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Permit CITY T I GA RD PLUMBING PERMIT T �, l DEVELOPMENT SERVICES PERMIT #: PLM2005 -00452 � JII 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/13/2005 PARCEL: 25101 AD -00400 SITE ADDRESS: 06655 SW HAMPTON ST 120 ZONING: MUE SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 034 JURISDICTION: TIG Project Description: Plumbing TI. Other fixtures are: (1) primer & (1) ice maker. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS: STORIES: 2 WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft • Owner: FEES NORRIS BEGGS & SIMPSON Description Date Amount 121 SW SUITE 200 PORTLAND, OR 97204 [PLUMB] Permit Fee 9/12/2005 $99.60 [TAX] 8% State Surcharl 9/12/2005 $7.97 Phone : 503 273 - 0320 Total $107.57 Contractor: JAMES ROOD PLUMBING 2459 SE TV HWY PM #168 REQUIRED ITEMS AND REPORTS HILLSBORO, OR 97123 Phone : 503- 648 -3907 Reg #: LIC 57355 PLM 34 -199PB 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 w i i 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requir = you to follow les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 0001 -0010 through o; - 9 -- 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by ca ing 503 - 246 -6699 or; 00 -2344. Is • ued By: � / i Permittee Signature: Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Fixtures ' ' _ - FOR.OFEICE USE_ONLY- �. � ,. __ .._ Plumbing Permit Application R ecervea /� Plumbing DateB 1 log Permit No.. / io. a I ' City of Tigard �jO i 3 Planning Approval Date/By: nnng Sewer Permit No . 11.t7 - 0 0 ASJ 13 125 SW Hall Blvd. j � �� �/ Plan Review Other Tigard, Oregon 97223 �'° Date /By: Permit No.: �Pc5 Post - Review Land Use , Phone: 503 639-4 171 Fax: � S =(�P9 / di� y Date/By: Case No.: Internet: www.ci.tigard.or.us Pe{ ® �, e .� 1� , Contact Ju ® See Page 2 for 24 - hour Inspection Request: 5C 10114 �∎`._� Name /Method: ((Up ‹.., Supplemental Information. 10 1 1-o 1NG :. TYPE OF =WORK. FEE* SCHEDULE •(for's"pecial�information.use checklist) ❑ New construction ❑ Demolition Description Qty. Fee(ea.) Total ❑ =New �1 &;2;fainilyM • Addition/alteration / replacement Other: a... ,.''',::,:4::4: i ;' i e l s 100 ft 'for eaciitu'tiiity'co nectio'lly,:- -• .. • - ' CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1 & 2- Family dwelling © Commercial /Industrial SFR (2) bath 350.00 Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 .JOB SITE - INFORMATION and LOCATION Fire . sprinkler - sq. ft.: Page 2 �,;. ... : , • Job site address: 66 S.W N te+, 5`a`.. .. . .„. ]: ;`Site�Utilities � '.�_��,,. , . Suite #: 1 D Catch basin/area drain 16.60 Bldg./Apt.#: 6� / � Drywell /leach line /trench drain 16.60 Project Name: An' &Y I 1 F l)/ t`'-W r pkva. Ct C.- Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 - 7 kri ave. Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 St sewer (no. linear ft.) Page 2 Subdivision: Lot #: Water service (no. linear ft.) Page 2 Tax map /parcel #: p l ei ii.. DU _ A D � . - , , '��� � '�`�� �' '. .�. . , '�= ?,�'... r�' i`.�. � - '��aFztii "re'�,tir,'Ifem� :�,..,, 1�: 4 ° r.:�•_ ,:. • • . DESCRIPTIONTOF.WORK . Absorption valve 16.60 - __ Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 - Dishwasher 16.60 Drinking fountain 16.60 PROP RTY OWNER kg' TENANT ,' Ejectors /sump 16.60 a me: i e /2 , /�I A �j - °' //4/" /v Expansion tank 16.60 Addre � : /�/ pc) I /D ,, W 0�o Fixture /sewer cap 16.60 /� Floor drain floor sink/hub A � I 16.60 City /State /Zip: �!� �i2 $ Garbage disposal 16.60 16.60 Fax: H ose bib Phone: ' iAPPLICANT.' ` : °'1 ` ' LI CONTACTrPERSON =` ° ° =`` Ice maker i 16.60 Name: Interceptor /grease trap 16.60 Medical gas - value: $ Page 2 Address: -- Primer / 16.60 City /State /Zip: ' -.. drain (commercial) 16.60 Phone: Fax: Sin /.asin/lavatory a, 16.60 E-mail: . ub/shower/shower -mail: ub /shower /shower pan 16.60 °:. ,.,� '- -:= , . ,'.CON ;TRACTOR.,e, '. -: ,, , _ Urinal 16.60 ' Water closet 16.60 , � Business Name: omeS . t,d i* /,, Ia Water heater 16.60 Address:a SE TV fill)' PNB # /‘P Other: City /State /Zi • : Other: • 4 ,, >a 4.A.; ::.;44 lPluQibiiiii ermitmFees,,, tt:; ;x.,,,, : „x,n.., Phone: �u) - gyp- 3� o7 Fax: sp3� / ��1 g� Subtota $ CCB Lie. #:571 5 Plumb. Lic. #: 49 p'6 Minimum Permit Fee $72.50 $ ) /-0 Authorized / G+ / Residential Backflow Minimum Fee $36.25 -- (( Signature: `l 4+ -...i/ 4 Date: ! R6 ) Plan Review (25% of Permit Fee) $ 'r'� �� .6 State Surcharge (8% of Permit Fee) $ I, ei 7 ' ` (Please pnnt name) TOTAL PERMIT FEE - $ () ?, 57 Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans wit isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: • Sife'U(ilities. Qty.. Fee.(ea) Total Square Footage: Permit Fee: Footing drain - I' 100' 55.00 0 to 2,000 $115.00 g drain - each additional 100' 46.40 2,001 to 3,600 $160.00 Footing 3,601 to 7,200 $220.00 1 Sewer - 1st 100' 55.00 7,201 and greater $309 00 Sewet - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - I st 100' 55 00 SI 00 to $5,000 00 Minimum fee 572.50 1 Storm & Rain Drain - each additional 100' 46 40 $5,001 00 to 510,000 00 $72 50 for the first $5,000.00 and 51 52 for each additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ca) Total including $10,000 00 Commercial Back Flow Prevention Device 46 40 $10,001 00 to S25,000 00 $148.50 for the first 510,000 00 and SI 54 fin Residential 13ackflow Prevention Device each additional $100 00 or fraction thereof. to (minimum permit fee $30.25) 27.55 and including $25,000 00. Rain Drain, single family dwelling 65 25 525,001,00 to 550,000 00 8379 50 for the first 525,000.00 and SI 45 For each additional $100.00 of fraction thereof, to Inspection of existing plumbing or and including $50,000 00. specially requested inspections -per hour 72.50 559,001.00 and up $742.00 for the first 550,000 00 and 51 20 lot Subtotal: each additional $100.00 or hi action thereof ,Y} 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 *. Quantity by (Fixture)'Work Performed Comments regarding fixture work: Fixture Type: 'Replace New Moved • Existing Capped Baptistry /Font - 13ath -Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commer - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" - 3" - 4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic increase of sewer EDUs, a sewer permit will be issued and Disposal - Commercial - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains I plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i• \Dsts \Permit Forn s \PImPermitAppPg2.doc 01/03 CITY OF TIGARD BUILDING DIVISION ' ± , ._ ., PERMIT #: PLM2005 -00452 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/13/2005 Phone: (503) 639 -4171 . m � i k Inspection Requests (24 Hrs.): (503) 639 -4175 .. .. INSPECTION WORKSHEET FOR DATE: 10 /3/2005 TIME: 7:07AM PAGE: 50 SITE ADDRESS: 06655 SW HAMPTON ST 120 CLASS OF WORK: SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 034 TYPE OF USE: PROJECT NAME: MARSHALL FAMILY CHIROPRATIC DESCRIPTION: Plumbing TI. Other fixtures are: (1) primer & (1) ice maker. OWNER: NORRIS BEGGS & SIMPSON, PHONE #: 503- 273 -0320 CONTRACTOR: JAMES ROOD PLUMBING PHONE #: 503 -648 -3907 Inspection Request Scheduled For: Date: 10/3/2005 Pour Time Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 017221 -01 503. 939 -4189 N Corrections /Comments/ Instructions: 0 47A -Z--- / 1/1'/7---" .q r PASS ❑ PARTIAL APPROVAL ❑ CANCEL - NO ACCESS ❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: i Date: , ; • Phone #: (503) 718-