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Permit CITY TIGARD PLUMBING PERMIT 1 DEVELOPMENT SERVICES PERMIT #: PLM2001 -00161 - 13125 SW Hall Blvd., Tigard, O 97 223 (503) 639 -4171 DATE ISSUED: 4/19/01 SITE ADDRESS: 14599 SW 128TH PL PARCEL: 2S109AD -07500 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 BLOCK: LOT: 001 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: Installation of irrigation backflow prevention device. FEES Owner: Type By Date Amount Receipt MASTERPIECE CONSTRUCTION INC PRMT CTR 4/19/01 $36.25 27200100000 15435 SW ASHLEY DRIVE 5PCT CTR 4/19/01 $2.90 27200100000 TIGARD, OR 97223 Total $39.15 Phone 1: 503 - 267 -6730 Contractor: JOHN DARBY LANDSCAPE INC 13867 SW BENCHVIEW TERRACE TIGARD, OR 97223 REQUIRED INSPECTIONS Phone 1: 579 -5298 RP /Backflow Preventer Reg #: LIC 7110 Final Inspection PLM 12319LCL 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 c- • (503) 246 -19: Issued By: 11-x_ Permittee Signatur Call (503) 639 -4175 by 7:00 P.M. for an inspection need e next b iness day Plumbing Permit Application Date received: /yp / Permit no.:/a ado /_QO/ City j. ./ Cit of Tigard -, i I ` J 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 ....2V-ii—Reeeipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial Ll Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special infori ation use checklist) Job address: ,/., / S' / < ' fI_ / Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: Ne 1 -and 2 -family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: IBlock: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: r / c ,i I ZIP: 9 >�. , � Each additional bath/kitchen Description and ration 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: f j i y ____. z i Manholes Address: F Z e 7 L Rain drain connector City: ` �, v ( ' T tate: t�b ZIP: T 2,42 3 Sanitary sewer (no. lin. ft.) Phone: q'$ I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: 7 /lso I Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: ' Alli Fixture or item: �� 'sorption valve Contractor's representative signature: � T/!6 /�t+� /`� ; ack flow preventer Print name: i Date: Backwater valve • CONTACT PERSON Basins/lavatory Name: . C) A _A42pp/6 Clothes washer Address: R Dishwasher V6_ Drinking fountain(s) City: 4 /4 i �� State: IP: Ejectors/sump Phone. Fax: E- mail: Expansion tank MINER Fixture/sewer cap Floor drains/floor sinks/hub Name (print): il,eit,5cika j/' P' —c' / .6,11„i�S 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. Notice: This permit application Minimum fee $ G • Z ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card Expires accepted as complete. TOTAL $ • $ Cardholder signature Amount 440 -4616 (6i00/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 for each utility connection) 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 $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. * * All New Commercial Buildings require plans with isometric or riser diagram and plan review. is \dsts \ forms \plm- fees.doc 10/10/00 ;3 ri CITY OF TIGARD BUILDING INSPECTION DIVIS MST -4'`�� 24 -Hour inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested S - Z Z AM / 471- 5 PM BLD Location /''Sf f 5 / za K Ae, Suite MEC Contact Person Ph 7C) - 5 PLM o 01 th Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Foundation Access !� ,,=, � u � C G -,c GA c /C &v.- FPS V / Ftg Drain SGN �7 Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear 0 1/'LA �� o L a > Framing p+� / Insulation (� Drywall Nailing - (> - �lI'�^-*C . Firewall / � V� Fire Sprinkler :' � U s / Fire Alarm /// Susp'd Ceiling I -- c........._ ' ( .P± " Roof • , ...... Misc: / 4 (rii2S Final i6)) ��. I „ a /N. PASS PART Al "/� �� r V ; i, ,k * 14r Ii /1, 47o (. 0h 2 a L C- - Post & Beam \\ ^^ (� (� / / Under Slab 1 7) L V `� fin/- -rX ` L� 2-66/- 0 d/ (0 1 Top Out lJ Water Service --Q c4 ( ∎ V f �c�.r Sanitary Sewer ,/ � Rain Drains t 'c' C - ) D-- t) Z CQ . Fin PASS PART A' 4 , 0 l ✓ \ Q .ter 2 MECHANICAL >jAWIF 7--t C CS - `J Q--r�► Post & Beam Rough In -r. V -.2._r. ► , l • f, 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 y. Approach /Sidewalk Date 7 /.i_/ I ns pector l (� Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. L CITY OE TIGARD BUILDING INSPECTION DIVISION � ,� oo /o S -- 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 ST BUP • Date Requested Z s AM PM BLD Location /C - ff SG' / Suite MEC Contact Person Ph 7 5 5 PLM g09/- d0/6/ Contractor Ph SWR BUILDING Tenant/Owner plYtA7 r 1 Ce.,14 ELC Retaining Wall ELR Footing Access: Foundation �J 2 �� 6 / FPS Ftg Drain C! SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath/Shear LM O 1 s V d Ov■c) Framing ' 62 0��'�•� 9 Insulation Drywall Nailing — P Firewall4/ _ I Fire Sprinkler W/ P M:4_ ^�J LA Fire Alarm Susp'd Ceiling AM I M -- ER L_ Roof Misc: 6 • Final b v -e - _ -' PASS ART FAIL �/ CPLl1MBLNG ' • Post & Beam 1\ Under Slab Gt C1 C,0/1 4- 0 Top Out Water Service ■40t,,—rt • n ` (' • Sanitary Sewer • . . C� Final PART FAIL 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 Approach /Sidewalk '` ( 7 Other Date Z S 6 Inspector ExJ3 Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • CI OF TIGARD BUILDING INSPECTION DIVISION L , o /� S, 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 ST � BUP Date Requested Z s AM PM /S BLD Location /U 5 - - /c. Suite MEC 5 Contact Person Ph 7 5 PLM / — 66/6 Contractor �7 Ph SWR Tenant/Owner / F / ' -«X C ELC Retaining Wall ELR Footing Access: Foundation (] 6a I �� / FPS Ftg Drain �t G SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear //�� p r Framing L M o o i - V O j Q l Tr A3) Insulation G Drywall Nailing — • - �� Firewall I , Fire Sprinkler A Fire Alarm , • Susp'd Ceiling `.� . 1 .% � �∎ • Roof t'/1^- -& Misc: • Final 1"> D 0 _ 6"v1 �� \/).‘ PASS BART FAIL CaSill 0 4..v‘ Post & Beam Under Slab —.� . c--e/1 Top Out Water Service � i . n �� . Sanitary Sewer Final PART FAIL 7; 5.7\77,77. Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL �y Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL tug 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 Date r--- Q Z ( 7 Other Inspector Ext� Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. BUP - Building Permit ELC - Electrical Permit 4 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 rou "h -in Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing I 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 4 Inspection Description Date Passed By Suspended ceiling Post/beam mechanical Gas line Engineered soils Mechanical rough -in Welding Lab Final Concrete Lab Final Fire damper Duct work Bolting Lab Final Smoke detector Fireproofing Lab Final Structural observation Mechanical final Final inspection PLM - Plumbing Permit Inspection Description Date Passed By BUP - Fire Protection System Permit Plumbing underslab .4 Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out _ Sprinkler fmal RP /backflow preventer SI2 C/G" , ✓ijj Fire alarm fmal Rain drain Storm drain Water service SIT - Site Permit Sanitary sewer J Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final S Z Crol Sprinkler supply lines 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 , I; DEVELOPMENT SERVICES PERMIT #: PLM2001-00161 �' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/19/01 PARCEL: 2 S 109AD -07500 SITE ADDRESS: 14599 SW 128TH PL SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 BLOCK: LOT: 001 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: Installation of irrigation backflow prevention device. FEES Owner: Type By Date Amount Receipt MASTERPIECE CONSTRUCTION INC PRMT CTR 4/19/01 $36.25 27200100000 15435 SW ASHLEY DRIVE 5PCT CTR 4/19/01 $2.90 27200100000 TIGARD, OR 97223 Total $39.15 Phone 1: 503 - 267 -6730 Contractor: JOHN DARBY LANDSCAPE INC 13867 SW BENCHVIEW TERRACE TIGARD, OR 97223 REQUIRED INSPECTIONS RP /Backflow Preventer Phone 1: 579 -5298 Final Inspection Reg #: LIC 7110 PLM 12319LCL 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. Q 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 d 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 c- • • (503) 246 -19: Issued By: (' Permittee Signatur : 1 /dk . i Call (503) 639 -4175 by 7:00 P.M. for an inspection need • he next b -iness day