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Permit CITY TIGARD PLUMBING PERMIT PERMIT #: PLM2001 -00084 �y; DEVELOPMENT SERVICES DATE ISSUED: 3/20/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 16545 SW 103RD AVE PARCEL: 2S114BB -20200 SUBDIVISION: RIVERVIEW ESTATES NO. 2 ZONING: R -7 BLOCK: LOT: 046 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 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: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of residential backflow preventio device. FEES Owner: Type By Date Amount Receipt WHALEN, JUSTIN + KERI PRMT CTR 3/20/01 $36.25 27200100000 16545 SW 103RD AVE 5PCT CTR 3/20/01 $2.90 27200100000 TIGARD, OR 97224 Total $39.15 Phone 1: Contractor: NATURAL TOUCH LANDSCAPING INC 22505 BENTS RD NE AURORA, OR 97002 REQUIRED INSPECTIONS Phone 1: 503 - 678 -1328 RP /Backflow Preventer Final Inspection Reg #: LIC 6811 PLM 10773 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. Yoy -rnay obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Iss d By: 1 , �; � 1 di •40 Permittee Signature: ajyL,` -- Call (50' • 9 -4175 by 7:00 P.M. for an inspection needed th next business day Plumbing Permit Application Date rece i ve d : ,/// Permit no.: d/` txZ$y . °R�. g City of Tigard :. I `•r 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: I 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 SCIIEDULE (for special information use checklist) _ Description Qty. Fee(ea.) Total Job address: i °.,, S 4 S cc, /p / v New 1- and 2- family dwellings only: Bldg. no.: I Suite no.: Tax map /tax lot/account no.: (includes di 100 Lot: I Block: 'Subdivision: • SFR (2) bath Project name: J1 ytl /y1 i L e SFR (3) bath City /county: T G4 a. 0 1 ZIP: Q- 2 2 4 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 Business name: 44 (44,..c T uc ff 1 po 1 n5 Manholes Address: 2 z azs api it iv S., Rain drain connector City: /4 H, -0, State: biz_ 'ZIP: q C C) - Sanitary sewer (no. lin. ft.) Phone: S tj3 -t,,7 8 ax: , rs _ 2r E -mail: Storm sewer (no. lin. ft.) CCB no.: 4 a / ( Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: Fixture or item: Contractor's representative signature: le-e--n...--e Absorption valve Back flow preventer / 27 • Print name: hie L R N e...1.4 w r o -e,r Date: 3 2d a I Backwater valve • Basins/lavatory Name: Clothes washer Address: Dishwasher City: State: ZIP: Drinking fountain(s) it y I I Ejectors/sump Phone: Fax: E -mail: Expansion tank Fixture/sewer cap Floor drains/floor sinks/hub Name (print): S 1 1.. A {`k I L�� Garbage disposal Mailing address: /if ; � S ,,v i e)/=40.4-4)C.- Hose bibb City: 'State: I ZIP: Ice maker Phone: (Fax: I E -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 ENGINEER Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I 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 $ vC� �S at % ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review ( %) $ '' 4 Credit card number: / / State surcharge (8%) .... $ d� . / D Expires within 180 days after it has been TOTAL $ S? Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00/COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavato 16.60 for each utility connection) rY 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 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed 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 • Tub or Tub /Shower Hose Bibs 16.60 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 Other Fixtures Water Service - each additional 200' 46.40 (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 8% STATE SURCHARGE * *PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** AII New Commercial Buildings require plans with isometric or riser diagram and plan review. is \dsts \forms\plm- fees.doc 10/10/00 CITY OF TIGARD BUILDING INSPECTION DIVISIO MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 �� f/ BUP Date Requested AM PM BLD Location /6 SN'S - tJ /G'3 rG! Suite MEC Contact Person Ph 6 7J /3 Z PLM J° )C 2 y Contractor Ph SWR BUILDING ELC Tenant/Owner Retaining Wall #I ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab p� s ' SIT Post & Beam ' Ext Sheath /Shear f,[` Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL 4 LUMBI ost & Bea Under Slab Top Out Water Service Sanitary Sewer R.: Drains erg PART FAIL s 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 2 U / Other ` / J Inspector Approach /Sidewalk D j / 2 Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • BliP Building Permit ELC - Electrical Permit Inspection Description Date Passed By I Inspection Description Date Passed - By Footing /Setback Underground cover Foundation walls Wall cover Footing drain Ceiling cover Waterproof bsmt walls — Electrical rough -in Slab Electrical service Crawl drain _ Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing -4 Inspection Description Date Passed By Firewall Low voltage Tilt -up panel Electrical final Masonry/Reinforcement Framing MFG - Structure set -up MEC - Mechanical Permit Insulation Drywall nailing Inspection Description Date Passed By Suspended ceiling Post/beam mechanical Gas line Engineered soils Mechanical rough -in Welding Lab Final Fire damper Concrete Lab Final _ Duct work Bolting Lab Final Smoke detector Fireproofing Lab Final Mechanical final Structural observation Final inspection -- PLM - Plumbing Permit 'f Inspection Description Date Passed By BUP - Fire Protection System Permit Plumbing underslab _ -V Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab _ Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP /backflow preventer Fire alarm fmal Rain drain Storm drain Water service _ SIT - Site Permit Sanitary sewer 11 Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final 3 4 Sprinkler supply lines Sprinkler underfloor /slab Catch basin/Manhole _ SWR - Sewer Permit Engineered soils I Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS • - CITY OF TIGARD PLUMBING PERMIT A -1 ', DEVELOPMENT SERVICES PERMIT #: PLM2001 -00084 ,�- '�'i � DATE ISSUED: 3/20/01 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 114BB -20200 SITE ADDRESS: 16545 SW 103RD AVE SUBDIVISION: RIVERVIEW ESTATES NO. 2 ZONING: R -7 BLOCK: LOT: 046 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 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: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of residential backflow preventio device. FEES Owner: Type By Date Amount Receipt WHALEN, JUSTIN + KERI PRMT CTR 3/20/01 $36.25 27200100000 16545 SW 103RD AVE 5PCT CTR 3/20/01 $2.90 27200100000 TIGARD, OR 97224 Total $39.15 Phone 1: Contractor: NATURAL TOUCH LANDSCAPING INC 22505 BENTS RD NE AURORA, OR 97002 REQUIRED INSPECTIONS e V Phone 1: 503- 678 -1328 RP /Backflow Preventer Reg #: LIC 6811 Final Inspection PLM 10773 7 subject to the regulations contained in the Tigard Municipal Code, State of OR. , This permit is issued su � g 9 p 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 0 Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. Yo -fray obta Cosies of these rules or direct questions to OUNC by calling (503) 246 -1987. 0 Is s d By: 1 9 ►� ,� f" i' ► Permittee Signature: Qiy�- -:��// W Call (50 • . 9-4175 by 7:00 P.M. for an inspection needed th next business day