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Permit ,' ' CITY OF TIGARD PLUMBING PERMIT 'I�; DEVELOPMENT SERVICES PERMIT #: PLM2001 -00142 1' Af DATE ISSUED: 4/6/01 13125 SW Hall B Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13301 SW 128TH PL PARCEL: 2S104DA -02700 SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5 BLOCK: LOT: 013 JURISDICTION: TIG CLASS OF WORK: ALT 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: Irrigation backflow prevention device. FEES Owner: Type By Date Amount Receipt JESS ALWAY INC PRMT CTR 4/6/01 $36.25 27200100000 STAFFORD SW STAFFORD RD SPOT CTR 4/6/01 $2.90 27200100000 TUALATIN, OR 97062 Total $39.15 Phone 1: 781 -4899 Contractor: AMERICAN PLUMBING SERVICES INC 5905 N INTERSTATE AVE PORTLAND, OR 97217 REQUIRED INSPECTIONS Phone 1: 289 -6498 RP /Backflow Preventer Reg #: LIC 108025 Final Inspection PLM 26 -567PB 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: �_ /�� i Permittee Signature: ` 4 Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next s usiness day -4 A - Plumbing Permit Application WO Date received: S /0/ Permit no.fiff209/ —OD /yam t ., , J City of Tigard � � � g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City ofTigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: T]'PE OF PERMIT CI 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement P. New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE S('IIEDULE (for special information use checklist) Job address: f " I 5t4.) 1 a fli r oti , 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.: SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: -1( -a i re) I ZIP: _ 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: , 4meri(_,. to Pi tiLhbr bt5 Manholes Address: 61 05 ,44 .tN4 v1 { Ve Rain drain connector City: r S tate: Oki ZIP: el 7 Sanitary sewer (no. lin. ft.) Phone: SQ3, j 9, lrfAFax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: J d pa.� I Plumb. bus. reg. no: x- 567on. Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer / Print name: I scoi , Date: q 6 B Backwater valve Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank Fixture/sewer cap Floor drains/floor sinks/hub Name (print): Garbage disposal Mailing address: Hose bibb City: I State: I ZIP: Ice maker Phone: I 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: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ �lo lis Notice: This permit application ❑ Visa O MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number / / within 180 days it has been State surcharge (8%) .... $ .9 0 Expires ays after TOTAL $ jr . / Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6A0O1COM) 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 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 I I Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New I Moved 1 Replaced I 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 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 DIVISION lit }' 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested y — / AM /sue PM BLD Location / 33 .S es/J $ Suite MEC Contact Person Ph LM Zeb/- c c P _ Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS + 1_ Ftg Drain Crawl Drain Inspection Notes: SGN ► ► Slab SIT WArA Post & Beam r Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL MBING Pos & Beam Under Slab Top Out Water Service Sanitary der j • AS PART FAIL MECHANICAL 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 �� I"� 6 Approach /Sidewalk Date Lt A / 0 / 6 Inspector VC .� Ext I R Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. BU P - 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 - V Inspection Description Date Passed By Suspended ceiling Post/beam mechanical Engineered soils Gas line Welding Lab Final Mechanical rough -in Concrete Lab Final Fire damper Bolting Lab Final Duct work Fireproofing Lab Final Smoke detector Structural observation Mechanical final Final inspection 1V - Plumbing Permit 4 Inspection Description Date Passed By BUP - Fire Protection System Permit Plumbing underslab 4 Inspection Description Date Passed By _ Crawl drain 7" Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP/backflow preventer y� i /D / , Fire alarm fmal Rain drain Storm drain Water service SIT - Site Permit Sanitary sewer Ai Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final '-/ /( o / ' ) Sprinkler supply lines ("a Sprinkler underfloor /slab Catch basin/Manhole SWR - Sewer Permit Engineered soils 4 Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2001 -00142 .- -! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/6/01 SITE ADDRESS: 13301 SW 128TH PL PARCEL: 2S104DA 02700 SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5 BLOCK: LOT: 013 JURISDICTION: TIG CLASS OF WORK: ALT 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: Irrigation backflow prevention device. FEES Owner: • Type By Date Amount Receipt JESS ALWAY INC PRMT CTR 4/6/01 $36.25 27200100000 ST 24300 SW STAFFORD RD 5PCT CTR 4/6/01 $2.90 27200100000 TUALATIN, OR 97062 Total $39.15 Phone 1: 781 -4899 Contractor: AMERICAN PLUMBING SERVICES INC 5905 N INTERSTATE AVE PORTLAND, OR 97217 REQUIRED INSPECTIONS Phone 1: 289 -6498 RP /Backflow Preventer Final Inspection Reg #: LIC 108025 PLM 26 -567PB 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 aN P 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: Permittee Signature: j Ii i Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next • usiness day N