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Permit T� 1 CITY TIGARD PLUMBING PERMIT I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00172 . A,� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/19/04 SITE ADDRESS: 16150 SW UPPER BOONES FERRYRD PARCEL: 2S113AB -00600 SUBDIVISION: BAIS1902CREEK ACRE TRACTS ZONING: I -L BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B 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: 2 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replacing (2) existing water closets. No change in EDU's FEES Owner: Description Date Amount PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 4/19/04 $72.50 PORTLAND, OR 97224 [TAX] 8% State Surcharl 4/19/04 $5.80 Total $78.30 Phone : Contractor: ADDISON PLUMBING 17506 SE RIVER RD. MILWAUKIE, OR 97267 REQUIRED INSPECTIONS Phone : 5O3 - 785 1840 Rough -in Insp Final Inspection Reg #: LIC 151754 PLM 3 -449PB 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 , / 1 � / Permittee Si nature: Issued By: , - .�/ . g /c 2 Call (50- 639 -4175 by 7:00 P.M. for an inspection needed the next business day i , Bu lding Fixtures , Plumbing Permit Application /5? OFFICE USE ONLY' - City of Tigard Dat ''` [ p 1,411 Permit No. L y/1n e ? �/7� 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ! Phone: 503.639.4171 Fax: 503.598.1960 / /a � Date/By: Other Permit No 24- Hour Inspection Line: 503.639.4175 . e�' I I Date ReadyBy. iii I El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: //CQ Supplemental Information t, ^s :'i; o r ,a, 4,, .1,^t xoG: *, ;.J.: ,: ..' ;;:' FEE .SC HEDULE' ,` � �, "TYPE �OF �WORK " , For special information use checkl ❑ New construction ❑ Demolition Description I Qty I Ea I Total ,® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) s > � : ;, - s' = t .r ` CATEGORYF C .O ON "STRUCTION r „ 1 - ., SFR (1) bath 249.20 � ; „„ate ��a ,.�:��..�Yt .v�.. � ^..�,, ,�r�N -. , , . ,, , e, , .,��a _.., ,.�r e � . � � , , ❑ 1- and 2- family dwelling EI Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 °,,,r, 'Ie : " { ' ^;�i J,© BSITEF TI v ''INORIVIAU1V= tAND`•tiC 0ATO IN •' ': >�_�_ .�. , = - .- ..:xa,w - ,_, ...,� . , m._,.. �. ^ , ','`I'.'' , -,, _._- Site utilities Job site address: ib%so 5 ..) w l %rcn,e s F6rv...1 Fab Catch basin or area drain 16 60 City/State/ZIP: - rIo-rd. (30- Drywell, leach line, or trench drain 16 60 Suite/bldg. /apt. no.: gka L. I Project name: To-v v. c6,,,,c..e ks Footing drain (no linear ft.: ) Page 2 `� Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16 60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.• Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page .2 Fixture or item Tax map /parcel no.: ., / Absorption valve 16.60 t. ' ::' .DESCRIPTION �OF :rWORIC'' _ Backflow preventer Page 2 �. ,. -1-170-t� s , ` Backwater valve 16.60 / &_' � A s�" n a Clothes washer 16.60 Dishwasher 16.60 ._, ^, ; ^_^ .. „, O •y,. .... _ . i - ,,,,,,,,,,,,,., Drinking fountain 16.60 Wg0:1 Y rPROPERTY';WNER „ : £:: ❑ ., T ' T :k.� .- _,y,_.. �< �r ,���'` . :., Ejectors /sump 16.60 Name: Q0.L \c,Z 9.,e,.. \cy (1.64 • Expansion tank 16.60 Address: t S3 5 o Sw c.,,,,... v... o : o - Q y.., ` Fixture /sewer cap 16.60 City/State/ZIP: lb,r Floor drain /floor sink /hub I 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 fir'' :x' a,�>�::n , :` ; ® ^ ' APP L ICANT = :° • ¢ "�: 'r ; ®` CONTACT PERSON` °r ° .ro. i' ,r� ' W Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical' gas (value $ ) - Page 2 Address: Primer 16.60 City/ State/ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 16.60 E -mail' Unnal 16.60 ,4 ^f' g+ l > `- ii 1 .. toa -a., _ `"�i`-_x1'P -�r. ; zn`L : ek . : z ,: - - .''' ' , :4 CUNTI 'ACTOR' t s 'r` ;.�> . " ;, "' , .s:' 1 -`' 16. :;i t; _. ia' 4i ���' �- ?�. m`: �: �" 2 ....,���t '�Eaar- .,- ,qww,�: s, >� �5 ... ,,�iR �d��;' a�'��,.n.��� „t , u.. . w ater '� 16.60 13. zo Business name: t A e v s ,, ,, , ‘ 1, t‘...34.).1.. .., ) l Water heater 16.60 Address: Other: 1 - TS i;c,, ct e_Lu� '� Subtotal City/ State/ZIP: vr�:Asrso , ,��`e.._ ov.. g 12 6'1 Minimum permit fee: $72.50 7) Phone: ( Sari ) 1 TY - tc,e�kp Fax: (Ss ; )-724„ -04.4v./ Residential backflow minimum permit fee: $36.25 7 CCB Lie.: IS‘1 5q Plumbing Lic. no.: 3 - 44q p4 Plan review (25% of permit fee) State surcharge (8% of permit fee) 6 .40 Authorized signature: TOTAL PERMIT FEE 7g , 30 Print name: 3`0.1 m Date: at -t q -o y, This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i \ Building \Pcrmits\PLMF- PermitApp doc 12/03 440- 4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information 'Fee Schedule: Residential Fire Suppression Systems: ,a. .eti�, - - -.e'. ;`.;:i' ^_'.t•c "; ':,9. , .a;d,`i - I' +,- - ., t. , i;, - ' >' i Fee: S uare:Foota e , °'Eerm t' q ,�.... -.. g Footing drain - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46 40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46 40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 V'alu " "ation: tPer';mit;:Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000 00 $72.50 for the first $5,000.00 and $1.52 for each c.i Neei(ea) FTotaG: additional $100.00 or fraction thereof, to and !'1Xt11I'e „Ol Itelll,s;# ^ ° :ty < „ ,''krow;' -i a 1 xm, ty : % kt including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00 Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1 45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and Including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . 1"fil ,;.H'`ae ' _ sa ° ;i,` p " rtQuantity:by(Fixfu> Wo'r`k Performed' t regarding arding fixture work: a� R.�;��,�� ' a.�a �s�w:i�::'� k ° .? ca i; �,MOVEdIi,'- ` <'ESlsfi�` Ce ¢d'•�” b b ;a�r:xf,:t;,=. g.•w"a.izdS ,�.?�t[f L_ ,,.. ; °t i,�iN2,W„'..^'. ,,s'•':fxa -..., r. .; ,'Sa =.� � .-p.P = .< Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" - 3" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet - Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i \Budding\Pmnits\PLM- PermdApp doc 3/03 CITY OF TIGARD 24 -Hour . �_ BUILDING Inspection Line: '(503) 639 -4175 fip.„ INSPECTION DIVISION Business Line: (503) 639 -4171 MST L � BUP / Received Date Requested — aD AM n PM BUP Location / to /.S(i ( / •'/L 6,907222 F.1 , Suite iV C___ MEC Contact Person .1 , Ph( ) 14 1 6 - g / I io PLM 1 1 — Do (7.-- Contractor Ph ( ) SWR BUILDING Tenant/Owner P92,1__ 4 c D ti- ELC Footing • Foundation Access: ELC 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 '" � I`�lL �� Roof Other: / /1//_ / /f/ ✓ / ..E / Final , - PASS PART FAIL - PLUMBING _ Post Beam � / / Under r Slab , _ ■ _ ��� ∎// ' r , Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain - Shower Pan Other: /min 1 e• ART FAIL M . ICAL Po 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 0 Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA iyV 'j - � Approach/Sidewalk ®ate 6 G� Inspector l V Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL