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Permit � , CITY OF TIGARD PLUMBING PERMIT r, DEVELOPMENT SERVICES PERMIT #: PLM2001 -00329 1` '�I �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/1/01 SITE ADDRESS: 10638 SW RIVER DR PARCEL: 2S115AD -06700 SUBDIVISION: DOVER LANDING ZONING: R-4.5 BLOCK: LOT: 050 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: ft WATER CLOSETS: WATER LINE: 50 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace approximately 50 feet of water service. FEES • Owner: Type By Date Amount Receipt COXE, GLENN KEELER TR PRMT CTR 8/1/01 $72.50 27200100000 921 BAYBERRY CT SPOT CTR 8/1/01 $5.80 27200100000 SEBASTOPOL, CA 95472 Total $78.30 Phone 1: Contractor: M.J.'S PLUMBING 1045 NE 79TH PORTLAND, OR 97213 REQUIRED INSPECTIONS Water Service Insp Phone 1: Reg #: LIC 36338 Final Inspection PLM 26 -592PB 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 • copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Is ed By: , „ _ , /u■ Permittee Signature: ,,/ `/ / Call (503) 63* -4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application Date received: g /'/i / Permit no.: L� / —er) C) - City of Tigard ' "- ' g y •� 1 ` •t Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 972 City of Tigard Phone: (503) 639 -4171 Projecdappl. no.: Expire date: Fax: (503) 598 -1960 4 Date issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT I & 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 information use checklist) Job address: O 6 3 2 I / v e- n Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: Tax map /tax lot/account no.: ( SF`R (1) 100 ft. for each utility rnnnection) Lot: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: I ZIP: Each additional bath/kitchen Description and location of work on premises:. Site utilities: Catch basin/area drain Drywells/leach line/trench drain Est. date of completion/inspection: Footing drain (no. lin. ft.) PLUMBING CONTRACTOR Manufactured home utilities Business name: t T S " cJ 447 . , ..- ? Manholes Address: /0 c' S � (, ) E 7 Rain drain connector City: � / -Q ¶State. I ZIP: -- z = 2 f 3 Sanitary sewer (no. lin. ft.) Phone: � C, (. g f 5 S I Fax S '5 I E -mail: Storm sewer (no. lin. ft.) CCB no.: __1d33 g I Plumb. bus. reg. no: o 2t s yz As _ Water service (no. lin. ft.) 5_0!,,50' 50' City/metro lic. no.: Li :7 9 /p Fixture or item: Contractor's representative signature: 1 Absorption valve Back flow preventer Print name: r k - .G Date: r- — 2 .1 Backwater valve CONTACT PERSON Basins/lavatory Clothes washer Name: ifs tie?,.. ''' vl� Dishwasher Address: Drinking fountain(s) City: ! e/ # 793 -.No' I State: . I ZIP: Ejectors/sump Phone: /o / -C9 /5 Fax: E -mail: Expansion tank Fixture/sewer cap _ Floor drains/floor sinks/hub �g Name (print): Y..� /.g -Lo'---- te�• Garbage disposal Mailing address: psf 4fAX aQ Z _Hose bibb City: G¢/(' ,4 ' Os c O�p I Stag I ZIP: , 7$ 7 _ Ice maker Phone:65 9f{7k 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 $ O` , �C J Notice: This permit application Plan review (at _ %) $ ❑ Visa Cl MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ *g7k45 Expires accepted as complete. TOTAL $ • Name of cardholder as shown on credit card $ Cardholder signature Amount 440-4616 (6r00/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 Lavatory 16.60 for each utility connection) 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: 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 Water Service - each additional 200' 46.40 Other Fixtures (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 CITY O? TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP c� Date Requested !� -- (40 AM PM BLD Location /6 3O R?4:0-Q-4 Suite MEC Contact Person Ph 7 9'3 - a9 5 PLM vg07>/ 6 3 Z` Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Note :��� - i , Slab ' SIT Post & Beam Ext Sheath /Shear p , � cyo Int Sheath /Shear J / Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Vier Service Sanitary Sewer Rain Drains F \1 PART FAIL 44110 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 [ I 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: I ] Unable to inspect - no access ADA Approach /Sidewalk c Other Date (� 1 Inspector f E:3 l Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .' CITY OF TIGARD BUILDING INSPECTION DIVISION - 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested AM PM BLD Location /0 (O' B 5 C✓. �Jv-- ' 7 Suite MEC Contact Person Ph PLM _900 / Oo 3 2 9 Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation �, FPS Ftg Drain ' 4 4j is ' /o? — SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm CAZI . Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out (Wate� Sanitary Sewer Rain Drains 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 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 Approach /Sidewalk - d Other Date Inspector 71 1 ��// - e Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.