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Permit .2 CITY OF TIGARD PLUMBING PERMIT x,41 4C DEVELOPMENT SERVICES PERMIT #: PLM2001 -00235 �`�" r'I II 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/7/01 SITE ADDRESS: 12630 SW WALNUT PARCEL: 2S104AD -03801 SUBDIVISION: ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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: First 100 feet/sewer connection FEES Owner: Type By Date Amount Receipt NANCY SMITH PRMT CTR 6/7/01 $72.50 27200100000 12630 SW WALNUT STREET SPOT CTR 6/7/01 $5.80 27200100000 TIGARD, OR 97223 Total $78.30 Phone 1: 503 - 524 -8895 Contractor: REQUIRED INSPECTIONS Phone 1: Final Inspection Reg #: 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: / �� Permittee Signature: 1 ,,,_ o � � Call 03) 639 -4175 by 7:00 P.M. for an inspection needed the nex business day . Plumbing Permit Application 1111111M., t Date received: Permit no.. L A / - 00035 a. -- , City of Tigard and �k t �lt� 3 Building permit no.: ` I II Sewer permit 1 g 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 1' :KNIT A 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: I.ZL 30 5) K Uu r 37 Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: Tax map /tax lot/account no.: 3 gD 2. % ,L p SFR (1) bath R. for each utility connection) SFR (1) bath Lot: ✓ IBlock: I Subdivision: SFR (2) bath ' Project name: / / N'C V 3 n'. / 17J SFR (3) bath City /county: 1 (icii D //✓/fSt/ • I ZIP: '77.2 a 3 Each additional bath/kitchen ' Description and location of work on premises: HD' it l, / 'n Site utilities: -<"eid Fie Catch basin/area drain Est. date of completion/inspection: L r U f Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: Af° E Manholes Address: Q / 4 /1 6,2 / A) 5 7 /,c) Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) 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:. Back flow Absorption valve B preventer Print name: Date: Backwater valve • CONTACT PERSON Basins/lavatory Name: p// / L 51 1 / /171 Clothes washer Address: / 2 6 3 0 S 0 1✓A L J u T S T Dishwasher Drinking fountain(s) City: 77( ,e') I State:O _ I ZIP: Lj7a 3 Ejectors/sump Phone:; t1 g',Yq Fax: -13 E -mail: /SrnM:; Expansion tank Fixture/sewer cap Name (print): JJPIJc' / Oz 4 Sm / 7.1 L. oh( Floor drains/floor sinks/hub Mailing address: /a /, 3 D 3 , W , 141f! L N u.T .ST. Hotage disposal g Hose bibb City: Tj ( ,2 I State:02 I ZIP: rj '7aa 3 Ice maker Phone: .5.2(./ AO S I Fax: -t3 I E -mail: 6n,,-/15474 -Rao /. 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 prope I own per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: // Date: & 7 D / 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 $ Plan review (at _ %) $ O Visa Cl MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires Name of cardholder as shown on credit card p accepted as complete. TOTAL $ Cardholder signature Amount 4444616 (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 Lavato 16.60 for each utility connection) ry 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" 166.660 0 PLEASE COMPLETE: 3" 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) 16.60 Garbage Disposal Laundry Room Tray Washing Machine \ Floor Drain /Sink: 2" Sewer - 1st 100' (1/2JA -44,k l ) 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 $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. is \dsts \forms\plm- fees.doc 10/10/00 / Lys CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 1 f • BUP 6 Date Requested -/ AM PM BLD Location 12,630 Sc✓ 14../4.61 04 Si" Suite MEC Contact Person Ph 9 3 7 3 / PLM 206/ -a U Z3 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 �0` f Roof . Misc: • - _ Final PASS PART FAIL • ma Beam Under Slab Top Out • Water Service air ain Drains Q #" • 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 StormlDrain - ' [ ] 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 ' / / � � � Other Date `- /9_ of Inspector �� �. Ext Final • PASS PART FAIL - DO NOT REMOVE this inspection record from the job site. • • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 • • Business Line: 639 -4171 BUP Date Requested - Le) AM PM BLD Location / (/ 34) Sw 1.4-' C i S r Suite - MEC Contact Person Ph & ?- ,9 - " �> 37 PLM 4/ G D Z3 j Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing . - _ Acce Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam • Ext Sheath /Shear Int Sheath /Shear Framing Insulation ' J L Drywall Nailing � (�( ta't f 7 Q C Tro:,-4 I / d 4 G e > Firewall Fire Sprinkler . 1 ` �� I r/ 2 P4 ✓`e Fire Alarm Susp'd Ceiling Roof Misc: ._ _ . Final PASS PART FAIL Post & Beam Under Slab Top Out Water Service anitary Sewer ' rains 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 .. 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 n _ Approach /Sidewalk D " ' / 0J O Inspector � �f�dY - Other Ext Final PASS PART .FAIL DO NOT REMOVE this inspection record from the job site.