICAL 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 Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA ( M Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL A