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Permit CITY TIGARD PLUMBING PERMIT ql DEVELOPMENT SERVICES PERMIT #: PLM2001 -00146 ' I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/10/01 SITE ADDRESS: 11970 SW LINCOLN AVE PARCEL: 2S102AB -01000 SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: R -7 BLOCK: LOT: 065 JURISDICTION: TIG CLASS OF WORK: REP 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: 20 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Repair of approximately 20 feet of sanitary sewer line. FEES Owner: Type By Date Amount Receipt BARBER, RAYMOND C AND PRMT CTR 4/10/01 $72.50 27200100000 NORMA A 5PCT CTR 4/10/01 $5.80 27200100000 11970 SW LINCOLN AVE TIGARD, OR 97223 Total $78.30 Phone 1: Contractor: TRI MOUNTAIN EXCAVATING INC 21605 NE 10TH AVE RIDGEFIELD, WA 98642 REQUIRED INSPECTIONS Phone 1: 360 - 887 -4144 Sewer Inspection Reg #: LIC 146353 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 • . • - opies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issue • By: , / :� . Permittee Signature: A , Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th>, " 13 siness day b 3 7. • Plumbing Permit Application . . •A Date received: ' /ca 6/ Permit no.: Ay2,1}/ - '- rt., - ' - t City J of Tigard ' ∎' ' Tigard Sewer permit no.: Building permit no.: 4 " " 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 Cl New construction )8( Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCIIEDULE (for special inforn ation use checklist) W ��CoL Description Qty. Fee(ea.) Total Job address: (i� 7(� New 1- and 2- family dwellings only: Bldg. no.: I Suite no.: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: (Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: 7 c..4.-d 1 ZIP: q 3 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: /Pi- Al'I PV41 A./ *.... cxG u- ✓'- i-, s Manholes Address: Z160SQ .1 C ve- Rain drain connector City: r • / 1,,/1 I State:vr/- I ZIP: qn `f Z Sanitary sewer (no. lin. ft.) ?7 15,06 Phone360 e ? - liMI Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: 11-/ , LS-) I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: f X, Absorption valve Back flow preventer Print name: J. 4 re., .S 1,... I Date: c9‘ /0 ' 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 Floor drains/floor sinks/hub Name (print): �(/dr.p.- )30.„ -d(fr Garbage disposal Mailing address: / /Gj 20 5..‘./. G/ ti co /0 Hose bibb City: I State: U5 ' I ZIP: Ice maker Phone: $D3 1.0 2�5'� Fax: 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: Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 7.,..,6 Notice: This permit application Plan review (at _ %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 5,51?) Expires TOTAL $ 7$, 36 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00/COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2- family dwellin only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixture in RICE TOTAL Sink 16.60 the dwelling and the first100 Q (ea) AMOUNT Lavatory 16.60 for each utility connection) 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 SUET TAL Urinal 16.60 8% STATE SURC ARGE Dishwasher 16.60 PLAN REVIEW 25% OF SU OTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 6 PLEASE COMPLETE: 3" 16.60 60 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity b/ Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink C- 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 Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixture (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 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 Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL 8% STATE SURCHARGE "PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow 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 • C1TY OF TIGARD BUILDING INSPECTION DIVISION sT 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 4/ t 0/6 I 1 AM PM BLD Location ` l .�.ry C- J N pc•' Suite MEC Contact Person Ph - , i v / 001 ‘ Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain � SGN or r�1 Crawl Drain Inspection Notes: . 2 . ):3 / G! Slab b-449 /`�� _ SIT Post & Beam , Ext Sheath /Shear Int Sheath /Shear Framing Insulation d -. Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final RT FAIL PLU Post & Beam Under Slab Top Out Water S - ice Rain Drai ` - Fi (7 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 PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA /7 Approach /Sidewalk �/ (f i 4/0/6 Ins Other Date Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.