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Permit CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2002 -00043 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/13/02 SITE ADDRESS: 13599 SW PACIFIC HWY • PARCEL: 2S102CC -00700 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: UNK 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: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: Remarks: Installation of RP device. • FEES Owner: Type By Date Amount Receipt GANG, THEODORE H + HELEN E PRMT CTR 2/13/02 $72.50 27200200000 8914 NW LAKESHORE AVE 5PCT CTR 2/13/02 $5.80 27200200000 VANCOUVER, WA 98665 Total $78.30 Phone 1: Contractor: HANNAN'S 19685 NE CALKINS LN NEWBERG, OR 97132 REQUIRED INSPECTIONS Phone 1: 503 - 538 -2994 RP /Backflow Preventer Final Inspection Reg #: PLM 36 -88PB LIC 136542 • 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. Yo - . :: -'n copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Is ued By: I • � ti • • Permittee Signature: , �,�� W. l all ) 639 -4175 by 7:00 P.M. for an inspection needed the next ..le'ness day r a , de Plumbing Permit Application Datereceived: / /On Permit no.: e - 513 -.0, , � ;, City of Tigard and ,' 1. `J 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 O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement O New construction 0 Addition/alteration /replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE S(:11EDULE (for special information use checklist) Job address: 4 1 Su) PCtC.t' L Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: C New 1- and 2- family dwellings only: J (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: T G rd I ( g 1P: 9-2 2,'Z, Each additional bath/kitchen D�s i d 1 on o y/ ogpremtses: Site utilities: f Catch basin/area drain Z �� Drywells/leach line trench drain Est. date of completion/inspection: Footing drain (no. lin. ft.) PLUMBING CONTRACTOR Manufactured home utilities Business name: I a ! `e1UII / / / -, . Manholes Address: A , , N , - , p . Rain drain connector City: /,, v State: ° ZIP: / - /6 Zd Sanitary sewer (no. lin. ft.) Phone:. o j '�j j zgzi; ' '0/ / E- mail: --- Storm sewer (no. lin. ft.) CCB no.: J , , 4 Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: i( Fixture or item: Contractor's representative signature: �� U J �i`Z/' Absorption valve (� Back flow preventer Print name: 1 A g / nn Date: -( - d Z Backwater valve • CONTACT PERSON Basins/lavatory Name: 41 11M111111, / LA Clothes washer Address u oriallvrringffi Dishwasher Drinking fountain(s) City: i Iffiz• r State: Q ZIP: 1 I ' Ejectors/sump Phone: 5 g . Q 1a Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Name (print):` CpJC� Floor drains/floor sinks/hub age Mailing address: f' j ` ) - c , y9 �}e C) Ho a bibb isposal City: fi - ^ , f 0 2,3 6 I State: OK I ZIP: 2 _ Ice maker Phone: $c} 3t321 Fax:( $ �E -mail: Interceptor /grease trap Ownerstallation /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 r� _ credit n Notice: This permit application Not all jurisdictions a:cept edit cards, please call jurisdiction for mom information. Minimum fee $ . , review (at _ %) $ Cl Visa 0 MasterCard expires if a permit is not obtained Plan rev Credit card number: / / State surcharge (8%) .... $ .' 0 Expires within 180 days after it has been TOTAL $ 7S? • 3e Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6100/COM) .r 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 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 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 3" 16.60 - PLEASE COMPLETE: 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 Other Fixtures (Specify) 16.60 Urinal 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 Water Service - each additional 200' 46.40 Other Fixtures ( Speafy) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 1/, go • Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 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. ** Ali New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. • I:\dsts\forms\plm- fees.doc 12/26/01 ,.CITY OF TIGARD 24 -Hour BUILDING ' Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business, Line: (503) 639 -4171 MST BUP Received Date Requested ? g AM PM BUP Location 1 3.C � , Suite �-� MEC Contact Person �� Ph ( ) .3 g ? PLM 2-667, Oodd /3 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing f 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 Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Other: / in , SS PART FAIL MECHANICAL , ./ E — 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 Dat ' Inspector � � � ' Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL