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11501 SW COLE LANE f I j I to t O 4 O r r� x ` s I I i 11501 SW COLE LN CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: P29/01 00027 DATE ISSUED: 1/29/01 13125 SW Hall Blvd.,T;yard, OR 9722.E (503) 639-4171 PARCEL: 2S110BA-08000 SITE AD'13ESS: 11501 SW CCE LU SUBDI\�rSION: EVERGREEN SPRINGS ZONING: R-4.5 BLOCK: LOT: 005 JURISDICTION: TIG _ CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFI my PREVNTRS: 1 OCCUPANCY GRP: F!OOR 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: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of back flow device _ FEES Owner: Type By Date Amount Receipt JAY RIVAS 5PCT CTR 1/29/01 $2.90 27200100000 11501 SW COLE LANE PRMT CTR 1129/01 $36.25 27200100000 TIGARD, OR 97224 - Total $39.15 Phone 1: 639-0436 Conii.,ctor: _ J SASSY PLUMBING CO 4105 SE RIVER ROAD MILWAUKIE, OR 97267 REQUIRED I dSPECTIONS RP/Backflow Preventer Phone 1: 786-2800 Reg #: LIC 33326 PLM 3-119PU 1 TI is permit is issued subject. to the regulations contained in the Tigard Municipal Code, State of OR. 'cdecialty Codes and all other applicable laws. All work will be done in accordance with approved plans his 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 N0ification 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: �L r� ).1�✓ Call (50W 639-4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application Date received: ,- Permitno.• !_/1,.: City of Tigard Sewer permit no.: Building Address: 13125 SW Hall Blvd,Tigard,OR 97223 P g permit no.: City nfligard Phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: 'n �,T�7��n '/)n/��/�+ Case file no.: Payment type: 71 &2fa mily dwelling or accessory U Commercial/industrial U Multi-family O Tenant improvement construction U Addition/alleration/replacemenl U Food service U Other: .1011 SITE INFORMATION FE.E.SUIE11,1111F(fo.r special Information n%e checklio) Job address: i Ekscri tion Fee(ea-) Total Bldg.no.: Suite no.: New I-and 2-family dwellings only: Tax map/lax lot/account no.: (includes 100 ft.for each utility connection) SFR(1)bath I,ot: Block: Subdivision: C f SFR(2)bath -- Project name: _— _ `,� j v�cr.L SFR(3)bath City/coun(y: [_'JZIP: ` I_7 J) L Each additional bntll/kitchen Description and to f• tion of work on premises Site utilities: J e t t y Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench_drain Footing drain(no.lin. ft.) Manufactured home utilities Business name: �[� /.� ("I b _kI_Q Manholes Address: Rain drain connector City: State: ZIP: Sanitary sewer(no. lin. _ Phone: Fax— Storm sewer--- — E-mail: � — (no,lin. ft.) �- CCB no.: — Plumb.bus.reg.no: — Water service(no. lin.ft.) City/metro lic.no.: — Blxlure or item: Absorption valve Contractor's representative signature: -- —.— _ Print name:_ e.r Y v, C < _, Date: Buck flow preventer Backwater valve Basins/lava(ory Name:` j l �� I l.t�/ Clolhes washer -- Address: Dishwasher I t,C'I 5 C- ? �� r1 � Drinking fountain(s) —��--- — - City: —1i � I L 1 State:(.)f! ZIP: '% 4)� � / Ejerlors/sump _ ___ Phone: t i (� I Fax: E-mail Expansion tank Fixture/sewer cap Name(print): ✓,l j �:1�;/ v /l� w Floor drains/400r sinks/hub ` Garbage disposal Mailing address: / (, ) I DI I'I Hose bibb _ City: 1 1 �.�,I r I 5tate:o ZIP: -7 -1,?�,? �l Ice maker Phone: It I 1V t I 11 Fax: E-mail: Interceptor/grease trap �— — — Owner installation/re•;drntial maintenance only: '1'1,e actual installation Primer(s) will be made by me or Ole maintenance and repair made by ioy regular Roof drain(commercial) _ oniployee on the properly I own as per ORS Chapter 447. Sink(s),basin(s), lays(s) Owner's signature: A*_Ik_.{yLr', I, Date: -i Sump kin ILI 10 f� Tubs/shower/shower pan Urinal Name: —.-- ---- --- -- Water closet Address: Water healer _ City: — Stair. ZIP: Other: Phone: _ Fax: Email _-- Total Not all juri.vdictions accept cmdit cards,,)leave call jurisdiction I'm mote inronneNon Notice.This pennit application Minimum fee................ U Visa U Mactett.'ard expires if a pennit is not obtained Plan review(at — %) Ctedit card number --L�--- within 180 days after it has been State surcharge(8%) .... F%piles TOTAL . AccX ted ascomplete. .......................$ -- - Name nr cudhnldrt as shown on credit card p --- ('"older signature —— Amount 4404616(&DWOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES Individual _ QTY (oa) AMOUNT (Includes all plumbing nxtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utill connection —� One 1 bath _ $249.20 Tub or Tub/Shower Comb. 16.60 Two(2)bath _! Shower Only 16.60 Three(3 ba) th Water Closet 1660 _ SUBTOTAL Urinal — _ 16.60 --8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL -- Garbage Disposal — 16.60 — TOTAL — Laundry Tray vv 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" - 16.60 - PLEASE COMPLETE: 4" — 16.60 -- Water Heater O conversion O like kind --T6 6-0— b 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 1-avatory Tub or Tuh/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 Trar -- Washing Machine �— Floor Drain/Sink: 2" Sewer-1 sl 100' 55.00 - — -- 3" — Sewer-each additional 100' 46.40 v —4 Water Service-1 st 100' 55.00 Water Heater — — — Water Service-each additional 200' 4B.40 Other Fixtures (S eci Storm b Rain Drain-1st 100' — 55.00 --- Storm 8 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 perthr _ _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 —� Grease Iraps 1660 QUANTITY TOTAL -- --- -- Isometric or riser diagram Is required it -- -- -- ------ Quantity Total Is >9 —'SUBTOTAL -- — — 8%STATE SURCHARGE �^ v "PLAN REVIEW 25%OF SUBTOTAL - — Required only if fixture t total is>9 -- — TOTAL 3 Minimum permit fee Is$72 50 4 8%state surcharge,except Residential Backflow Prevention Device,which Is$36 25•6%stale surcharge 'All New carnmercir 3ulldings require plans with Isometric or riser diagram and plan review IAdstslforms\plm-fees.doc 10110/00 CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4176 Business Line: 639-4171 MST BUP Date Requested -` U AM PM BLD Location ��Z.-� 5�.1_ Suite MEC Contact Person Ph PLM Contractor— Ph SWR _ BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: - Foundation FPS Ftg Drain Crawl Drain 1•ispection Notes: SGN Slab Post&Beam SIT Ext Sheath/Shear Int Sheath/Shear Framing Insulation -- Drywall Nailing Firewall - - Fire Sprinkler Fire Alarm Susp'd Ceiling _ Roof Misc. Final - PASS PART FAIL LIlMH Post& Beam —� Under Slab V � Top Out J� _ Water Service Sanitary Sewer Rain Drains WASS PART FAIL ANICAL -- -- - Post&Beam Rough In ---- -- Gas 1 i.ie Smoke Dampers - Final PASS PART FAIL ELECTRICAL -- _ Service Rough In UG/Slab Low Voltage Fire Alarm Final — — PASS PART FAIL SITE - Backfill/Grading _ Sanitary Sewer Storm Drain [ J Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ J Ple• call for reinspection RE: [ J Unable to inspect-no access ADA Approach/Sidewalk Other Date ?=tl1 S. Q 1 Inspector Ext Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.