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Permit • CITY TIGARD PLUMBING PERMIT 1 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00310 �,f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/2/2004 SITE ADDRESS: 06855 SW BAYLOR ST PARCEL: 1S136DD -01300 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Remarks: Dishwasher and sink. FEES Owner: Description Date Amount MALCOLM ESLINGER 11575 SW PACIFIC HWY [PLUMB] Permit Fee 7/2/2004 $72.50 TIGARD, OR 97223 [TAX] 8% State Surchan 7/2/2004 $5.80 Total $78.30 Phone : 503 620 - 9515 Contractor: UNIVERSAL PLUMBING (DAVID RAY OAKLEY) 8811 SW SPRUCE STREET REQUIRED INSPECTIONS TIGARD, OR 97223 Phone : 452 Rough -in Insp Top -out Insp Reg #: LIC 111472 Final Inspection PLM 26 -589PB 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699. Issued By: Permittee Si nature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business dal") Building Fixtures r• Plumbing Permit Application lication FOR OFFICE, USE ONL - City g Cit of Tigard JUL 2 2004 Rece 7/2 ved ,, /,,'d Permit 1 rte+' 1 utNo - �d ✓ !� 1., n .66 1 117" 13125 SW Hall Blvd., Tigard, OR 97223 Plan RevievG /// .�,y�t �j 7 Phone: 503.639.4171 Fax: 503.59�8;p'g l OF TIGARD / M 5 i ' '� t\ Date/By: Other Permit h �✓ LV'� - V 17 / 24- Hour Inspection Line: 503.63 ?� L 5 DING DIVISIO -•1 � Date Ready/By: See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: ;1 I S upplemental Information - :e.,,, ".� =� ":a�. »:si. ��: .:z�° ::<n-; "� .^�a,:._ :�.,,�.as "�.. .; «,"�" ".e�°< at`;'-.: .;�^ w'; �`r� : :c� «5 " .rE%?,c ; - "; >it � :�;:: : , ; "` .`. ,- : >� , . , PR' . O ff � ??. W©RK '" . M 4; )�s ''. r FE Fr* SCHED fnTi a . _ . ,. ; ❑ New construction ❑ Demolition For special information use checklist. Description Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) : I ry III I' VI I 'CATEGORY ireCO SfTRCJC'T1(01Y r MA-rs ' . SFR (1) bath 249.20 El 1- and 2- family dwelling Commercial/industrial SFR (2) bath 350.00 El Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: :`. « - -,.," ;. r " Fire sprinkler ( sq. ft.) Page 2 '' i r *df3B' S1TE I , MI AND ITSUat 03!iE:l ` W K : r. Plivws - .._ .,s., v ,.a0.. te n .. k,a Site utilities es Job site address: e$37 13 /� D y ' , Catch basin or area drain 16.60 City/State /ZIP: r ® 7 J 3 Drywell, leach line, or trench drain 16.60 ® �� I i i Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: l Project name: 1, ,0 o f , / tom � , a Manufactured home utilities 110.00 Cross street/directions to job site: -- ! II Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 ( f , Subdivision :B`K Z. J f p� 1A , ik n _ Lot no.:/3 Water service (no. linear ft.: ) Page 2 no.: si36.� D ©1380 I4670 Fixture or item Tax map/parcel no. _ s -,,; a:rF .ter " " .; °, «eiz Absorption valve 16.60 > l ro WORK l '� ° / = .... "t -'.'i DIJSCR , LON �; , `. , '' <a ,. � �. � 4 ,• T. � s,� � _.. �. �� ,. , t% >�.� A .��e Backflow preventer Page 2 ( fir Backwater valve 16.60 . ���� 4). � )� 4 /j� r ' Clothes washer 16.60 1/v v/ /�'�Y Dishwasher / 16.60, /b, 60 t,, .;t: - : t, , " .u�,� >� °�r;. ' o> . r� =,:' .1`%` *, ., :ar vark -rv.�. - ., . of ,f `P ROPER t f) , . . � r ?" .w �" �., � .,�;�� ` k �?._..r :.,.�,��w� s.�s.:� Drinking fountain 16.60 1 � Ejectors /sump 16.60 Name: �.!` r Expansion tank 16.60 Address: // 57S 5� 0 4.- !174 Fixture /sewer cap 16.60 City/State /ZIP: ! ` � Da. 9,2 Z3 Floor drain /floor sink/hub 16.60 Phone: )� -9 6/ 6. Fax: ( 67.0 - 73° Garbage disposal 16.60 ° +4";: s ^ :.:, . «t _ ' ''.; Hose bib 16.60 A «T WA i I P ?LIC T ? ` ` ' ; fi 60ilC PERSQN > i *:.a .,., -'- 1 ss._ ,,,, �� € .. i j . .A tt-A. '" .k _ :fix Ice maker 16.60 Business name:.' 'Q� i ��� Interceptor /grease trap 16.60 Contact name: L., _ J; j ', � .P Medical gas (value: $ ) Page 2 Address: I _ , l� ll�Z� , Primer 16.60 City/State /ZIP: • / ( 0 4..... 9 7 7 Z3 Roof drain (commercial) 16.60 J ) � I Qs'< t ..- Fax:: a _��_9475-- 10)asin/lavatory / 16.60 /6, 40 Phone: (� ��� L5 b e 4 . Urinal pan 16.60 E -mail: �� 1 � 5: N � Urinal 16.60 h` . l WiiNtl 3C OR Gl t tl l . a Water closet 16.60 �� � �:.� '��a. t��W� -�,. �.,k?�..:�.� �. _ fit � ,4 Business name: OA) i iJ 0.154.( P / ;,i b,'. d O Water heater 16.60 Address: Rs ii S c.,) .S�py'uee. S - P `� � Other: City/State /ZIP: / p 9 ,y�� Subtotal i (s AT D O ' . Minimum permit fee: $72.50 Phone: (54 ) 45- _ "9.i/go Fax: ( 053) pit/ q�+6/ Residential backflow minimum permit fee: $36.25 7 2 Plan review (25% of permit fee) CCB Lic.: / /j Plumbing Lic. no.: sitfZ IP State surcharge (8% of permit fee) 5, Authorized signature: F e � . � � TOTAL PERMIT FEE 7/ 30 Print name: - o d e ©Aictr/ Date: 7... /._ of This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. is\ Building \ Permits \PLMF- PermitApp.doc 12/03 440- 4616T(10/02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: m ;" `r�. �v,� ^»,°, .:es;t:. „✓ „ : +� , " � � "";; kr "' "i:'�'€�� ` : '" � = `��r • ,. to ea Total g . e Fo®tage Perm t�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 a ,a, ;:r� 1 „:; Storm & Rain Drain - 1st 100' 55.00Uat1O � ermlt Fie $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 ;;3 , a -f,, , t � • r additional $100.00 or fraction thereof, to and a= pa ture�or It - =,,, y Feo� w ,,Total . ,_ , � "��.r .__a�A� =,�, .� _�;�.� _z�, � _ ,. '��`��:e�- 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 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for 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 * . t 3 Q iTiT Sy (Fyxtuee) 'brkgPerf n `; Fix ate-Type x 1 e* t Replace ���_��� -xtsn c peat ' Comments regarding fixture work: 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 Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory • • Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity -Co ial - rvite / total is >9. Swimming i er Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP p� Received Date Requested 0 —3 / AM PM BUP Location w Suite C Contact Person Ph ( — "980 (71' ah 3 / d Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection No e) / /� SIT Post & Beam % Shear Anchors -- Ext Sheath /Shear 4i (1/-1 Q/nei!Lf �✓ Int Sheath/Shear Framing Insulation Drywall Nailing Firewall • Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: • PAS 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 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date F(? (f 1� -/ Inspector Lnw I I ,I KL `"J_ Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL