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Permit
�rf ; CITY TIGARD PLUMBING PERMIT r, I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00554 l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/10/2004 SITE ADDRESS: 07555 SW HERMOSO WAY PARCEL: 2S101AB -01501 SUBDIVISION: HERMOSO PARK ZONING: MUE BLOCK: LOT: 021 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B 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: 20 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: 3" belly in lateral. Excavate, fix belly backfill & replace. FEES Owner: Description Date Amount JOENS, JOHN D MARJORIE A 7545 SW HERMOSO WAY [PLUMB] Permit Fee 12/10/2004 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 12/10/2004 $5.80 Total $78.30 Phone: Contractor: BROBERG CONSTRUCTION 33362 HILLSCREST DR SCAPPOOSE, OR 97056 REQUIRED INSPECTIONS Phone : 503 Sewer Inspection Final Inspection Reg #: LTC 156098 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: � Permittee Signature: j ,,/- /� /Call , 2 . Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business d r , Plumbing Permit Ap lication FOR OFFICE- USE - - ONLY- -- _ - City Tigard Application, Received D -iy` /�` Permit 1 � �y�lj(�� 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: ��, (/'r ` � Plan Review Phone: 503.639.4171 Fax: 503.598.196 4 'N�i 51) �' Date/By: Other Permit No.: p 6 24- Hour Inspection Line: 503.639.4175 ��C O 2�U4 ' I � W - - Date Ready/By: ,uris El See Page 2 for Internet: www.ci.tigard.or.us of 1 - Supplemental ,y 1� ,,a�:ax 1 le e o � Information :. ' $. 1 . - .x. .e..,, i � I�AP;vV4;.'� ...7 °:�'i^:'c<.;.: " :2x�°r. ^ M .£Y t ... Y.+. ^'2,?'4::4?:;4 T"e}Ti' ,� - --, E F ' ? -,TXP •h � p . , o ` ` z ,; 'tFEE * „.S :GHED - te na a:, '= `�'''+ - =. ` �a- c:�- sc:.z.r ��.-. �sxaa,.. b ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. Ea. Total ❑ Addition/alteration/replacement ® Other: 4 - , t - I ZCp r 4 I r New 1- 2- family dwellings (includes 100 ft. for each utility connection) .; +a «€=- <,cw,�ta.::.a`.u::s'.;.�„u -.fix *ti �^ . A vx ; �;:,�,!; = °s P b , CAT s5,, OE CONST'RU, TIOI� tj t „ » - SFR (1) bath 249.20 . ❑ 1- and 2- family dwelling 2 Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/latchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler sq. ft.) Page 2 T i" ` OB STI'E ika0 T O IM , AM ', ° 4 • . I� ( 4 ) g i ' t - .,u'1TD xia dk6 ON -7Ni a=t Site utilities Job site address: ti s" 5 S C, v✓ J ervv„ Catch basin or area drain 16.60 City/State/ZIP: - 716.,,w D l og q -? 2 Z 3 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: Le� b '2.-"41- Av-e Manholes 16.60 rn" '/O (VIAA"a W Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ZO ) ,91 Page 2 5'5 e -2- Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item ': fi .: = , e , a a. r...; g Absorption valve 16.60 .i . -1'4 . ` � . * 4. , , :p :1 ....SC TI0 1 OF WORK " v i � : - iz�"'ik Backflow preventer Paget 3" 5.1"&i. AAn L A e r ani -dZ , /, j Ajt Backwater valve 16.60 A-1 lam f�R.f, s / Clothes washer 16.60 II Dishwasher 16.60 . 1 l if a Drinking fountain 16.60 • :: . PROPERTt& ©W1YElt x ,; tTttN`4N'T M ... rm.- Ejectors /sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City/State/ZIP: Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 11.1-4" 1 0 4I'I 1[ 4 - a .;�'.,; <. Jy CQNTr �. x £ Hose bib 16.60 ; �; ra r "rw 5,; �E,f' _ �� C1' PERSON � Ice maker 16.60 Business name: r; &r�T GC>i Interceptor /grease trap 16.60 1 Contact name: leO 3 Medical gas (value: $ ) Page 2 Address: -Z'M S 6 (,- / - AV-e- Primer 16.60 City/State/ZIP: / dk , / -- (4 1) 1 Z 3 Roof drain (commercial) 16.60 Sink/basin /lavatory 16.60 Phone: (503) 3Si - ii R9 Fax:: (5o3) 2,5-9 -25-'iO Tub /shower /shower pan 16.60 E-mail: C-e'° - 6 r ,R Urinal 16.60 :', •+ g q . ,- V ry a ; -' ','' ?pair:}:: SY •'i� _ • l .�, :- . , i C T CTORm, xs s 4 : 1 ,4 Water closet 16.60 Business name: Water heater 16.60 Address: Other: / Subtotal 1 City / State/ZIP: Minimum permit fee: $72.50 -7` o '� •Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: j j 6 09.15 Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) f 8 0 '�_ f , " ! Authorized signature: l� ri .�tw TOTAL PERMIT FEE 7- 3 4' Print name: 70,7,,,- g.. pips J Date: (Z -10 - 6 Z-( 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. i \Building\Permits\PLM- PermitApp.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: SYteLtilit><es : g . A�..i .£A Sgu,arelFootage.: . ; Perm><tFee Footing drain - 1S 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 rTof " ";•` .. additional $100:00 or fraction thereof, to and FsixtureorItem t .E,� y ( F: .x . ��. ...� _ �_ . . : ._ °. 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 * . . , ' Quantrt by(Ftxttare) V�ork'- Performed ')(, Stlt2'iC Ty[i0 x y Tait, `- 0 x t tY R .Ia � -, � ° , � aK gtei A ch � ?� d. '. 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 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 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: i \ Building \Permits\PLM- PermitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 p. ul BUP Received ei ed y `�� Date Requested / , r AM PM BUP Location 7 5 5 Suite MEC / Contact Person Ph ( ) 3S - (mg PLM a 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 / F ire Sprinkler � A" Fire Alarm Susp'd Ceiling Roof Other: — Final PASS PART FAIL PLUMBING Post & Beam W Under Slab �` Rough -In Water Service kaliltary ewer ' Rain Drains j Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAI MECHANICAL 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 El Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA / Approach/Sidewalk Dat d / r Inspector �l/ 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 DIVISION Business Line: (503) 639 -4171 MST 6 PM / BUP Received Date /,1 n te Requested A � BUP Location 7 sS 5 7 �-� -'`� Suite MEC Contact Person Ph ( ) PLM 961 6 S•y 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 R Susp'd Ceiling r e- � / Roof Affr / ) Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In F f. Rain • rains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL 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 Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL ;Id.-- L._ CITY TIGARD PLUMBING PERMIT I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00554 ,,,11I . r DATE ISSUED: 12/10/2004 �-! -.. a,, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 07555 SW HERMOSO WAY PARCEL: 2S101AB -01501 SUBDIVISION: HERMOSO PARK �� r r• ZONING: MUE BLOCK: LOT: 021 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B 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: 20 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: 3" belly in lateral. Excavate, fix belly backfill & replace. FEES Owner: • Description Date Amount JOENS, JOHN D MARJORIE A 7545 SW HERMOSO WAY [PLUMB] Permit Fee 12/10/2004 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 12/10/2004 $5.80 Total $78.30 Phone: Contractor: BROBERG CONSTRUCTION 33362 HILLSCREST DR SCAPPOOSE, OR 97056 REQUIRED INSPECTIONS Sewer Inspection Phone : 503 Final Inspection Reg #: LIC 156098 r ifS D‹ 3 8 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 ft! 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: Permittee Signature: yJ . — Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day BUP - Building Permit ELC - Electrical Permit J Inspection Description ; Date Passed By 1 -NI Inspection Description Date Passed By • Footing /Setback Underground cover _ Foundation walls Wall cover Footing drain _ _ Ceiling cover Waterproof bsmt walls - Electrical rough -in _ Slab _ _ Electrical service Crawl drain _ Electrical final Underfloor insulation Post /beam structural _ — -- — Shear walls /anchors ELR - Restricted Ener Permit Roof nailing — — 4 Inspection Description Date Passed By Firewall _ Low voltage Tilt up panel Electrical final Masonry /Reinforcement — Framing MFG Structure set-up MEC - Mechanical Permit Insulation _ _ Drywall nailing Inspection Description Date Passed By Suspended ceiling — Post /beam mechanical Engineered soils Gas line Welding Lab Final Mechanical rough in — — Concrete Lab Final Fire damper Bolting Lab Final _Duct work Structural observation — Smoke detector Fire p roofin Lab Final _ Mechanical final _— • ---- g - -- Final inspection — - PLM - Plumbing Permit _ BUP — Fire Protection System Permit Inspection Description Date Passed By Plumbing underslab _ 4 Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab — Post/beam plumbing Sprinkler rough -in S • rinkler final Plumbing top out • RP /backflow preventer Fire alarm final Rain drain Storm drain _ Water service SIT - Site Permit Sanitary sewer 4 Inspection Description Date Passed By Culvert /catch basin _ Footings Pump /fill' septic tank Foundation walls Plumbing final Sprinkler supply lines — Sprinkler underfloor /slab Catch basin /Manhole SWR - Sewer Permit Engineered soils i Inspection Description Date Passed By Engineering acceptance — Sanitary sewer Final inspection Final inspection Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits • is \dsts \ forms \InspRecordBUP.doc 04/17/01