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Permit CITY TIGARD PLUMBING PERMIT Ik DEVELOPMENT SERVICES PERMIT #: PLM2001 -00658 ,..�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/18/01 SITE ADDRESS: 13088 SW ST. JAMES LN PARCEL: 2S109AB -10900 SUBDIVISION: RAVEN RIDGE ZONING: R -7 BLOCK: LOT: 038 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 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: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of back flow preventer. FEES Owner: Type By Date Amount Receipt CHARLES KIM PRMT CTR 12/18/01 $36.25 27200100000 16655 SW IVY GLENN ST. 5PCT CTR 12/18/01 $2.90 27200100000 BEAVERTON, OR 97007 - Total $39.15 Phone 1: 503 - 515 -6011 Contractor: ANCTIL PLUMBING INC 16900 SW MERLO RD BEAVERTON, OR 97008 REQUIRED INSPECTIONS Phone 1: 503 - 642 -7323 RP /Backflow Preventer Final Inspection Reg #: LIC 24184 PLM 26 -162P6 EXPIRED • 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 mort 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 calling (503) 246 -1987. Issued By: ; , ,/�� _ _ Permittee Signature: 2 _ ,/_ Ar.04 Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day BUP - Building Permit ELC - Electrical Permit J Inspection Description Date Passed By J Inspection Description Date Passed By Footing /Setback Underground cover Foundation walls Wall cover Footing drain Ceiling cover Waterproof bsmt walls Electrical rough -in Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing Inspection Description Date Passed By Firewall Low voltage Tilt -up panel Electrical final Masonry/Reinforcement Framing MFG- Structure set -up MEC - Mechanical Permit _ Insulation _ Drywall nailing 4 Inspection Description Date Passed By Post/beam mechanical Suspended ceiling Gas line Engineered soils Mechanical rough -in Welding Lab Final _ Fire damper Concrete Lab Final Duct work Bolting Lab Final Smoke detector Structural observation Mechanical final Fireproofing Lab Final Final inspection PLM - Plumbing Permit BUP — Fire Protection System Permit Inspection Description Date Passed By Plumbing underslab 4 Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP /backflow preventer EXPjrF Fire alarm final Rain drain /i../c 3 Storm drain Water service SIT - Site Permit Sanitary sewer Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final Sprinkler supply lines Sprinkler underfloor /slab Catch basin /Manhole SW R - Sewer Permit Engineered soils 4 Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits is \dsts \ forms \InspRecordBUP.doc 04/17/01 C� � ti CITY TIGARD PLUMBING PERMIT PERMIT #: PLM2001 -00658 . i DEVELOPMENT SERVICES DATE ISSUED: 12/18/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13088 SW ST. JAMES LN PARCEL: 2S109AB -10900 SUBDIVISION: RAVEN RIDGE ZONING: R -7 BLOCK: LOT: 038 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 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: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of back flow preventer. FEES Owner: Type By Date Amount Receipt CHARLES KIM PRMT CTR 12/18/01 $36.25 27200100000 16655 SW IVY GLENN ST. SPOT CTR 12/18/01 $2.90 27200100000 BEAVERTON, OR 97007 Total $39.15 Phone 1: 503 - 515 -6011 Contractor: ANCTIL PLUMBING INC 16900 SW MERLO RD BEAVERTON, OR 97008 REQUIRED INSPECTIONS Phone 1: 503 - 642 -7323 RP /Backflow Preventer Reg #: LIC 24184 Final Inspection PLM 26 -162PB • 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 calling (503) 246 -1987. / Issued By: , 4 ,, ..� ,,_� Apr i ' Permittee Signature: ��I /_/, ar.s4 Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day 4 • Plumbing Permit Application Date received: /a —/g7 / Permit no.: j(i)/ .—.0d �.�,� � i Cit of Tigard RECEIVED PLANNItl .,•� � � ewer 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 DE C 1 2001 Date issued: By: V I Receipt no.: Land use approval: CITY OF TIGAR Casefileno.: Payment type: TYPE OF PERMIT )41 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement 0 New construction Addition/alteration/replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: / 30B 8 S'L( 5 4..1...w„, 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: IBlock: I Subdivision: SFR (2) bath . Project name: R p ( Co ,,� -f e n,,, SFR (3) bath - City /county: �� I ZIP: Each additional bath/kitchen Description and l ation of work on premises: Site utilities: Ir yGf c i,' at — De,, - ,( 4,E ��(�-- Catchbasin/areadrain Est. date of completion/inspection: Drywells/leach line/trench drain - PLU f lI11NG CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: / 4.4..-,, , AI fl / -,,d ' ..b. Manholes - Address: fG file, l'Lt/ /- (,V( Rain drain connector City: I State: al ZIP: 9 7o06 Sanitary sewer (no. lin. ft.) Phone: Fax Fax: G4 Z 7 -mail: Storm sewer (no. lin. ft.) CCB no.: Z6'/ Plumb. bus. reg. no: �2.10i3 Water service (no. lin. ft.) City/metro lie. no.: iq 5 Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer 27 Print name: 4 i /t.,..1.ac, Date: 2--1 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): /3 o .�y -r Garbage disposal Mailing address: /113: /'� , tthe Hose bibb City: ,., State: CA r Ice maker Phone: 52 -1)/ 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 ENG I N Mt R 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 $ r �� Notice: This permit application Plan review (at %) $ 0 Visa 0 MasterCard expires if a permit is not obtained d Credit card number: / / State surcharge (8 %) .... $ 7 ". S Expires within 180 days after it has been TOTAL $ 3 (j 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 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 I Quantity by Work Performed I 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 16.60 Urinal Other Fixtures (Specify) 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 Z? 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 h .2-f • 8% STATE SURCHARGE 2v1v **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL . $3715 * Minimum permit fee Is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $38.25 + 8% state surcharge. ** All New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. is \dsts \forms\plm - fees.doc 08/29/01