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Permit CITY TIGARD PLUMBING PERMIT Aki DE VELOPMENT SERVICES PERMIT #: PLM2003 -00336 '�°'` o DATE ISSUED: 7/10/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14835 SW 103RD AVE PARCEL: 2S111CB 00400 SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5 BLOCK: LOT: 003 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: 90 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of 90' of sewer line to connect existing house to sewer lateral. Septic tank is to be pumped, filled and inspected. FEES Owner: Description Date Amount MCNIERNEY, CHRIS & LISA 14835 SW 103RD AVE [PLUMB] Permit Fee 7/10/03 $72.50 TIGARD, OR 97224 [TAX] 8% State Tax 7/10/03 $5.80 Total $78.30 Phone : Contractor: LOVETT EXCAVATING INC 17385 SE TODD LN GLADSTONE, OR 97027 REQUIRED INSPECTIONS Sewer Inspection Phone : 503 - 504 - 2847 Insp existing /capped fixtures Reg #: LIC 125507 Final Inspection 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 ad 1 a td-by the I regon 1 Issu d By: j�_� G���� Permittee Signature: A w A Call (503 639 -4175 by 7:00 P.M. for an inspection needed the • xt business day Building Fixtures P umbing Permit Application FOR OFFICE USE ONLY Received Plumbing Date/By: .7 /U G� Permit No.: a r `5 -e -;o Planning Approval Sewer City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post Land Use Ganriv�N1 J � ° ( Contact Case No.: II Internet: www.ci.tigard.or.us .' I 1 Contact Jys,q- ® See Page 2 for 24 - hour Inspection Request: 503 639 - 4175 -- Name/Method: /C Supplemental Information. I. l F ,., TYPE OF WORD i 4:, .3x r ; . ', '''e FEE* SCHEDULE (for special information use checklist) Li New construction ❑ Demolition Descri i tion Qty. Fee(ea) Total ddition/alteration/re.lacement Other: x i* ;° ! . ' t I 9 CONSTRUCTION x: .. g„ ; � SFR (1) bath 249.20 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00 ❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder Other: Each additional bath/kttchen 45.00 Pa :e 2 • i g l � ; �, t }. � .I Fire sInnkler s• . ft Job site address: / g 35- 5 G A 03 r E x , Suite #: I Bldg./ pt. #: Catch basin/area drain 16.60 Project Name: Drywell /leach line /trench drain 16.60 1 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) y (f Page 2 ■ Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2 ■ Water service (no. linear ft.) Page 2 Tax ma. /• arcel #: or � ' . z A E is b aw , Mum iteIq. E ., 5 Absorption valve 16.60 S .Q ( r r)N ae i (sy Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 i. _ 1 r'. . 'e?' . . ;.. ! - Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City/State/Zip: Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 D., ¢ri i i ,,` ! :i :: " Ice maker 16.60 Name: ov-e -1--T & 2c C O < 1 w Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone: ( Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 r = ' » Urinal 16.60 � 16.60 Business Name: L r o V J l - r4 Wat closet Love � Water heater 16.60 Address: 2-92 c,.5 A� f /-e . Other: City /State /Zip: G-►- aw , (4 71j gO Other: Phone: J) / -2 S`/7 Fax: 0 - -6 `3 .__ ,r, h m Ii :. ' .,,_. ,. Subtotal $ CCB Lic. #: /25 Plumb. Lic. #: Minimum Permit Fee $72.50 $ uthorized Residential Backflow Minimum Fee $36.25 Signature: Date: Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ (Please print name) TOTAL PERMIT FEE $ 7 Q - 38 Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: :Site Utilities Qty., F (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 greater $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 a additional $100.00 or fraction thereof, to and Fixture or Item Qty. ;„ Fee' (ea) Total 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 $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 *. Quantity by (Fixture)" Work Performed " Comments regarding fixture work: Fix Type: keplaae New Moved , -. Eaistlri Capped 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" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic increase of sewer EDUs, a sewer permit will be issued and Disposal - Commercial - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: _ is \Dsts\Permit Forms\P1mPermitAppPg2.doc 01/03 " AliLLPUMP SANITATION SERVICES Dalko Corp. E 191 13023 NE Hwy. 99 #7 - Vancouver, WA 98686 -`_ (360) 887 -2969 Port. (503) 285 -5838 C CUSTOMER'S ORDER NO PONE DATE 1 Lt ti - 5' ZSb / ICY!) 3 , NAME 1,_8 ve., - E_� C � 4 ADDRESS t L k 35 5 4 ro3 t(ccor() D 6R SOLD BY ASH C. I CHARGE i ON ACCT. MOSE. RETD I PAID OUT 7 _ I QTY. DESCRIPTION PRICE AMOUNT 1 4 S. I r I 4 . i -, , PayORIIiis inVOiCe. NET 30 days. A fire charge of'1 % per month Cr 96 per Kati) wip Ke c#i2rgerl on unpaid balances. — AZ CoMection fees w81 be assessed ff necessary. TAX . RECEIVED BY TOTAL ,vim All claims and returned goods MUST be accompanied by this bill. ':; ,x<..s,F; loll CITY OF TIGARD 24 -Hour BU4LDlNta Inspection Line: f503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 7 AM PM BUP Location 7 3-S Ce-L% - Suite MEC Contact Person Ph ( ) PLM ?L b 6 3 3 ' Contractor Ph ( ) 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 Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final • RT FAIL Post & Beam Under Slab Rough -In W arter - am Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fin. dig r. PART FAIL CHANICAL 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 El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA p Date l �� Ins ecto/? 6 7 Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL