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Permit tF CITY TIGARD PLUMBING PERMIT PERMIT #: PLM2001 -00276 , ,��; DEVELOPMENT SERVICES DATE ISSUED: 7/9/01 13125 SW H all Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12162 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00200 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of (1) sink. This sink is replacing a sink that had been removed in the past so the plumbing is existing. Apparently no permit had been taken out for the capping. FEES Owner: Type By Date Amount Receipt SAUNDERS, WILLIAM W TRUSTEE PRMT CTR 6/27/01 $72.50 27200100000 2155 KALAKAUA AVE STE 500 SPOT CTR 6/27/01 $5.80 27200100000 HONOLULU, HI 96815 Total $78.30 Pl1one.1, Contractor: MYERS + SONS PLUMBING 6024 SW JEAN RD, BLDG F LAKEOSWEGO, OR 97035 REQUIRED INSPECTIONS Phone 1: 684 -6602 Top -out Insp Reg #: LIC 00040389 Final Inspection PLM 26 -305PB 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 pei=mit 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: ` % 1 j // Permittee Signature Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business ( ) Y P day --it) o -- o . ? 5' 1. Plumbing Permit Application Date received: 6 /» � Permit no.: �/BOG 1t%O -. ,1 , City of Tigard ' `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 PER1'IlT ❑ 1 & 2 family dwelling or accessory f Commercia1industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction Addition/alteration/replacement ❑ Food service 0 Other: JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist) , Job address: /2 /62 SW $Gho Ifs •k-vii Rd, Description Qty. Fee(ea.) Total Bldg. no.: 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: [Block: Subdivision: SFR (2) bath Project name: ,LiO c./;,, UL o rl'oNI SFR (3) bath City /county: I ZIP: Each additional bath/kitchen DI and location of wofk on premises: Site utilities: MS rA/1 Neu 5 is Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUM III NG CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: V q (Rs K SONS IIP /th 4 4 (3/AY Manholes Address: (oa I/ S Je PD. Rh 'y. F- /r]( Rain drain connector City:1-4,t e 40 Su - o I State:ae I ZIP: 7 3 j Sanitary sewer (no. lin. ft.) Phone: 6841 - 660 Z I Fax:fp / -G e.6/ I E -mail: Storm sewer (no. lin. ft.) CCB no.: 4 /0338 9 I Plumb. bus. reg. no: 6 -gas pe Water service (no. lin. ft.) City /metro lic. no.: ,2138 Fixture or item: Contractor's representative signature: A��'�l�, AY, - Absorption valve Back flow preventer Print name: ��rr�>�ia�'''�— Date: (p .2 D Backwater valve • CONTACT PERSON Basins/lavatory Name: ` ,s47/t/e 'vs eove Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank Fixture/sewer cap Floor drains/floor sinks/hub Name (print): Garbage disposal Mailing address: 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 b.' - h ' ; ; 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 $ �� ✓� 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 %) .... $ Expires TOTAL $ ? g - 0 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00/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 16, 6 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 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 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 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 "Th; 5 UN r 1L GIAD A 5 /NK -I f or Grease Traps 16.60 h n Q hgeN ,Appel) /N 4tiQ pAST QUANTITY TOTAL to P //YSi-o /l ed .4 Nf /A1 G/#/K Isometric or riser diagram Is required if /N 411.e 6 0,,,A4 p 1 /140 ell /7 Quantity Total is > 9 nNe h4 eN. PLi/A4 RI Ng 1 S *SUBTOTAL &OM r I 4 • l; ex/ ST>N . f-LANn S /n/K IN /iv RA P 1 8% STATE SURCHARGE Lui051� /S sORF'e iliountren iN f hp ResT2ctm4 **PLAN REVIEW 25% OF SUBTOTAL ' Required only if fixture qty. total is > 9 1.1e�ICrN Z ep /. 1 5 p gv /4e f'U 9 TOTAL $ . 4 ii Is S' /nl /L , * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. i:\dsts \forms\plm- fees.doc 10/10/00 /•sTP 'CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 7- // AM PM BLD Location /Z (c V Sw SG4/"$ 4 ve 7 /Lai Suite MEC Contact Person Ph G� � PLM Zv■/ e'V Z 7 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 Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PAS PART FAIL Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains v y� y - ART FAIL M ICAL 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: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date l / Inspecto L / / L fa V 4 - • E Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.