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Permit d C ITY OF TIGARD PLUMBING PERMIT Ak DEVELOPMENT SERVICES PERMIT #: PLM2004 -00399 ....0-'All 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/1/2004 SITE ADDRESS: 12730 SW GLACIER LILY CIR PARCEL: 1S133DA -05100 SUBDIVISION: AMART SUMMERLAKE ZONING: R -7 BLOCK: LOT: 073 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 5 OTHER FIXTURES: TUB /SHOWERS: 2 SEWER LINE: ft WATER CLOSETS: 2 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replacing 5 lays, 1 shower, 1 tub valve and (2) toilets. FEES Owner: Description Date Amount PULITO, GERALDINE K + BENNETT, EARL C [PLUMB] Permit Fee 9/1/2004 $149.40 12730 SW GLACIER LILY CR [TAX] 8% State Surchan 9/1/2004 $11.96 TIGARD, OR 97223 Total $161.36 Phone : 503 - 524 - 8037 Contractor: SEYLE'S PLUMBING PO BOX 2116 LAKE OSWEGO, OR 97035 REQUIRED INSPECTIONS Phone : 503 Rough -in Insp Top -out Insp Reg #: LIC 121862 Final Inspection PLM 24 -360PB 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: // i �_ , L Permittee Signature:( \\AI I t ),t,...L Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Building fixtures ECE1 ED Plumbing Permit Application) 0 2004 ; FOR OFFICE USE ONLY vdi City of Tigard DateBy Veit c � Permit No Ain �v � r^ �� (,03 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGAF,O Plan Revi: Phone 503.639.4171 Fax 503.598 1960 DateBy 6 3au � �� ° `' 1 °1� Other Permit No. t 24- Hour Inspection Line BUILDING DIV 503 639 4175 4J � E (A Date Ready /By. Juns 0 See Page 2 for Internet: www.ci.tigard or.us Nonfed/Method. 77 Supplemental Information • �;,g ; s ; '- _...5*' V .r. ^�.gaw i, , — _ $ Air,,, •� �. � N > .': • " > c" airs '^,?G. �cr.'ncs„ �, �" �:.. � .r�° - � }4, r �' ,a, =•..• T � ...;� .. .�ks ttt„ ,? iv, `a�.�' �r �#•.°•. %r r`�„ x*in�5r:�'.�:s.+ns. =.k. �! � ..�..;.,..»,;. -7 . 'a' h 'TYP OF.� �, v ° l 1 -i' < . - .: w ,FEE *:^SCHEDULE'"' ' .�� xa.�,� _ . _ - `a�,— ��4^`�� =" _...�.,,..ac,'.t`tu r =� �i�,�:A�_ �u7-.z s 3 n G �. k2r.� ='`` z'�`u'SEYa� ss i r.�_: ":257�'«s"::'` .. ia rs,,, rw: „=aasr. - - .. . For special information use checklist ❑ New construction ['Demolition Description l Qty. Ea. Total g Addition/alteration /replacement ❑ Other. New 1-2-family dwellings (includes 100 ft for each utility connection) •4 ti ='ti's $ 'a ^Src Se+"i Va. #�.=.t� ^<^°'M3"<25y 7R; . . .. e++ T .^^ct :��f., x, ii✓ . . i°; = ; CAT EGORY ®E4CONSTRUGPI, '` , 0 , t 5 • is . „ SFR (1) bath 249 20 . s =. ss;l.� .,,c�.•-. arsaanw , �m�:�'.a.�; ,, �:.se�:..r,<. - * �. �a” € -..r. g 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 1=] Accessory building 1=I Multi-family SFR (3) bath 399 00 Each additional bath/kitchen 45 00 ❑ Master builder ❑ Other: _ Fire sprinkler ( sq. ft.) Page 2 °' y JOl3"STTE a6iiiikTION D LfOCATION . z ' ' _,• , ` s t..:._ ... . c,.=n cz;:^ .;.. - r_. .- =w4 -s;rf : f ..s a a , S ut Job site address: I Z 73 O &LAG %FR L-i t- L `( 2 t RC Le Catch basin or area drain 16 60 City/State /ZIP: Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.. I 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 - ) Page 2 Fixture or item Tax map /parcel no.: ;,..,. : , ., a r s, ,* ,'., �t w, ,, ,, Absorption valve 16 60 = `i ::W,0.,i t) `sV E ;pF - WsQRICe '.4.41::-%.„, ' n t . u ,xar' �z s. =.r.r Y t . l Bacicflow preventer Page 2 ?AT t'1 145P L �2) Backwater valve 16 60 Clothes washer 16 60 , Dishwasher 16 60 Drinking fountain 16 60 ? ,a"' ,m' ;a r - ., i" ° °ac- s iz) „ ;ay.„i„ } w •, • <” k .,:,.w: - ' >.. y ,. u, g , .a PROEE'RT O,H'NI = ;' .: ,y "4 W ® ?i:TENAN , :� t , * �..o� a:.4a":.dt;y...^;teC.. ;z^1t ^ =::.r�.- ..rmtt »� ' d.�s • ,�,�°^ ° x ., d �% �• � lY ^",.e: a- =v� Ej ectors /sump 16.60 Name: got, Iv Expansion tank 16 60 Address: Fixture /sewer cap 16.60 City/State /ZIP: Floor drain/floor sink/hub 16 60 Phone: (03 ) 51 , -1— $037 Fax: ( ) Garbage disposal 16.60 _.:a .' , _,:,.,: .,,..x.,w 4 ,, Hose bib CONTACTPERSON " "'•i 3 s ,dz " ,i544: z��su r._�.� x Ice maker 16.60 6 60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value. $ ) Page 2 Address: Primer 16 60 City/State/ZIP. Roof drain (commercial) 16.60 Phone: ( ) Fax: . ( ) Sink/basi avatory 5 .6 16 60 Tub /shower /shower pan 1 16 60 E -mail: Urinal 16 60 ;, - 1" a PR54;7- 4r'.:;'ni ' IEgk 14 ,.i'd... `af-*f ..... u #iii4fi 7i, 1 °,fir: ,y".'4 ,„,f ;ii ;` ) / lia' 'a` 1,101 ' 1 COPif,t.t OR' vT t � y Water closet 16 60 ''�� '� �a � i.� �_r._,�� zip;:,= ��'. k '�. � Business name: S el Le S t p Lt! ri &1N6 (a , Water heater 16 60 Address: (1, 0 , ,Co.f 1L Other: Subtotal City/State /ZIP. (Ate OS w et, 0 Minimum permit tee $72 50 4 'l Phone: ( .5) to ....-1.6 °I q Fax: ( 51 3C y — Zeal., kx' / Residential backflow minimum permit fee $36.25 / 7•'1(1 CCB Lic.: j7 .'b°(, Z 4 , y t,� p ( Plumbing Lic. no.: ZN{ — fo 0 � 5 Plan review (25% of permit fee) t ^ State surcharge (8% of permit fee) 1/. /& 1 Authorized signature: ,.x.. ( TOTAL PERMIT FEE 1 1 I . (d, Print name: eff 7e,\.1 Date: / It ( This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tn -County Building Industry Service Board I \Buiidtng\Pernuts\PLMF- PerrrutApp doc 12/03 440-461 6T( 1 0/02/COM/WEB) Plumbing Permit Application - City of Tigard �► - Page 2 - Supplemental Information Fee Schedule: • Residential Fire Suppression Systems: i`� ` za y , . _ _• '«,�'" ? � , ;1., , le ea ;Veal = _`.°, °. S <e .:` :. , .$ " .:•,$ : „ , ) , . , .. _ :, 3 ,'ermi ET 04, ,. m .. �� .a,.� .*" , 2 ;� quare�F ootage= � .:.. �. r,,, ,�, __�,_ ��� Footing drain - l' 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 � �" Storm & Rain Drain - 1st 100' 55 00 $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 $1 52 for each ''''' =$ i' "'' ` ` iz.Fee'` e a f additional $100 00 or fraction thereof, to and , Fixture or It e rrir K ,4. °: 4 ;: c2 01 t <= )° ' -0 1'01 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 * . ;; fi ; - ,`',': "� ..., fib, „Quantity liy•( iaiii' ej Work,P,erfo' "rmeil ;.,. [ z �.a' id FsxturE # q e ;" , . ' % :: -0 r,'v „ ' "�, Z�Replace s' :.. '. Mo`ved � Gxis ..,.ac eii 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” - 3" 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 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. Urinal Other Fixtures• • \Budd,ng\Pemuu\PLM- PemutApp 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 o AM PM BUP Location l °( - 7 36 - Ct-elp- Suite MEC Contact Person Ph ( ) d PLM 0,3?? Contractor Ph ( ) 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 Under Slab ,O OUI _fir. Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final t , r PART FAIL CHANICAL 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: El Unable to inspect — no access Fire Supply Line 171‘,/, Approach /Sidewalk Date G L/ I nspector Approach/Sidewalk Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING i Inspection Line 33) 639 -4175 INSPECTION DIVISION Business Line: (503) 63• 1 (, ST Received Date Requested / Z AM PM :Up Location _ _41— / i _ . • _, uite E 'O 06 4 Contact Person �� �r� Ph • ( / ) 4. — 7 7 PLM G�Y - Ud �9 Contractor Ph (_� � ' 3 SWR BUILDING . Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: �l Crawl Drain O CJ ELR Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PA I FAIL U MBI Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain ower `a 1 Other: Fin - $ FAIL CHA Post & Beam Gas Line nn Smoke Dampers" Fin - • P ART FAIL CTRICAL. Service Rough -In ® g *S\ UG /Slab 6 l Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: Unable to inspect - no access Fire Supply Line - (� ADA' ® C /Z7f ° / / �\ Approach/Sidewalk st® Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL