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Permit (2) C ITY OF TIGARD PLUMBING PERMIT 4,. ' #1 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00563 - --- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/1/2005 SITE ADDRESS: 12630 SW GRANT AVE PARCEL: 2S102BD -00800 SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R -12 BLOCK: LOT: 009 JURISDICTION: TIG CLASS OF WORK: ACS GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Bldg. fixtures. FEES Owner: Description Date Amount ROMAN CATHOLIC ARCHBISHOP OF PORTLAND IN OREGON [PLUMB] Permit Fee 2/1/2005 $72.50 2838 E BURNSIDE [TAX] 8% State Surcharl 2/1/2005 $5.80 PORTLAND, OR 97214 Total $78.30 Phone: Contractor: MAREK PLUMBING 3229 SE 160TH AVE PORTLAND, OR 97236 REQUIRED INSPECTIONS Phone : 761 Top -out Insp Final Inspection Reg #: LIC 75624 PLM 34 -229PB 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 952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699. _ Permittee Si nature: Issued By: �/���� g � ��� i Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day AS I/O 0. 60 `D o $ 6 Building Fixtures _ d, 00,33 CEIVE® • Plumbing Permit Applic n FOR OFFICE USE ONLY o' ts r � City Of Tigard D n EC 27 7 2' ( R eceive d DateB \D- , ? Pemut No ? ,,` .-- 3 005 13125 SW Hall g Plan Review Blvd , Tigard, OR 97223 ( D4 �i/'9 r Phone: 503.639.4171 Fax: 503 598 1960 CITY OF TI t /9a ; �� l i A\ Date/By �: ^ � Other Permit No 15U_ 04999, —E 24 Hour Inspection Line: 503.639.4175 yu ti . ni« �i Date Ready/By 0 See Page 2 f - .. .. � for Internet: www.ci tigard.or.us Notified/Method ( � Supplemental Information � r _ ...,"�� :�. ��sz ^ar�m =`,�;+ ' ° :a. ; . - ::� `,�... z�..�.,�. a,� ; r,M.�;,, � °'t: - „T s"' � ,.� j ,�. ,.:�, M- ?3 ; ,a ::a y ;�, �- :�.� c -. -�;, =;:t:' � " �:;;F:'': 'er m . f'"'''''1'4";' ' ; ;`�P,' ' 7'' } t - . :; s.„ ,'z„ .,; .,:4°: W ; e :, .�' 1,-- '• . m „;' ;*:`'�: Vii"- - "•i: .' � . v ,,r -, , .,;e r, ;. EE' . , „-: , ` - x,�,'= "' , � -rE_;;� `.r::TYPEOF °WO ,, � x .�.,:.,..�. ; :,_ ���._,.�,��� � r s ° t.�cS���,.���,a� , ..�i�rx;. a.�. � n,, •.��u� �:t'..».. �" ,,.. b , �- _ ;'�' „t`�°K.i,�3 s�i�.r.r,a�;:` New construction ❑ Demolition For special information use checklist. Description Qty I Ea Total ❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft for each utility connection) -,,,,, .,- Nx -rt F,,,CnTfelt ON 4, , ta SFR (1) bath 249 20 ❑ 1- and 2- family dwelling ❑ Commercial /industnal SFR (2) bath 350.00 Accessory building ❑ Multi - family SFR (3) bath 399 00 Each additional bath/kitchen 45 00 ❑ Master builder ❑ Other: ,.r 'r r ate.,, Fire sprinkler ( sq ft.) Page 2 t4 ° t° 11.61 *- R1FORIVIAFIO1v .41�f itraGATI • g , <` ` `.'- t �= ,.:,r��:�, ���i•a�c��� > -�� � .c� s= �;:, ��,�� °,�- �� °::,:'„,�. „�������M Site utilities Job site address: , `Z6,`5Q S \ \/ *Z 0 _ 4 , ,,t-r A y ,.. Catch basin or area drain 16 60 City/State /ZIP: —r16,p 20 O32, °)'-/ 2-z3 Drywall, leach line, or trench drain 16 60 Suite/bldg /apt. no.: I Project nart itQf}. ,bQISN9i2D4bT,.3 Footing drain (no linear ft • ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site. 5 v. Q ,,, Sr ( I ty t Manholes 16 60 vr/ S "Y co' Is Rain drain connector 16 60 4 Sanitary sewer (no linear ft.•, - a Page 2 0 ' m Storm sewer (no. linear ft.. V ) ,E 1 Page 2 IIM- Water service (no linear ft : ' . ' 2 0'1X' Page 2 Q, Subdivision: Lot no.: c 4�� Fixture or item Tax map /parcel no.: 2 5 I , 0 2 D . k ,; ter, , r. ; ,. ,. z . Absorption valve 16 60 , ;� s `, : DES`CR1P OFµ W >. � ',` `° '4,,;= .. r_. `` =3 ;,,' ;,.. „z,,,,: f, $; - , im _ a. ,,,, Spa . „, C._;.. s t :i - „-�;u Backflow preventer Page 2 C19l.1ST.2 r 1 000 S F ST O .jac t% Backwater valve 16 60 Clothes washer 16 60 Dishwasher 16 60 ,a .. - ,,.,, °, .. >,r.. „�. ... ' ,, a =vim Drinking fountain 16 60 ki tli R7t OPEI "O ? C : : : :4` - ir T s ,��'� ., �, . f�«. „, �� �. t 4[;' �'z ,..a �. � - � �,.. ,. � Electors /sump 16 60 Name:' t17A n1CtTY}gcdCf'l lSaf OP 01= I p UMaP1.Q 11+2 CielSCreN Expansion tank 16 60 Address: 2.e, --.....1.444,1..,s I _ Fixture /sewer cap 16.60 City/State /ZIP• FCj €2,-r 441 N,D C> 6)720 Floor drain/floor sink/hub 16 60 Fax. G 24' 23 q- Garbage disposal 16 60 Phone: (�j03) �c '� — 4 I 7, (� 03 ) ;;- . t, r �� , ,,. ,„, -,. ..- v ,,, , ., ;-n: - Hose bib 16.60 :: rf i.y "`''rl hfV Alvin '"�` � "° ?„ CON T1 ,&,-,o., ERSON ; , ,„ - g � �� ° ` � ` ,,i : � ,� t.to ' Ice maker 16.60 Business name: cam. No -F+b21S,,1 Interceptor /grease trap 16 60 Contact name: tp.f36. Ke.,tc re i S^ES © 60 Medical gas (value. $ ) Page 2 Address: °) Q5 S \\( (. C IC.-1.42._, Primer 16 60 City/State /ZIP:I — M . Q Q e aD a c 7 Roof drain (commercial) � 16 60 Sink/basin /lavatory >. `Z 16 60 .3 2- Phone: (5'05) CaGS a9 -- 4-179 Fax: : (503) 4,24 -2SV)- Tub /shower /shower pan 16 60 E -mail Urinal 16 60 �' ;_ ;x,7,0 ri m - _ ,.- 2 ,ti ;kk 'k, , ; -P- '.'. - , s"s`a �. t, -Y ' i . . ,��. - ¢ "�F" =.z? k ..,z,: y ” .. J ,.. - 'in..' ' -` l l .0 r s " 1 ,-,g-4,:"1,,,,J,:: 3= . ;',A OR = 4.,! ;,,n ? r , 1t Water closet � 16 60 c , Business name. , } f je C / ,A PA/51 /26W Water heater j 16.60 , ( � Address: -r- : 3- v p " J J /© �J / .1 `1 \,k / A n i Other � 1 City/State /ZIP: po,e -A ` d h1 97 6 \ ` �'\ ' W A Subtotal 2 ( q C9 / �\ n Minimum permit fee $72 50 /J� q Phone: 6- ) 76/ O/ 7f Fax: ( ) , \,v Residential backflow minimum permit fee $36 25 I /A 2J ^ L CCB Lie.: 7 1z y Plumb ng Lic. no :79202 2Z2 1.'‘ Plan review (25% of permit fee) State surcharge (8% of permit fee) 7 -0 Authorized signature: ! TOTAL PERMIT FEE 5 0 Print name: j R A � �� Date: �_ ” A3 , This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tn- County Building Industry Service Board. i \Buttdmg \Permits \PLMF- PermaApp doe 12103 440- 4616T(10 /02 /COMIWEB) @Q-b I - Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information 02; Fee Schedule: Residential Fire Suppression Systems: S'lte Ut l • ,1e'd= ,,s Q ,.Y „F e(ea T o tal, t: 1 ;. „��� �, , . 'g � : �: �. :-,:u4 ;��, ���.� . �S mare, Fo e: - �t_� ���{;.,_ a _,q.. �.�.w,,.g�.�; =. x�� •`Pe>�m Fee.: Footing drain - 1s` 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 5 ” 7,201 and greater $309.00 Sewer - each additional 100' - 46 40 tit . yD Water Service - 1st 100' 55 00 j'"dv Medical Gas Systems: Water Service - each additional 100' 46.40 �.: ' a , : §Perm t.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 "fee (ea }:,,, :.T.otal ; additional $100.00 or fraction thereof, to and F1XUl'e r.1telll gib - .. ,GHQ Y , r - 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. • Fi 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 * . Qua htj l5' fixture) Wark. rme Pic T;y+ e:` ; M:i.' ,.�_ , *% zi: A _ Replace,'' :6 -, �f°' ,`'� r a, r = r,- isflog ca pped` Comments regarding fixture work: >. i' dlllo 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" Car Wash Drain Garbage - Domestic Disposal -Commercial *Note: If the fixture work under this permit results in an - Industnal Ice Mach /Refng. Drains increase of sewer EDUs, a sewer permit will be issued and 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 Commercial Isometric or riser diagram is required if fixture quantity - 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 r\Bu iduiglPermns\PLM- PemntApp doc 3/03