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Permit CITY OF TIGARD PLUMBING PERMIT . DEVELOPMENT SERVICES PERMIT #: PLM2001 -00451 ,.I II 13125 SW Hall Blv Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/25/01 SITE ADDRESS: 10585 SW MURDOCK ST PARCEL: 2S110AD -02800 SUBDIVISION: LANG HILL ZONING: R -12 BLOCK: LOT: 025 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM 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: 40 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Repair sewer line. FEES Owner: Type By Date Amount Receipt CAGLE, THOMAS E PRMT CTR 9/25/01 $72.50 27200100000 PO BOX 26 5PCT CTR 9/25/01 $5.80 27200100000 TUALATIN, OR 97062 Total $78.30 Phone 1: Contractor: CAMROCK EXCAVATION P.O. BOX 1228 BORING, OR 97009 REQUIRED INSPECTIONS Phone 1: 503 - 558 -9819 Final Inspection Reg #: LIC 141879 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 may obtain copies of these rules or direct questions to OUNC by c. s • (503) 246 -1987. Issued By:. �`iP /�`drAwz - Perm u re. � _ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the news day . A Plumbing Permit Application D ate received: 9/20/ Permit no.: /1y 20Of - AO 5. -4 ' �,, City of Tigard °' �� b Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 972 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT j r 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: /i tS .r>t' /� �(/4? D,&t' S > 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.: SFR (1) bath Lot: IB1ock: I Subdivision: SFR (2) bath Project name: s SFR (3) bath ' City /county: / / E.-l/,) 41,1 I ZIP: Each additional bath/kitchen De on and to ati f worl op mi Site utilities: ,o/ ses: . 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- 1 / ? j //i '� % / J hi./ G Manholes Address: / i , d) k _ Rain drain connector �i City: r q F- ax: �jfa ZIP: ir > d , Sanitary sewer (no. lin. ft.) 4 0 — Phone: � � i r I g 30 E -mail: Storm sewer (no. lin. ft.) � CCB no.: / / 15 7 / I Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: 3 a/0 1---_,,,.., Fixture or item: Absorption valve Contractor's representative signatu Back flow preventer Print name: 1� r IS 15 ate: G° -2 4 / Backwater valve CONTACT PERSON Basins/lavatory Nam , eogr - Fz4 �Ct- - Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone:94 Y ; Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): 2 � y 95 C,¢G Floor drains/floor sinks/hub address: Garbage disposal Mailing 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 ENGINEER 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,,Q ' S 6 Notice: This permit application Plan review (at %) $ 0 Visa 0 MasterCard expires if a permit is not obtained Credit card number. / / State surcharge (8 %) .... $ 5 , PD Expires TOTAL 180 days after it has been TOTAL $ — 2P.30 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 dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE • TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT 16.60 for each utility connection) Lavatory One (1) bath $249.20 Tub or Tub /Shower C omb. 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 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: New Moved Replaced 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 3^ Sewer - each additional 100' 46.40 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 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. is \dsts \forms\plm- fees.doc 10/10/00 'CITY OF TIGARD BUILDING INSPECTION. DIVISION MST. 24-Hour Inspection Line: 639 -4175 Business Line: 639 -4171 , � J BUP i Date Requested g' AM PMA BLD Location co. Mu 'Do C/C V. Suite MEC Contact Person Ph PLM 0 - 0 °V-ri Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear _ Framing - .eca Q.�-- �-- 2 6) e rl e a( Insulation / Q J Drywall Nailing - Firewall Fire Sprinkler Fire Alarm - Susp'd Ceiling Roof Misc: Final P�r_�RT FAIL ./ Po ��=i m Under Slab Top Out Water Service itary Sewe lb. . 1 PART FAIL M ' ANICAL 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date Other ( Inspector A41 Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.