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Permit - A CITY OF TIGARD PLUMBING PERMIT A- 4p DEVELOPMENT SERVICES DATE PERMIT PLM2001-00214 1 -00214 431- ''` � 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12945 SW WALNUT ST PARCEL: 2S104AD -02801 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: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: TUB /SHOWERS: 1 SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Bathroom remodel. Replace one shower, one water closet, one lavatory, add one new lavatory. FEES Owner: Type By Date Amount Receipt JOHNSON, ERIK SHAWN + PRMT CTR 5/23/01 $72.50 27200100000 J NINE LYNNE 5PCT CTR 5/23/01 $5.80 27200100000 1294294 5 SW WALNUT ST TIGARD, OR 97223 Total $78.30 Phone 1: Contractor: GEORGE DAVIDSON CONSTRUCTION 2265 NW 113TH AVENUE PORTLAND, OR 97229 REQUIRED INSPECTIONS Phone 1: 503 - 641 -2771 Rough -in Insp Top -out Insp Reg #: LIC 136682 PLM 34 -357PB 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: � Permittee Signature: 6cst9Q6v Call 3 5 7:00 P.M. for an inspection needed the next business day ( 3) 639 -4175 b Y Plumbing Permit Application Date received: S - ,2 3 - of Permit noI -eV ,Z I SI ''•' - ,I. � Ci of Tigard 1 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: Receipt no.: Land use approval: \ Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement Cl New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: 12.9 45 Svc) WALIJI T ST_ 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: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: I ZIP: Each additional bath/kitchen Description and location of work on premises: Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain I'LUAIBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Businessname:60 t)AUl a°U. TtWL#lOU Li— ( -- Manholes Address: •Z4,5 t lw l IV't Ai Rain drain connector City: Poe-rtto D I State: p(, I ZIP: CI )t2 I Sanitary sewer (no. lin. ft.) Phone: ( 3 - IS & fl I Fax: 6131 M331 E Storm sewer (no. lin. ft.) CCB no.: 1344, $ Z Water service (no. lin. ft.) I Plumb. bus. reg. no: Fixture or item: City /metro lic. no.: 34 3S - 1 / 653 Absorption valve 4 4 . Contractor's representative signature: S, ,f Back flow preventer Print name: ( t,?J S IlIZV I t..SD IJ Date: - 0 I Backwater valve CONTACT PERSON Basins/lavatory Name: Eta ■ 1L1SO Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank Fixture/sewer cap Name (print): G JDt14 0 A7 Floor drains/floor sinks/hub - Mailing address: 1201 AS Sul loAt.N>,1T' s Garbage disposal Hose bibb City: .-4-t aka j, I State: VQ I ZIP: () ZZ. 3 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) 2. Owner's signature: Date: Sump . k , , k i ; : Tubs/shower /shower pan 1 Urinal Name: Water closet I Address: Water heater City: I State: I ZIP: Other: • Phone: I Fax: I E -mail: Total -J, Not all jurisdictions accept credit cards, please call jurisdicnou for more information. Minimum fee $ 7).s '-' Notice: This permit application Plan review (at _ %) $ ;S irD ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) $ Expires TOTAL $ 751r 3D 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 Z 16.60 3 3 2 0 for each utility connection) One (1) bath $249.20 Tub or Tub /Shower Comb I 16.60 /6 ( o Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet I 16.60 / /, , 4.,/? 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 3" 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 Urinal Other Fixtures (Specify) 16.60 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: - l / Rain Drain, single family dwelling 65.25 / / �-' i- ^ T.'v? e : • : " 14 ! i L t ' k l� e "„`' Grease Traps 16.60 l t . QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 `SUBTOTAL 7,3 $V (06. 8% STATE SURCHARGE ,1', `*PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ 1 - / r t L» * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backllow Prevention Device, which is $36 25 + 8% state surcharge ** AII New Commercial Buildings require plans with isometric or riser diagram and plan review. is \dsts \forms\plm- fees.doc 10/10/00 CITY'OF TIGARD BUILDING INSPECTION DIVISION/7 P 6� 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested AM PM BLD Location / z91 5 ) w4-41 f°" Suite MEC Contact Person Ph 7ff PLM ZeAd - o Z/Y Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: A Foundation '...-- a eLli.-Ice. — !. FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear • Int Sheath /Shear J.1/ Framing . r' 44. v i u I I 4 S 4.,1 , Insulation Drywall Nailing - � I�S7 4 / / 14s ( .er r Lvfr„ vi c.. u� s Firewall Fire Sprinkler 'V •e c ,' 1)./ 6-11 , O -n � f / S S UP. . Fire Alarm Susp'd Ceiling Roof Misc: - Final • PASS PART FAIL (PLUiBIN • ost & Beam • Un• -'b o• O_ Water Service • Sanitary Sewer Pr" Rain Drains (� 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 [ 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 S t; C) Inspector . t) I L-f 7 V 4 Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job, site. 1/ Z D '-- P 6:2) CITY'OF-TIGARD BUILDING INSPECTION DIVISION . - 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 M ST • BUP Date Requested 740 AM PM BLD ,Location / 24 E( S Sw (4/611,1j- r-" / ! 1,1j- S /— Suite MEC Contact Person Ph 7'f--(6 U 9 7 4Z /e( Contractor t!jvt" i s Ph -- es 2 2- S R BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab I SIT Post & Beam Ext Sheath /Shear '" SL / 1— W/i— \-1.6w 4 I - L 6W . Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm . Susp'd Ceiling - Roof Misc: Final - PASS PART. FAIL Post & Beam Under Slab 6M/ Top Out Water Service • Sanitary Sewer Ra Dra• s Final - - ART FAIL - ANICAL Pos & 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 Approach /Sidewalk n Other Date �/ /6 Inspector C Ext Final PASS PART FAIL • DO NOT REMOVE this inspection record from the job site.