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Permit 'A •" C ITY OF TIGARD PLUMBING PERMIT I'll DEVELOPMENT SERVICES DATE ESSUED: 2/1/2005 04 -00271 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12630 SW GRANT AVE PARCEL: 2S102BD 00800 SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R -12 BLOCK: LOT: 009 JURISDICTION: TIG CLASS OF WORK: ACS GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 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: 197 ft WATER CLOSETS: WATER LINE: 73 ft DISHWASHERS: RAIN DRAIN: 70 ft Remarks: Site utilities for 1000 sq ft storage shed FEES . Owner: Description Date Amount ROMAN CATHOLIC ARCHBISHOP OF PORTLAND IN OREGON [PLUMB] Permit Fee 2/1/2005 $211.40 2838 E BURNSIDE [TAX] 8% State Surcharl 2/1/2005 $16.92 PORTLAND, OR 97214 [PLMPLN] Plan Review 2/1/2005 $52.85 Phone : Total $281.17 Contractor: THE EXCAVATORS LLC PO BOX 690 YAMHILL, OR 97148 REQUIRED INSPECTIONS Phone : 503 Sewer Inspection Water Service Insp Reg #: L1C 152333 Storm Drain Insp Rain Drain Insp 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: ��j Permittee Signature: ' /, I Call (503) 639 -4175 by 7:00 P.M. for an inspection need next business day Site Utilities s ', Plumbffig Permit Application FOR OFFICE USE 'ONLY ' City f Tigard ( t" Received Permit No . Y g and � � ED Date/By: ., �A �� A7 13125 SW Hall Blvd., Tigard, M9,722� n �N LJ Plan Review y Phone: 503.639.4171 Fax 503.5989 960 // if ' ' I i Date /By: ( l' " p Other Permit No Ada 24- Hour Inspection Line: 503.639.4175 i r fU E!'.11+ , Date Rea. Jur,s m See Page 2 for Internet. www.ci.ttgard.or us �J Noti fied/ Method ...I Supplemental Information ,� »� ,,, �., .ice- ti-a. :�,. ,,P,' ;,y.! ",i.; i' .ilttdn - 97',: - ret�= " :., ,, �.� -., " vk »p •'S' • "t� ;,;, ; +. F % «: 6 ,,,( = +'' @k r x i& „ -a,. i, t t �,., ` - '.4 „ * „`;=') ,`, r." ^, -; t &,,y, 3 . ,-- Lv e,:. FEE,.,,SCHED.ULE'-,` i a.�t'� a , £,s: '; TY)'E'�.OF, . WO1t = ,.k'�' .'�.- ;,..;, s ,r r� ;�. � ,H - „t ':,,. t , >- ,?!,; <, aY'��. ;i'�": `,-! r�a °- , - t ' ' i'- .Sia;s.• . f` =."k',., � �� : � &' :,ac.:� , a:n rd „ .�.,�„ °' `., .,., „ -'I "c, . ..... +�ffi.� w, .- . R,,:.w. ,�.�- , � , , s<_^";. i-'','.. w-,..,., �a,. t,. xir ku+,, t�t� "'ffi,rw."a�„lausr. , »s.. � .: I De t ecial in d.i r� For s p information use checklist. NZ New construction RI iI LUNG �fI1lmoht ion Description 1 Qty 1 Ea 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (mcludes 100 ft. for each utility connection) \ , !`M -11� � ifT,P1'° "- ° :',,;,, ::m'i ' ; ?" I.A` dv :.. i ^w5,r �-t ,`k, >,P,.;� •.�.. :. =�i - 'Ja t ' >'t-,` -% i d =,, ,;',N, ;," t`; ' ' ^ ATE GO RI `OE " ` „ .1 . ., : ` '," + . SFR (1) bath 249.20 1 �i� �a.l e: r: r�$:IarJ „ ,r �' c�rnr+ t., �r, r. cs� •�,r= z. „_,��+e��.� =�.k ���w �;, 4. � � I _. - , - ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 il, --------- Accessory building ❑ Multi- family SFR (3) bath 399 00 Each additional bath /kitchen 45.00 ❑ Master builder ❑ Other. Fire sprinkler ( sq. ft.) Page 2 a r -'� ;w , s'� . a.= ��;; . .rep= .4sux^i > - - » „ raz6: >„ , r,z�,,. C, ; . , ta u., ^ �.. 1 3 ` ,- t.;'' a' fr dOB STCE ^ INFO LO'CATION,`>y. =° ; i. _ ,' � t „ -= ,, ; ,d(? .,a.. � S�i. c-wz'•�? „i se.a.,0 . ,..n ,„,,,,,,,.:,^:. s,.,x ,x ;,, 2,,.., - t' 'I'7:+.✓ , 1, r;" - Site utilities Job site address: I 'Z.co 3c;) S\"/ 2^a f".1.1 Avg Catch basin or area drain 16 60 City/State /ZIP: -'r-1 0 4 0..P ,, CD d2., °) "? 22`3) Drywell, leach line, or trench drain 16 60 �- Suite/bldg /apt. no.: Project name ANT . Rsq Q p�, � 3 wt. Footing dram (no linear ft ) Page 2 C Manufactured home utilities 110.00 Cross street/directions to job site: "5,,e C, e tog mot" @ :rf s^t iot Manholes 16 60 N,r./ S \\( CO Ic- r:etie_...ti5,...C1 Rain dram connector 16.60 Sanitary sewer (no. linear ft.: Page 2 N Storm sewer (no. linear ft :"70 Page 2 `N Water service (no linear ft.: 11)) Page 2 Lot no.: Subdivision: 'SO* - Fixture or item Tax map /parcel no.: 2 5 i 1 .72'3 p Absorption valve 16 60 ra==y � < ,�� -,� - <��., <r:c3a:�., �.;«��=�: -�:^,. ' ,�, :.:��,,."i ' "`'r" � ' "fr, _ - M , T,'V,,` .` I "" ' aDESCRIPTION-'OF= °.W,ORK; , -,' _, , ,s , =. „��.•.��.�a'�., , . „_ _ + � .., ,_��; .~F)'�z� _� .,�, � .:ads o �� �� >�,.. ���� �' =. �m ` •r Backflow Page Co N1 S. ri? -t tC4' ( OD© Sf Sttp42-02s . :.I-47L Backwater valve 16.60 Clothes washer 16.60 . Dishwasher 16 60 _ r, 5. a. 5 ,.f p.r,: ; . :! `. {= !) 'r, i .. TENAI ti ` :: Dnnking fountain 16.60 fi a .PROPER'. '::' , WNE . I i F ' 3 ❑ ,.° e, '�:� '� ��. � R _ .. mow..__ ._,.� ":�r<.,.��K. =,k w - E�. ��Ya,� :.���,. . �,, �� 1.� El ectors /sump 16.60 Name :p it<Orit 0i(.,aC f ` tzc13RtC.H0R a F� �'4^ Expansion tank 16.60 Address: -2,62,3,52, t 124 t , � Fixture /sewer cap 16 60 City/State /ZIP: l 0 iz-rt,_,, r,t,D 1 Q p 724 q_. Floor drain /floor sink/hub 16 60 Phone: (5 4:r") (o3 - 4 Fax: (+503) X2.4 - 23 rD - Garbage disposal 16.60 �, _ � �; • „- � V'S' , ' ' .�fi, � bPLI:CANT:a' r,l' :; ?' CON3TACT P} SOPi ,,,ax,.:;,N, Hose bib 16 60 " Ice maker 16 60 Business name: ' r �� -3, yy f pl?.IS.I'i Interceptor /grease trap 16.60 Contact name: dam' 's 1. 503-6s9 -- ` c4D Medical gas (value: $ ) Page 2 Address: ( 3 2; 3 S \\/ Scan-7513424 . ,P Primer 16 60 City/State /ZIP: ��p QD tD 0)2,2_2_3 Koof dram (commercial) l6 60 (S 3) (.03� - 1-1 Z 9 Sink/basin/lavatory 16.60 Phone: o Fax: : (5 ®3) ��¢ -�5( Tub /shower /shower pan 16.60 E -mail: Unnal 16 60 ': =a r :' z: :; z: �,":t- ' ..?`.' ;,x', y �k v :'a -�; ., �` " '. . S . 's .t -; . ,' . , " , r 'i , . -.. ,:,'":74-' "* '. - 4 '44 r :, „tz; 7 ' ',, ' .,,CONTRCTOR ',', t'`,:;5„,, `. l s j' ... Water closet 16 60 - .aw+ . ,s « " t�,.,, m,;:.r, , r.,. ":... , „ r ,:, , ,,.t.:, :, fix: , ,, Business naineTt3 b ' ; '�� A�c; ® , r i (K_ Water heater 16 60 Address: -R O -7 Q� 4 ci 6 Other: City/State/ZIP: (/ Subtotal ty /State /ZIP: �/ � _� \' � / Minimum permit fee: $72.50 (3 ( Phone: (� ) f [�'�' j ;�'y'1 Fax: ( ) Residential backflow minimum permit fee: $36.25 ,11.40 z ? .4601/z Plan review (25% of permit fee) 5. 4 ,5l CCB Lic.: f5233 � ? /z 04 Plumbing Lic. no.: ( � r � � State surcharge (8% of permit` ee) /k).6(-- Authorized signature: TOTAL PERMITFEE Print name: � �e.rzr- Q Date. 6, /7( ( : ) ,:f_ This permit application expires if a permit is not obtaineo within 180 days after it has been accepted as complete. ' *Fee methodology set by Tn County Building Industry Service Board t \Bwlding\PermnsWPLMU PermiApp doc 12/03 440- 4616T(10/02 /COM/WEB) ■1 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: • Residential Fire Suppression Systems: �.,� ,,,�;.�, ' -r' . ° .` €'' ; ,",iiyg; s .i ,���� 'r ��rc� =viC' , � � ,.c�- �. �� " "�°!: ` 4- kSfR•;. :' 'rt ° "'' �, n ; ,., 4 .w r y Qt'y, „:” x ee (ea).>>: .',Total; .,; l �,,r • " ='Per .It Fee: �S><te,Ut>lites;,�,rr :'��' �;:�: , '" �y'�'���; ,.:� : � .� t � ..� �� um��, , , ���� �,, x:� F� . �_, . =5' , ,. ��_�� ��' ,x . r, - ><i!?., .. ,�� -" 4/4 Footing drain - l 100' 55.00 0 to 2,000 $115,00 Footing dram - each additional 100' 46 40 2,001 to 3,600 $160,00 3,601 to 7,200 $220.00 15-71 Sewer - 1st 100' 55.00 5,77,-,o0 7,201 and greater $309 00 Sewer - each additional 100' 46 40 c-60 73 1 Water Service - 1st 100' 55.00 55 00 Medical Gas Systems: Water Service - each additional 100' _ 46.40 , �r� at �..�r.���; s'��_ � ;� , � _� � >"Valu><on " ., P Fee Storm & Rain Drain - 1st 100' 55.00 5500 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Dram - 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 F r , k ,,•, ;ys „ „, :r; additional $100 00 or fraction thereof, to and axtu're gr;;IteIAX ;t " ' F br '': Qry. ,Fee -(ea : rotai , r �s���ti- ���� _���> � =�.n<�,� €� _ =�, �aa�, 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 Dram, 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 y� $50,001 00 and up $742.00 for the first $50,000 00 and 51.20 for Subtotal: 1.40 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 * . : "''',W otif ;'4 4 1,501: ,;£. Quantity,by.(Future) \3 ork Performed','; f -�".. ; eft ' s n 1 Re Tice ii Fixture-gTyPe , i ; 1 .K , < P H , , `' ' t. Comments regarding , fixture work: i``�y'"'��w:^��`r:�� 5 s�'�"?R.� , � : ° � Moved -.� �Ezistin �;i =.:,Qapped� . Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru • - Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Dnnking 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 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 ( • Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service — Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet 1 Plan review is required if fixture quantity total is >9. , Unnal Other Fixtures: i \Building\Permns\PLM- PermltApp doc 3/03 • CITY OF TIGARD . . . - BUILDING DIVISION PERMIT #: PLM2004 -00271 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1/2005 Phone: (503) 639 -4171 — �A'� u��n "NI�iNV Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 86 SITE ADDRESS: 12630 SW GRANT AVE CLASS OF WORK: SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 009 TYPE OF USE: PROJECT NAME: ST ANTHONY DESCRIPTION: Site utilities for 1000 sq ft storage shed OWNER: ROMAN CATHOLIC ARCHBISHOP OF, PHONE #: • CONTRACTOR: THE EXCAVATORS LLC PHONE #: 503 Inspection Request Scheduled For: Date: 4/19/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 004788 -01 503 - 639.4171 N Corrections /Comments/ Instructions: • / l . _ Y PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED J )271- Inspector: Date: - Phone #: (503) 718-