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Permit ..= CITY OF TIGARD PLUMBING PERMIT r DEVELOPMENT SERVICES PERMIT #: 3/5/02 2 -00076 '.`'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/5/02 SITE ADDRESS: 11825 SW WALNUT ST PARCEL: 2S103BA -00700 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT 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: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Less than 100 f.t. sewer line work. Septic tank to be removed, or pumped, filled and inspected. FEES Owner: Type By Date Amount Receipt GAARDE, RICHARD J II AND PRMT CTR 3/5/02 $72.50 27200200000 JUDITH O 5PCT CTR 3/5/02 $5.80 27200200000 11825 SW WALNUT TIGARD, OR 97223 Total $78.30 Phone 1: Contractor: OWNER REQUIRED INSPECTIONS Phone 1: Sewer Inspection Reg #: Final Inspection 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: !' _ : %T/ C- Permittee ,4, of Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day 1.ae.19a- -oo r , Plumbing Application Date received: Permit no.: Lin 2(,)0 - //i/ 7(O °�r,) j `J g City of Tigard 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: EMI Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT i & 2 family dwelling or accessory ❑ Commercial/indust s . ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Additio:' alte ion/re •lacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist) Job address: j I SAS 5(4) LRial_kiu V g\ • Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: Tax ma /tax lot/account no.: (includes 100 ft. for each utility connection) P SFR (1) bath Lot: (Block: I Subdivision: SFR (2) bath Project name: GA A-1 e _ Qsrn ode_ L SFR (3) bath City /county: I ZIP: • Each additional bath/kitchen Description d_ to tion of orrko on premises: ti � Site utilities: 6 ,:y,, t � { Catch basin/area drain Est. date of completion/inspection: .-( Z , Drywells/leach line/trench drain PLUMBING C_ ONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: lilt Manholes Address: Rain drain connector 1 _ City: I State: I ZIP: Sanitary sewer (no. lin. ft.) ih9 Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print name: Date: - Backwater valve CONTACT PERSON Basins/lavatory Name: Clothes washer Dishwasher Address: State: ZIP: Drinking fountain(s) City: I I Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): j� a -, . �oJ osyyz Floor drains /floor sinks/hub Mailing address: 1 $ ZS g L WcALINA 1 S-I' Garbage disposal Hose bibb City: T -� I State: Os( I ZIP: 972_2,3 Ice maker Phone: S /037b3l 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 prcjety I qwn as r ! ' S hapter .i. Sink(s), basin(s), lays(s) Owner's signature. `ne:L. - - ,b : e: 3 - 6$ 2 -• 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 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ '7, • SV ❑ Visa ❑ MasterCard Plan review (at _ %) $ expires if a permit is not obtained i Credit card Dumber: / / within 180 days after it has been State surcharge (8 %) .... $ 5 . Expires TOTAL $ --- ICd. n Name of cardholder es shown on credit card accepted as complete - $ Cardholder signature Amount 440 -4616 (6/00/COM) PLUMBING PERMIT FEES: - i PRICE TOTAL New 1 and 2- family dwellings only: 3. 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 PLEASE COMPLETE: 3" 16.60 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 15-'51" 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 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 -7C2 ' Quantity Total is > 9 *SUBTOTAL 8% STATE SURCHARGE 5 **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ s, * 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 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 AM PM BUP Location // � /44 1 Suite MEC / _ Contact Person ,j Ph ( ) PLM O — 04974 Contractor c ) SWR / � j!d! 6:44 ELC BUILDING Tenant/Owner I Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain � � Slab Inspection Notes: j'j s SIT Post & Beam ��l/✓� "�� J Shear Anchors pti 1- Ext Sheath/Shear ti` Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm • Susp'd Ceiling Roof Other: Final PASS PART FAIL UMBIN Post & Beam Under Slab • Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Oth- • iy PART FAIL ANICAL 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 Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST a e z ® INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested PM BUP d !! ll Location MEC Contact Person Ph ( )" / 7 PLM cad 7j6 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain 1 I/1P /V v a Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation _7 14 1 7: e740. 4 a — A/ Drywall Nailing Firewall r j. fi - r.-/ 7u G ,° ►t �a.,r Fire Sprinkler �� '°� Fire Alarm �d C -P , Susp'd Ceiling ' Roof Other: Final • PASS PART FAIL PLUMBING Service -- O'+'^ /!�l 5.' i C9�t - Water lll Se � / l � ' G Sanitary Sewer Rain Drains • Catch Basin / Manhole • Storm Drain Shower Pan Other: Final PART FAIL ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final /j 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 El Please call for reinspection RE: 111 Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date ^ - 2 ° r Z Inspector/ /� 2-441.- Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL