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Permit CIT OF TIGARD PLUMBING PERMIT WIN DEVELOPMENT SERVICES PERMIT #: PLM2004 -00215 ' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/14/2004 SITE ADDRESS: 13241 SW ESSEX DR PARCEL: 2S104CA -01100 SUBDIVISION: HILLSHIRE ZONING: R -7 BLOCK: LOT: 011 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: 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: Back flow preventer FEES Owner: Description Date Amount MONTE MEHRING 13214 SW ESSEX DRIVE [PLUMB] Permit Pee 5/14/2004 $36 25 TIGARD, OR 97223 [TAX] 8% State Surchari 5/14/2004 $2 90 Total $39.15 Phone: 503 - 590 - 7090 Contractor: OWNER REQUIRED INSPECTIONS Phone : RP /Backflow Preventer Reg #: 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: - - -P �r? L Permittee Signature r aw . Call ( 03) 639 -4175 by 7:00 P.M. for an inspection nee. -d the next busjness d. Building Fixtures • Plumbing Permit Ap I {�3, l do I VEDA Received FOR OFFICE USE ONLY' , ` '- City of Tigard Date/By Pemnt '4CfL/ awe q-n€21 13125 SW Hall Blvd , Tigard, OR 97223 n � I Plan Review Phone 503 639 4171 Fax 503 598 19601Q 1 `4 Date/By Other Permit No 24- Hour Inspection Line 503 639 4175, . e• li Date Ready /By runs 0 See Page z for Internet www ci tigard or us OF TI�' NottfiedMethod Supplemental Information ,p P ; $ "n € ?° (I .. v .lsk'G �. ,Hy, v ': tizisPE A { j y yai�a'2 'r. ,. * ' it . 6 C. Ca . a .2 Ono a2'u...,, a , t slit% F .x'a,s a'n?dc<:]L; � a4:�_ : s tx...�. � .. _ _ � ` . . For special inform¢nore use checklist. New construction ❑ Demolition Description I Qty J Ea 1 Iota) K Addition /alteratton/replacement ❑ Other New 1 -2 -family dwellings (includes 100 ft for each utility connection) R''katt ' Ctr CAtEGORY ' Ortiartiail SFR (1) bath 249 20 0 1- and 2- family dwelling ❑ CommerciaVmdustnal SFR (2) bath 350 00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399 00 Each additional bath /kitchen 45 00 ❑ Master builder ❑ Other Fire spnnkler ( sq ft) Page 2 t Y ; �m eK 1 r � R. ma e , e ) Y r, `a gifi itt I t MATIO1X1FA'ND,tiOCATION,�'i " " G? �� x res r_, e .a�.w,. bs '" ± c""�r,<£ Site utilities Sob site address I id, l' � • StA) ES9 21 tj Catch basin or aim di am 1660 City/State /ZIP "'r LC A Y C) ill--- '7 2- a- 3 Drywell, leach line, of trench drain 16 60 Suite/bldg /apt no Project name Footing drain (no linear ft ) Page 2 Manufactured home utilities 110 00 Cross street/directions to job site Manholes 16 60 Rain drain connector 16 60 Sanitary sewer (no linear ft ) Page 2 Storm sewer (no linear ft ) Page 2 Subdivision Lot no Water service (no linear ft ) 1 Page 2 Fixture or item Tax map /parcel no Sr Iy,,��"'7fac' z swat..,- s.,...,,.s , t .. v . R i. . r y, ,;..c - �. as Absorption valve 16 60 � �; DESC2, ., AY -OR r I ' j � ;, -, �; ,,. w g Backflow preventer Page 2 uL p'-' i � / 1 E J 1� F KI M K-L-L.✓... Backwater valve 16 60 1'S i t .. ` 't N ,Gf C, � rui Clothes washer 16 60 ( Pa LU �1 Lpc , u � Dishwasher t 6 60 x { 4 aa.„,.,a<r-_, ; .k 4 "'ad° „saute, m a s Dnnlang fountain 16 60 Electors /su * t�f :1 2Lyk oWNER+3` � [' ` L r" ,/� tic ' ° v 6 1 Me /" 70 ti r G M L 1 I _A w C mp 16 60 Name 4 \ Expansion tank 16 60 4 Address � ^ s tA) ES9Qc J (L • Fixture /sewer cap 1660 City/State /ZIP '""I ) G A h - d t> D ✓t.. y'no j _3 Floor drain /floor sink/hub 1660 Phone (903) ;` qo 1o9 Fax G3) 7 , 15 73g / Garbage disposal 16 60 " `� "' L'flrnA4PP e � a �M } �frr i {] CO.IX, FPDRSON'iy.,� '-1! Hose bib 16 60 I 3 §J7;7 _ s,er., . ir'W r �t„ m . 4 o9A6 c,..,m -.,S - Ice maker 16 60 Business name Interceptor /grease trap 16 60 Contact name Medical gas (value S ) Page 2 Address Pnmer 16 60 City/State/ZIP Roof drain (commercial) 16 60 Sink/basin /lavatory 16 60 Phone ( ) 1 Fax ( ) Tub /shower /shower pan 16 60 E-mail Urinal 16 60 y ; S ;(; Tt:' a ' CO OR )} T ?' 7; aiij Watel closet 16 60 Business name Water heater 16 60 Address Other Subtotal City /State/ZIP Minimum permit fee $72 50 Phone ( ) Fax ( ) Residential backflow minimum permit fee $36 25 --, G'a.5 CCB Lic Plumbing Lic no Plan review (25% of permit fee) / TOTAL PERMIT FEE 3 State surcharge (8% of permit fee) , • 9 0 Y Authorized signature t n li 45--- l r //' ' 'Phame / 'i 0 ,,, 1 - , si 6_44e,N� Date 5A � This permit application expires if a permit is not obtained within -- 180 days after it has been accepted as complete *Fee methodology set by Tn-County Building Industry Service Board , \Buddmg\Pennns\PLMF- PemutApp doe 12/03 4404616Tttc/02/COM/WEBi Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • • Fee Schedule: Residential Fire Suppression Systems: S1teYiJtlhtlesr "� r _. Y,ti - ,Q[ ; Fee 00ta ek PCrmit ee' • Footing drain - I" 100' 55 00 0 to 2,000 $115 00 Footing di am - each additional 100' 46 40 2,001 to 3,600 $160 00 Sewer - 1st 100' • 55 00 3,601 to 7,200 $220 00 7,201 and greater $309 00 Sewer - each additional 100' 46 40 Water Service - 1st 100' 55 00 Medical Gas Systems: Water Service - each additional 100' 46 40 Villltatl.w�aii 011:a;$;,,;,u, t 4 . i,,r c= ,.� i+•: un.':a - :�i,^m=•" ^-- • - °° • +• - Storm & Rain Dram 100' 5500 ¢ , W , � , in ,fheYnllt - $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 v. - .r,�r •..� _ - s a. •,- �• a� K iii t •'i nFee eh r ,, -To additional $100 00 or fraction thereof, to and ;Fixture OC Item i ":•X'iwft a ei "; 8-0?t' , Q Sit T S' gat ( x•S.FS 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 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 * . 6 ?' f -, 'ti:' ' , iQua`ntiti7by.(F ` x'tu_r "e)3Vork "P- ei'foFmedi px• Fixture Type: 30 , u, 'tL r= • �� aReplace• k; Me 'z ;fi : • � � w : k i ng,v,Sdn xis d4 j:gapped} Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall Dove Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" -3" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach /Refng Drams 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 - 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 • \Budd,ng\Pcrmrs\PLSM- Pemuupp doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION' DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested c� l0 — ' AM PM BUP Location /,3a q1 PJ 2 d- PL7-' Suite MEC Contact Person -- Mtn Ph ( i7J 3-, 979e PLM a Oc '7- Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab In ectio Notts: _ • g SIT Post &Beam t l✓-a�� ��-Jy, lf:.�- �c-�e1 Anchrs Ext Sr ea h / „ _ 1 411 n m t She Y / /�XI �!i ✓+ � l/ Int Sheath/Shear r -f �� 041-44-1 Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm � ear r Susp'd Ceiling Roof ( Other Final �f /� / EL ■ — /OP– rata -a/ - i PASS PART FAIL PLUMBING Post c ^! ? Under Slab Rough -In Water Service Sanitary Sewer Rain Drains �] Catch Basin / Manhole / Storm Drain - — - Shower Pan a i�' Oth- • Q'7'iLr PASS PART F I i T �� - MECHANICAL I � Post & Beam Rough-In Line EXPIRED Gas Line Smoke Dampers Final I/I ©/d c PASS PART FAIL C/(� 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 �( Approach /Sidewalk Date�/�� U Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL