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Permit ,, .. if C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2004 -00417 ,� 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/10/2004 SITE ADDRESS: 11565 SW DURHAM RD 110 PARCEL: 2SI 10DC -02400 SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: 1 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: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: T.I. Adding (1) lay, (1) washer, (1) water closet. FEES Owner: Description Date Amount MOODY HOLDINGS 5701 NE 105TH # D [PLUMB] Permit Fee 9/10/2004 $72.50 PORTLAND, OR 97213 [TAX] 8% State Surcharl 9/10/2004 $5.80 Total $78.30 Phone : 503 860 - 0235 Contractor: CENTURY PLUMBING 2710 E HANCOCK NEWBERG, OR 97132 REQUIRED INSPECTIONS Phone : 538 Rough -in Insp Rough -in Insp Reg #: MET 00003257 Top -out Insp LIC 19085 Final Inspection PLM 36 -24pb 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: 40 Alir Permittee Signature: ,se, Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin1 ss day Building Fixtures Plumbing Permit Application - FOR OFFICE USE ONLY City of Tigard Received � o / 46 Pem i N � � (1 ii,oto• % t B1 DateDate/By. . w y 'J ! 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review a - Phone: 503.639.4171 Fax 503.598 1960 � f J l +� Date/By. Other Permit No v��OaG� �..J _ 24 Hour Inspection Line: 503.639 4175 E!1 LL Date Ready/By Jun El See Page 2 for Internet: www.ci.tigard or us Notified/Method: 3 �� Supplemental Information `ai"'§.• v.. , - rz�"o�'� aw- ^.r.. �..,;iea'� •7� w'ase:�� � sr - , i ',�,,,, e ..'�. , ��rr. ,� ; ,� .. , ¢ � :Y ar.«� 9 �. s x».�'g g } as � � °.�xr�r •.•.2'vq .:- � g��: u r3u"�§� �, •i�'.. - -" SP n, €� , ' '' N , � ; }TYPE , OF W ORK , #,'J t • Y , � i ,�, I FEE ;SCH , .. • +:- �' � _. � , kx+r�t.,��"��.wr!x+ia�r� .�,�2� `��F� -s . Y.� &im'� ". '�'._�..'�`- �t�::_ .c: �f :x' w *:e n S;� _: 64-•.. For special information use checklist. El New construction ❑ Demolition Description Qty Ea Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection) `. <= e, f'y �.r -� s,, ,c s`r° aa:.a 4A tf <� s' ; >3 ?'' ijil• 13 � t;Z GATEG Witt @ = ,�s iT =ice e rr; y `J SFR (1) bath 249.20 El 1- and 2- family dwelling ❑ Commercial /mdustnal SFR (2) bath 350.00 ❑ Accessory building ID Multi-family SFR (3) bath 399.00 • Each additional bath/kitchen 45 00 ❑ Master builder ❑ Other: ��, �� � � Fire sprinkler ( sq. ft) Page 2 1_% ry OB SITE I IWRiSIATIDNI }AND ,L' OCATION= A �'° > r' - ' , - i , „ •7c5 'nor &��''?'; .AAA:.,—, $:.�K,rs,,' r,,sce „.m,.,: , .,;a , =,r„s: °:, .,.. ' ° ;%�-,.: —Av a Site utilities Job site address: /l5 .' ` 560 ' t/r i t , _' //a Catch basin or area drain 16 60 City/State/ZIP: / ( or d,. 9 7)--2-7- Dr ell leach line, or trench drain 16 60 Suite/bldg. /apt. no.: I Project name: / `( j � Footing drain (no linear ft. • ) Page 2 Manufactured home utilities 110 00 Cross street/directions to job site: Manholes 16 60 ( >f/KG'lo -■ 41 1 'q (-J Rain drain connector 16 60 Sanitary sewer (no linear ft : ) Page 2 Storm sewer (no linear ft.. ) Page 2 Subdivision. I Lot no. Water service (no linear ft. ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16 60 +,.» „au"��'�: �`. ,'.`�*';'- s�,;.'a <,;�s� ' zx:. ..� ..y,,.�r ...:r��y ",,. �� 4��� ,�r.,�. •, "c��r�rfC irte” •4`^i` •� a :i.: " i ;' v. CR /p,', ^'''s3" P 8 1, _•l s '3 A - 4 // / CRIPTI, OF:,WO • - -'" ", %Z.. ua Backflow preventer Page 2 Backwater valve 16 60 Clothes washer / 16 60 Dishwasher 16.60 „ , ;rya, ,. •,:'r m• -. s r. ?..a . s� ` `. a . f .i . , .:, -, • 4 4 v , Drinking fountain 16 60 s- • + *ROPER' . O N ER' ' e w l , ; t ; ,.6 : ,® TE N° s � �„ ��.:�.; .�� » •� / :+t. =� i '�: ;�•a_ 4 .�: �, �<,s.*� a„� :.k � � Ejectors /sump 16.60 Name: 4 ao4 � / � /ls r7r r Expansion tank 16.60 Address: 5 7(7 . /6,5 7f�1 O 17 Fixture /sewer cap 16.60 City/State/ZIP: ,/, /4,te-/ 9. Floor drain/floor sink/hub 16.60 Phone: ( 5- a 3 ) g "',6 9 O 5r Fax: ( ) Garbage disposal 16.60 APPLIC Ai'�1T Y ., t � *` ta ` -, _ i i z itu / 24: Hose bib 16.60 ` `r`'.s.lX4/9"../44 Ice maker 16 60 Business name: Interceptor /grease trap 16 60 Contact name: / 01 gut as Ab1yc/--e Medical gas (value $ ) Page 2 Address: Pnmer 16.60 City/State /ZIP: Roof drain (commercial) 16 60 Sink/basin/lavatory / 16 60 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 16 60 E -mail. Urinal 16.60 1V : :WX l °': C®N.TRACTOR' ' • - 1 1, r ` , •1 . =.,r•hz.: �'i r :: °, •, , :g,,,. V,i5 ,. ,1 , ,J. �', � , ":1'- �Sr Water closet / 16.60 Business name: �Ln k ,....„ . _\ . , ,� _ Water heater / 16 60 Address: 1 / Other City/State /ZIP: Subtotal - Minimum permit fee $72 50 Phone: ( ) Fax ( ) Residential backflow minimum permit fee: $36 25 /a CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) i State surcharge (8% of permit fee) ,S Authonzed signature: ja g Wi V� � O v TOTAL PERMIT FEE 7p� 6 Pnnt name: Date: 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 t \Budding\Perrmts \PLMF- PermiApp 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: ,, # f >, , ,.,: ,. r l x ''''*(315- Y °Eeer ea) otal' ., d , ,S,�te Uilit>es , y S uare oota a Permit Fe 'e #A'' 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 r- �s,.�; °-�� v 4 gr •�.;.. �.v .aE.F,,m-. -. ° alu ";; 5 Per F Storm &Rain Drain - 1st 100' 55 00 $1 00 to $5,000.00 Minimum fee $72 50 Storm & Rain .F e e(ea)'r,To'fa l . : 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 = iF1 ° Xt U 're OI IIICITIM' j Y > „7a Qty; "'' -.: additional $100 00 or fraction thereof, to and 3 i w�. 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 $100.00 or fraction thereof Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . °; ; _ 'i' ' IWO i; ua ititj%; �by� ;(Fikture)„Work;'Performe$;,"' e tea', , Q h- s � Re lace':`` 4 . 11 Fixtutze�T�ype i%.� ��. � �� --` k EgION ° ,. ° Mbed,, Exstin : cap 0 Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Dnve Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" -3” -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an -Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains 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 Bradley Quantity Total Commercial Isometric or riser diagram is required if fixture quantity Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Unnal Other Fixtures: I \Building\Permns\PLM- PermiApp doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received g - Date Requeste VC) /7 AM © BUP Location t ( Suite /1 1 MEC , / Contact Person C - J ' 5 Ph ( ) cs4 1 -- �S Z 7 "oc T �/ f , Contractor Ph ( SWR ( BUILDING Tenant/Owner `I-A-A-I Lis 5 ` ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall .0, Fire Sprinkler or Fire Alarm Susp'd Ceiling Roof Other: Final PA PART FAIL Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole (11 Storm Drain Shower Pan PART FAIL HANICAL 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: Unable to inspect — no access Fire Supply Line n ADA Approach /Sidewalk Date / ( � Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION'tlIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested — 7 AM PM BUP Location / - • t<A t</ %y2 2J Suite , C MEC Contact Person Ph ( ) SID PLM 6 Li/ 7 Contractor 0 /1A.(,:4 Ph ( ) 8c1"88rL3 SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING �. Post & Beam �� .j Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: p I AN PART FAIL ICAL 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: ❑ Unable to inspect — no access Fire Supply Line ADA 19)/' Approach /Sidewalk Date N. • Inspector Ext Other: Final ' O NOT REMOVE this inspection record from the job site. PASS PART FAIL