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Permit y CITY OF TIGARD PLUMBING PERMIT "" � �' +'' Iek DEVELOPMENT SERVICES • PERMIT #: PLM2001 -00034 � - - - c - 1 + 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/2/01 SITE ADDRESS: 12287 SW LANSDOWNE LN PARCEL: 2S103BC -08100 SUBDIVISION: MLP1999 -00005 MOSES PP2000 -077 ZONING: R -4.5 . BLOCK: LOT: 001 JURISDICTION: TIG CLASS OF WORK: NEW 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: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 268 ft WATER CLOSETS: WATER LINE: ft • DISHWASHERS: RAIN DRAIN: 109 ft Remarks: Installation of 268' of sanitary line to include two laterals and 109' of storm drain lines. FEES Owner: Type By Date Amount Receipt JAY MOSES PRMT CTR 2/2/01 $342.00 27200100000 12287 SW OWNS 5PCT CTR 2/2/01 $27.36 27200100000 TIGARD, OR R 9722 97223 INSP CTR 2/2/01 $62.50 27200100000 Phone 1: Total $431.86 Contractor: BRIAN CLOPTON EXCAVATING INC PO BOX 509 REQUIRED INSPECTIONS Phone 1: 503-682-0420 Sewer Inspection Reg #: Storm Drain Insp Final Inspection • This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You m retain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issue B 6 � / Permittee Signature: � �� 1 � �" / ifr ---- Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • Plumbing Permit Application Date received: Permit no.: `ltt �]., .p6U3e f - s� City of Ti P : ,, All `J Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist) Job address: rate 5u) LA.Nt,D6i)DWAA$ Ly410 E Description Qty. Fee (ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: o 9,0 SFR (1) bath Lot: IBlock: I Subdivision: SFR (2) bath . Project name: m®s.� e fil l- T1 pt SFR (3) bath City/county rin Spip_i) W¢ jl . I ZIP: Cj -rag , Each additional bath/kitchen Description and location of work on premises: Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: F3 i 2 u lA,0 C.LD Pi pArAvA'Y1 NCs Manholes Address: P_ v i gpx 1) 5 Rain drain connector City: L2114- r.»a /1 _ State:©FkI ZIP: Gm on) Sanitary sewer (no. lin. ft.) abf) /5/7,frt Phone: ( $a: (,yam I Fax: , 31 O E -mail: Storm sewer (no. lin. ft.) 104+ /o •4'i CCB no.: 033 Plumb. bus. reg. no: Water service (no. lin. ft.) City metro lic. no.: if, ! a4.g Fixture or item: m (� Contractor's representative signature: �� eC i ! Absorption valve ♦ Back flow preventer Print name: jJ S c CID kilo Dar': � O) Backwater valve CONTACT PERSON Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank . OWNER Fixture /sewer cap Name (print): f 7 '-( t g 5 Floor drains/floor sinks/hub Mailing address: 5l - I� yq 2, O Garbage disposal Hose bibb City: I State: I ZIP: Ice maker Phone: I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump • Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: akAgip„ (OA - Phone: I Fax: I E -mail: Total Minimum fee $ c8(7/ ao Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application ❑Visa ❑ MasterCard Plan review (at _ %) $ - -expires if a_permit is obtained Credit card number: / / State surcharge (8 %) .... $ c i 3(o - - Expires within 180 days after it has been TOTAL $ ,q49 • 3' Name of card as shown on cre card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00 /COM) PLUMBING PERMIT FEES: _. `=.: .r, - A -. '- ° _ _ : :iPRICEi` °ATOTAL. !New4.1�'and�2 '=family "dwellings:orily:sr' !'- .4 5 - ;t,,-' '` " ° OUNT. inclu "ail" lumb fixtures •-- Wi PRICES TOTAL _ - :'FIXTUREG .' . � �_; ` - ��_ - _,_ ; .�.QN,.n °� �'(ea)_,. AM � . , +( �. p `�`�° Sink 16.60 ',the dw 4 and the firsN00 c ,,: QTY' - ''= -(ea) : : ' AMOUNTr' ' a if'dachiutilityA ririectwn); ',., ar'ct' , Lavatory 16.60 One (1) bath $249.20 • Tub or Tub /Shower Comb. . 16.60 Two (2) bath _ $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL . •. ,. . Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL . Garbage Disposal 16.60 TOTAL e . Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 • " ' ` ';'° `: ; ' Quantity by'Work Performed.= ,. Gas piping requires a separate mechanical ° Fixture Type:F;°s ' ; : t New., '.'Moved k';Replaced >a Removed/ permit. = Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' / 55.00 650 d • 3 ,. Sewer - each additional 100' A 46.40 9 4" Water Service - 1st 100' 55.00 Water Heater Other Fixtures Water Service - each additional 200' 46.40 (Specify) Storm & Rain Drain - 1st 100' / 55.00 c ,6C) Storm & Rain Drain - each additional 100' 46.40 .,P ,.v Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device" 27.55 ` Catch Basin • 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling • 65.25 Grease Traps 16.60 QUANTITY TOTAL " = r.:v `' Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL ` , * e l act 8% STATE SURCHARGE ,''3 q; ' w- °,' @r: ' :: 'nom **PLAN REVIEW 25% OF SUBTOTAL '� Required only if fixture qty. total is > 9 _ a r - r , a7 .-..y TOTAL ', , $3 eie,q / * Minimum permit fee is $72.50 + 8 %.state surcharge, except Residential Backflow l ff �� Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. i:\dsts \forms\plm- fees.doc 10/10/00 .:CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 2 —I I AM PM BLD Location z Z �7 S w 4415 L-✓\ Suite ME Contact Person Ph 7,3 6 30 L 200 / —oo 3 C( Contractor Ph SWR BUILDING ,a Tenant/Owner ELC Retaining Wall ELR Footing • Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: � / SP SG N Slab r3 Post & Beam Ext Sheath/Shear O / �c.yl� � ��"1� — 0000S Int Sheath /Shear �� i, Framing . G Insulation . Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING :`; m rov .r Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains e Final PASS PART FAIL MECHANICAL;`•; Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL',',4 MF Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE ` Sackfill /Grading Sanitary Sewer orm Drain /61 [ ] Reinspection fee of $ required before next inspection. Pay at City Hall; 13125 SW Hall Blvd Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk "Z Other Date �� ( Inspector Ext7 Final i ?Pff . PART FAIL DO NOT REMOVE this inspection record from the job site.