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Permit CITY TIGARD PLUMBING PERMIT ; DEVELOPMENT SERVICES PERMIT #: PLM2000 -00424 9 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: SITE ADDRESS: 14980 SW 109TH AVE PARCEL: 2S110AD -90069 SUBDIVISION: CANTERBURY WOODS CONDOMINIUM ZONING: R -12 BLOCK: LOT: 069 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SFA 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: 1 OTHER FIXTURES: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Relocate watercloset, hose bib & add Lavatory FEES Owner: Type By Date Amount Receipt ANDERSON, DANIEL W PRMT CTR 11/20/00 $72.50 27200000000 14980 SW 109TH AVE 5PCT CTR 11/20/00 $5.80 27200000000 TIGARD, OR 97224 Total $78.30 Phone 1: Contractor: DEAN POTTLE PLUMBING 5704 SE FRANCIS PORTLAND, OR 97206 REQUIRED INSPECTIONS Rough -in Insp Phone t Reg #: PLM 26 -664PB Final Inspection LIC 134791 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. l Issued By: (,,-7 L Permittee Signature: Q o l � all (50339 -4175 by 7:00 P.M. for an inspection needed the next business day , Plumbing Permit Application Date received: Permit no.: rifr1 Zrcro. or yzy 4 " 4, 1 > ; City of Tigard ,� : a II y Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT 0 - 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist) Job address: 1 y g 3 (' e5 (j. `0 ) Description Qty. Fee (ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: 2$ 1 104D- go(' bq SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: 'f ( q p,t, I ZIP: Each additional bath/kitchen Description and kication of work on premises: ge(oc.:..CZ fit•, k i Site utilities: lAcs o.,. L \ vi a4kd low ;s' Oti 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: o e. lc .�W; Manholes Address: ' p' + /' „c �'S Rain drain connector City: per la:�rJ 'State: 0 r -1 ZIP: 9 '7;0 ( Sanitary sewer (no. lin. ft.) Phone: c - 30 i '7I Fax: 1E-mail: Storm sewer (no. lin. ft.) CCB no.: 1 6 if 7 i I 'Plumb. bus. reg. no: a G • Ca.( pp) Water service (no. lin. ft.) City /metro lic. no.: is ,fq a, -- p � Fixture or item: Contractor's representative signature: ] 60 Ai Absorption valve Back flow preventer Print name: , e_a_i, - Date: / l( 1 0 (0 u Backwater valve CONTACT PERSON Basins/lavatory Name: Clothes washer f (, , CO �'�� ■ Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank Fixture/sewer cap Name (print):, 14 Floor drains/floor sinks/hub er°� Garbage disposal Mailing address: Z i f Q R o c [ 09 I Hose bibb City: -1 c �, a A I State: or I ZIP: Ice maker Phone: ( - ( 9 .* f I Fax: 1E-mail: Interceptor /grease trap Owner installation/resi ential 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: 'ZIP: Other: 4 I f... of / in f , Phone: I Fax: 1E-mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 12' 5 Notice: This permit application Plan review (at %) $ S , O ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) $ Expires TOTAL $ 7 g. 30 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00 OM) VttVW mAtI'h Fe. 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 Lavatory 16.60 for each utility connection) 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 1 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. ** All New Commercial Buildincjs require plans with isometric or riser diagram and plan review. is \dsts \forms \plm- fees.doc 10/10/00 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-1-lour Inhpection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 1/ ij AM PM BLD Location / q 9 jd -5 w /U y / I- Suite MEC Contact Person Ph M-310 V PLM 2.4 dO V 2 Contractor Ph SWR BUILDING Tenant/Owner )9/7('/ p/c4 ft://' ELC Retaining Wall ELR Footing Access: D (., _ 10c' -- /� FPS Foundation Drain SGN Cr I Drain Inspection Notes: Slab �r CTS ,^/ ,� — Post & Beam - SIT Ext Sheath /Shear Int Sheath /Shear Framing d t )/Le ee / 5 ' 44 9 U.Q 7 �� Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL •ost & Beam Under Top � �"l Top Out Gu Il Water Service Sanitary Sewer Rain Drains 47' ART FAIL r. ' NIGAL 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 Approach /Sidewalk D / / — 0 -0o Other Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.