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InitiallyGood .w.n.••«....,..,,,....sw.,w.w��.r..�.w..r..,....w..,,...,«..w.�««K.wwwwrwv�rwwrrrwaww:-w+m++.+nw.r,.w�wr Nrr�IWe+NfbN+�'w liWwr�w+WorlwH-aA+rMIAO'eiwMMlPwwa�w�wnw.-w.v«w.wrm:u...,:...,w...._.,wanrWnY.. N In O O N W fD r n I 12500 SW BELL COURT CITY ®F T I G A R D -- MECHANICAL PERMIT -_ R' DEVELOPMENT SERVICES PERMirf/: NIEC1999-00149 13125 SW Hall Blvd., Tigard. OI 97223 (503) 639-4171 DATE ISSUED: 4/8/99 PARCEL: 2S104AA-00900 BITE ADDRESS: 12500 SW BELL CT SUBDIVISION: BELLWOOD ZONING: R-4 5 BLOCK: LOT: 058 JURISDICTION: TIG CLASS OF WORK: OTR FLOOR FURN: ^--- EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: _ BOILERS/COMPRESSORS _ HOODS: FUEL_ TYPES 0 3 HP: —� DOMES. INCIN: WOD — 3 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: GAS PRESSURE: 50 + HP: CLO DRYERS: S: 1 FURN < 100K BTU: AIR HANDLING UNITS C ----- OTHER UNITS: FURN >=100K BTU: <= 10000 cfrn GAS OUTLETS: > 10000 cfm: Remarks: Installation of wood stove. Owner: --- _-- _ FEES ---_ -- OLSON, ROBERT I AND Type By Date Amount Receipt SYLVIA A PRMT DST 4/8/99 $25.00 99-314360 12500 SW BELL CT 5PCT DST 4/8/99 $1.25 99-314360 TIGARD OR 97223 _ Phone: Total $26.25 ---- Contractor: _ _ o II j�o12Tt_A�� C� �17aC� REQUIRED INSPECTIONS � Woodstove Insp — Phone: 1 es_ , 7s Misc. Inspection Reg #: Final Inspection This permit is issued subject to the regUlations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. Al! work will be done in accordance with approved Ir,ins. This ;permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTIONOregon law requires you to follow rules adopted in the Oregon Utility Notification Center. I hc.se rubes are set forth in OAR 952-001-0010 through OAR 952-001--0080. You may obtain copieE, of iii lse rules or direct questions to OUNC by calling (503)246-9189. Isrve By: ��/l">l�2: !,� 1 Permittee Signature: Call t5R3) 639.41"'1 ay 7:00 P.M. for inspections needed,t a next business day CITY OF TIGARD Mechanical Permit Application Plan By,C PP Recd ey�� 13125 SW HALL BLVD. Commercial and Residential Date Recd '/-$- TIGARD, OR 97223 Date to P.E._ (503) 639-4171, x304 Date to DST Print or Type Permit# LiR� _ Incomplete or illegible applications will not be accepted Called -- Name of DevelopmenttProject eseriptlon Table to Mechanical Code City Price Amt .lab Street AJress SuneN A Permit Fee — 10 00 I ,- e-- , ) 4 j-` LL ell 1) Furnace to 100,000 BTti Address (� L/l includingducts&vents see footnote 1,2 600 BidgN cItyistate t� Zip 2) Furnace 100,000 BTU+ /(? 0.y � � ) L including ducts&vents see footnote 1,2. 7.50 - Name 4pr nam of busin u) i 3) Floor Furnace — Owner ' includingvent see footnote 1,2 6.00 `�� " ALJ - Mallinp Address M i 4) Suspended healer,wall heater or floor mounted heater see footnote 1,2 — 5.00 -� 5) Vent not included In appliance permit citylstale Zlp Phone ,] lJ —_ _3.00 �.,,G Cil ;' I I IL (, Check all that apply: "Boiler Heat Air -- ---- t ortwa u) For items 6-10,see or Pump Cond Qty Price Amt footnotes 1,7 Corn 6)<3HP,absorb unit to Ocr:upant Malting Address 100K BTU _ _ _6.00 7)3-15 HP,absorb unit CNyrBtate Zlp Phone 100k to 500k BTU _ 11 00 - 6)15-30 HP,absorb unit.5-1 mil BTU 15.00 Contactor Name F ( p 9)30-50 HP;absorb UT C, I �- r. unit 1-1.75 mil BTU _ 22.5.0 Prior to permit Mei ing Address - 10)-50HP;absorb unit Issuance,a copy / c S• >1 75 mil BTU _ 37.50 of all licenses is Zip Phone 11)Air handling unit to 10 000 CFM — are required H 4.50 expired in COT O on Const C card U%F Date 2,L- 12)Air handling unit 10,000 CFM+ database_ � � - Z _ ___ 750 Architect _ "•m• 13)Non-portable evaporate cooler _ 4.50 Melling Address - 14)Vent fan connected to a single duct or _ 3.00 15)Ventilation system not included in Engineer Cry%state �-`— ztp Phone s0pliance permit_ _ 4.50 16)Hood served by mechanical exhaust ----- --- --- 4.50 Describe work to be done: -- 17)Domestic incinerators New O Repair O Replace with e;a kind Yes* No O __ —_ - 7.50 Residential O Commercial O 18)Commercial or industrial type incinerator _ 30.00 _ Add'nional information or aeseription of works 15)Repair units 0 4,50 ood stove - — NOTE: For Gommercisl projects only;Units over 400 lbs require 450 structural as Coles 21)Clothes dryer,etc Type of fuel oil O natural gas O LPG O electric p 4.50 2 )Other units 1 hereby acknowledge that 1 have read this application,that t�^i nforrme'ion4 50 given is co". ci,that I am the owner or authorized agent of 23)Gas piping one to four outlets the owner.that plans submitted are in compliance with Oregon State laws See footnoto 1 2.00 24)More than 4-per outlet(each) Signature of Owner/Agent Date ^_ .50 r Minlmu-n Permit Fee$25.00 SUBTO fAL 5 co rt Person Name Phone - --_- - . I I j 2 SURCHARGEPLAN REVIEW 25%OFS SUBTOTAL Fconotes for commercial projects only: Required for ALL Corr_^ierclal permits only 1 Piovide`ull schematic of existing and proposed gas!ine and pressure — TOTAL G�A 2. Provide drawings to scale showing existing am proposed mechanical nails. _ 'State Contractor Boiler Certification required "---�—� "Residential A/C requires site plan showing placement of unit IVnechperm doe rev 02/4199 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP _ _— __ � C _ Date Requested_ =� .-.__AMPM BLD Location_ ICL rk� �� ____— Suite _ MEC Contact Person Ph -- PLM -- Contractor. SWR _ ---. _ Ph -- -- BUILDING Tenant/Oei7,at` �� J I ELC —_ �} ELR v Retaining Wali — Footing FlInspection ccess: FPS Foundation Ftg Drair. _ - SGN Crawl Drain Notes: Slab �__-- ------- SIT Post&Berm Ext SheathrShear Int Sheath/ihear Framing -- -e. InSU:^tion Drywall Naini ja Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling ----- Roof Misc --- -- �"� Final PASS PART FAIL --------- -------- PLUMBING Post&Beam --- - Under Slab Top Out Water Service - Sanitary Sewer Rain Drains Final 1 % _ PASS PART FAII- MFURAWC71F _ _---- Post& Beam Rough In r t k� �1?I`✓ — Gas Line . Sn r�ioke Damps -- — � PA/RT FAIL. _ TRICAL Sery;ce Rough In UG/Slab Low Voltage Fire Alarm — — Final --- PASS PART FAIL _— -- --- - SITE ----- ---... Backfill/Grading T— Sanitary Sewer Storm Drain ( J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( J Please call for reinspection RE'._ —__—_ ( J Unable to inspect-no access Fire Supply L..-,? ADA \ I Approach/Sidewalk Date t -Inspector �fes..-. r Ext Other _ l r Final PASS PART FAIL DA NOT QtEMO�i E this inspection record from the jobs e. CITY OF T'G A R D _ ELECTRICAL PERMIT PERMIT#: ELC2000-00056 DEVELOPMENT SERVICES DATE ISSUED: 2/10/00 13125 SW Hall Blvd.,Tiqard, OR 97223 (50?1 639-4171 PARCEL: 2S104AA-00900 SITE ADDRESS: 12500 SW BELL CT SUBDIVISION: BELLWOOD ZONING: R-4.5 BLOCK: LOT : 058 JURISDICTION: TIG Protect Description: Install 4 branch circuits in single family dwelling. RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: _ PUMPIIRRIGATION: EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 arnp: SIGNAL/PANEL: MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER _ _ BRANCH CIRCUITS _^ _ADD'L INSPECTIONS _ 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT: 601 - 1000 amp: _ _ PLAN REVIEW SECTION_ _ _ 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOM__INAL: —Reconnect only: SVC/FDR >= 225 AMPS. CLASS AREA/SPEC OCC: Owner: Contractor: OLSON, ROBERT I AND RED'S ELECTRIC CO INC SYLVIA A 2002 SE CLINTON ST 12500 SW BELL CT PORTLAND, OR 972.02 TrGARD, OR 97223 Phone: Phone: 233-6467 ORIGINALReg #: SUP 2059S LIC 000044 r ELE 26-152C —_ FEES Required Inspections Type By�— Date Amount Receipt Elect'I Service PRMT KJP 2/10/00 $53.55 00-321659 Elect'I Final 5PCT KJP 2/10/00 $4.28 00-321659 Total --- + $57.83 This Permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty Crries 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 ynu to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503) 246-198% PERMITTEE'S SIGNATURE yy� �� ISSUED BY: OWNER INSTALLATION ONLY The installation is being made on property I own which is not h tended for sale, lease, or rent. OWNER'S SIGNATURE: ------- �_� DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: �` °`J� DATE: l' /-OAO LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day 02/09/2000 16:01 2331281 REDS ELECTRIC CO PAGE 01 *8/09/99 1101"1 11:28 FAX 503 368 1900 CITY OF TIGMW Boaz CITY OF TfGARD Ei9Cc�i 13125 SW HALLElectricalf�emBLVD. nit Appfieatio�+ Ren eed By_ _ TIGARD OR 9Y223 / uat.Rec'a-_- -- �� Phone(503)638-4171,x3� / l Date to P.E..____-_ Inspection(503)83941 iS � Dam to PDST__________ Print of Tr _ Fax(503)698.1960 � e Permit mlt M C, C 2000 000 5'(- a for illegible will)nct be accepted Called I. Job Addmaa: II. Comp/ete Fee Schedule Below: NA Tie O((k!VAIOprTlAflt_ - __ Nuns.of Ina�praflors�,.r�.rerit aNaw�d Name(or norrNl of buelnfrere) $_ r�Lpr��c'i lI,f„� / 8ervlcs Included: Items Cost sum AQdreas J,�ipv f��c 40, Nasldendal-par unit -- - Clty/Stalts2lp w IBM sq,fl.or less 117,I6 4 Eac)t adeannal 300■r1.A w Commercial t.,1 firttlderltial Limited FrPortion thereof __- $ 26 75 1 arrpy : 60 CO Fant Maurl'd Horne or MoeWa, — 28. Con"etor limtalletlon only: Dwaang SeMca,or Feder __ 6 72,s 2 (Prkw so Pwmlt Isrurnee,appllavrlw mrst provide cumtraoo,-Ilasrxne sb.aeryrlcse or Feraere v� I lee,,v4al for COT dr 1. -� Inatelladon.alwalinn,nr ralucallon Elec',1rel Contnllcla _ e 44.25 2 t4k 2C0 amp.or lose Address O s�� 201 amps to 4t]V ernpe _ ti as.50 '~__ 2 City� BtatA- 401 amps in 600 amp. 1 120.60 ? �`- _ Zip ` � � - - 1101 amps 10 1000 4mpe 6 197.60 2 Phrmis No �7 - - - Job No - Over fi1000 amps or snit., -.._�L�S�Z wW.15 2nrmeol only u_ EIa c. Cnnt Lice,No. ~_ F Date 01 --- - - - ' 4c.Te"rary Marvia+e r-Feeders OR State CCB kog, Np ��yr-1 EI.Dete / po Z__ Instaiianon.altatpllun a relorsUun GOT t3wlnaes Tax or Mtrfrn No. -R Gxp _ 7M amps o-less i 63.W _-� 2 ��,,� 201 amps to 4o0 amps -� f 60,28 2 5)grwturs Of$1lpr. iclpC' - -Y�i�- 4U1 amps le 6(10 eewrs _ Jj 107 Oa a 2 over 0010 amps to 1000 voha, License No. Dah,l�� ass,"b"alww Phone No. 1 ��^�� 4d.8rench Clrcwlls - New,altaratlory or exurislon per panel 2b. For oWn@r//1a(M//adOns: a)The lion for branch cjrrxas M1"po►chess of aervfce or foodPrint Orrrmwe Name Etch by e. F,ad1 Manch draft 5 t 36 2 Addmes- ----- b) rhe fee for Dr&%Ch dru,0s --- City--- — ._ _ Mate_.__ �Zip without porches,of awlar Phone No '- er Nedor raw �_... Flat Nation cfrw _ $ 37.50 The installation is being mane on proper y I morn Which IP not Esclh eddlllnnal Drench scan - Intendad for sale,Iasis or rent 4e-�1p00WASM0 (Sentim or lewder not tnduded) OwntSt'e Slgnellt►e Fbc h Pmp or Irt 4*)fl cj"-CM 1 42 75 -^� _arn Olen or nrlUlne 49henn _ 1 4276 signal ry wtls)or a IMrhNed one p r .W 3. Flan ROvIsar sscdon (K requlrod);^ Panel,elterallm or salanslen li 6000 Minor Lahels(10) ! 107 Playaee check a -- le pprooale It*m end entair he In sarcllort SSR. 4t Ewh edtftm1sl InapaOMon over 4 or mare residential unbt in one ph'Vctunt the alloaraple jr,etty Ct 1119 move -_ Service artd feeder 228 wrnoa or r110fn Per Maparglon { 110.00 over am vol6r rlornlnel INr how 1 10.00 `-- C4tasifsvl area or kmduA COMM", apodal orru nricy as _ 8 69 00 Plant dseara ed In ME C Challhr 5 S. Fees s 4 Enter io(sl nt ahoy*fens N 1 C4 f1i. submit:ears of plane safe apt2ltcatlen wryer any rx the aAova apply, 8% urcheye(051[ ryt nsqukeH Ibr rmoorary oorratrw-o .,Jn aeMewa. 9rtle�sl 1 t �tQTI ft Enter 2111%M on % e so IM _. Plan r1*"6gW IT_rag!*"(Sec.e) PERMn 8 MCOME VOIL)IF WORK OR CONSTRUCnON AUTHORIZED 13 NOT C406WENCED Ml,*N 110 DAYS,OR IF CONSTRUCTION OR u '------ WORK IS SUSPEN ED OR AnIN m MMEU FOR A PERIOD OF Iso DAys Pk rijsr Ari uni 0 SI LI--1—' l'.;, Al'AM'I AFTER WORK 18 COMMENCED--�'_ - 1-001 Ae/artn Dust J 7 i rtsutrormslalswte.bc CITYOF TI GA R D PLUMBING PERMIT s DEVELOPMENT SERVICES PP PERMIT#: PLM2000-00034 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4471 DATE ISSUED: 2/8/00 SITE ADDRESS: 12500 SW BELL CT G1' YPARCEL: 2S104AA-00900 SUBDIVISION: BELLWOOD ! ZONING: R-4.5 BLOCK: LOT: 058 JURISDICTION: TIG CLASS OF WORK: ADD 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: 1 OTHER FIXTURES: TUB/SHOWERS: 1 SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installatir, of one lav, one toilet, and one tub/shower. _ FEES Owner: --- -' — Type By Date Amount Receipt OLSON, ROBERTIAND SYLVIA A PRMT DEB 2/8/00 $50.00 00-321625 SYLVIA 12500 SW BELL CT 5PCT DEB 2/8/00 $4.00 00-321625 'TIGARD, OR 97223 Total v $54.00 Phone 1: --- Contractor: OREGON CITY PLUMBING 611 *7TH ST OREGON CITY, OR 97045 REQUIRED INSPECTIONS Phone 1: 656-8558 Top-out Insp Reg#: LIC 0002132 Final Inspection PLM 3-20PB 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 obUin copies of these rules or direct questions to OUNC by calling (1503) 246-1987. . ,� ! sued By: � a � Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day i City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 13125 SW Hall Blvd. Permit t# 111 0 Q�.a Tigard, OR 97223 (503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE P4 .M pw.kpTro ��/t t �`�� Now Single Family Residences Only o" 7 1 BATH HOUSE 5140.00 [12 BATH HOUSE$195.00 ICU ❑ 3 BATH HOUSE$225.00 Address c.wa�", n. Fee includes all plumbing fixtures in the dwelling and the first 100 feet of water service, sanitary :,ewer and storm sewer. See fees below. No.. n.m.°rLin".eM FIXTURES QTY PRICE AMT C) Sink 3 00 Lavatory 9 00 - . Owner — S(� �e � ' �_•f Tub or Tub/Shower Comb. _ 9.00 `Vie'"` zip Shower Only 9.00 i_ F1 • Water Closet y 00 ""'°rte.".„r Dishwasher 9.00 Garbage Disposal 9.00 Occupant Washing Machine 900 Floor Drain 9.00 Nater Heater 9.00 _ Laundry Room Tray 900 Mm. Urinal _ 9.00 Other Fixtures (Specify) 90 Morn Ad&— poen. Contractor OREGON CITY 1"t IIMBING & HEATING s0o 9.00 r.WrerM.� Zp 900 OREGON CITY, OREGON 97W, sewer 1st 100' 3000 (503) 656-8558 T•'�° Sewer -ea. Addit. 100' 25.00 Water Service 1st100' _ 30.00 I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00 infonnation given is correct, that I am the iwner or authorized agent of the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00 I am registered with the Construction Contractor's Board, that the Storm &Rain Drain Addd, 100' 2500 number given is correct. (If exempt From State registration, please give reason below.) Mobile Home Space 25.00 Back. Flow Prevention Device or Anti-Pollution Device 9.00 Any Trap or Waste Not Connected to a Fixt,ire _ 9.00 Describe work new Qas d i�tlon (y'alteration c) repair O Catch Basin 900 to he done— residential Q non-residential Q Insp. of Exist. Plumbing 40 UQ/hr Existing use of Specially Requested Inspections 40 00/hr building or property Rain Drain, single family dwelling 3000 Residentiai backflow prevention - devices 15.00 Proposed use of — building or property '(Except residential backflow prevention devices) NOTICE 'Minimum Feet 80"�gUSTOTAL PERM'TS BECOME VOID IF WORK OR CONSTRUCTION ��yy AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF ?Zow-6,URCHARGE CONSTRUCTION OR WORK IS SJSPENDED OR ABANDONED - FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED PLAN REVIEW 25% OF SUBTOTAL TOTAL. Soecial Conditions ---- -- Date issued _by CITY OF T I GA R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00102 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/26/03 SITE ADDRESS: 12500 SW BELL CT PARCEL: 2S 104AA-00900 SUBDIVISION: BELLWOOD ZONING: R-4.5 BLOCK: LOT: 058 JURISDICTION: TIG CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOCR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS. SEWER LINE: 25 ft WATER CLOSETS: WATERLINE: '100 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace approximately 25' of sewer service FEES Owner: -- --- -- —_ Description Date Amount OLSON, ROBERT I AND SYLVIA A I1'I.UMBJ Permit Fee 3/26/03 $72.50 12500 SW BELL CT ITA XJ 8%State Tax 3/26/03 $5.80 TIGARD, OR 97223 PITY OF TIGARD MCS 4/1/03 $31.50 ITAXJ 8%Statc Tax 4/1/03 $2.52. Phone Total $112.32 Contractor: RESCUE ROOTER PO BOX 1728 WIL_SONVILLE, OR 97070 REQUIRED INSPECTIONS Phone : 685-9050 Sewer Inspection — Water Service Insp Reg#: LIC 127325 Final Inspecticn I'LNI 34-168 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 Issued By: 1 Permittee Sicrnature: Q- Call (563) 639-4175 by 7:00 P.M. for an inspection needed thQ next business day I Building Fixtures ICF USEONLY Plumbing Permit Application Itecei%cd i'lumbing • Date/at Permit No.: �- Planning Approval Sewer City of Tigard Date/By: Permit No.: 13125 SW hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: - Phone: 503-639-4171 Fax: 503-598-1960 .....r, , Post-Review Land Use r Date/By: I Case No.: _ Internet: www.ci.tigard.or.us Contact Juris.: see Pate 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: _^ Supplemental Informaliun. TYPE OF WORK _ FEE"SCHEDULE(for special Information use checklist M_N�w _construction _ Demolition - Description Qty. Fee(ca.)T Total Addition/alteration/replacement Other: New t-&2-family dwellings Includes 100 ft.for each utlllt connection CATEGORY OF CONSTRUCTION SFR 1 bath 249.20 1 &2-Family dwelling _ Commercial/Industrial SFR 2 bath 350.00 Accessury Building Multi-Family SFR 3 bath _ 399.00 Master P.uilder J Other: - Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Firesprinkler-sq.ft.: Pae 2 Job site address: 25 U W Lf, Site Utilities Suite#: Bld ./Apt.#: - Catch basin/area drain 16.60 Dr well/leach line/trench drain 16.60 Project Narne: _)" U � K 6 t Footin drain no.linear R. Pae 2 Cross street/Directi ns to job site: Manufactured home utilities 110.00 } Manholes 16.60 Rain drain connector 16.60 Sanitary sewer no.linear ft. Pee 2 _ Lot#: Storm sewer no.linear ft. Pae 2 Subdivision: _-_ - M Water service no. linear ft.) Page 2 Tax map/parcel #: Fixture or Itern DESCRIPTION OF WORK Absorption valve 16.60 Backflow preventer Pae 2 -- --- Backwater valve 16.60 --- Clothes washer 16.60 ------ _- --- - Dishwasher 16.60 Drinking fountain 1 16.60 _ PRO TENANT ' _ 16.60 Narn(1: 13L 10. t_,, Expansion tanti 16.60 A Address: ' 17,1,56L., ,W �-,6 �� i Fixture/sewer cap16.60 >F Floor drain/floor sink/itub 16.60 p_ City/State/Za , C' Garbage disposal 16.60 P11o11eC '��1(!`�1G� F_ax _ Nose bib 16.60 APPLI_CA_NT _ CONTACT PERSON Ice maker 16.60 _N_ame: lnterce tor/grease trap 16.60 _ Address: - _ Medical gas-value: $ Pae 2 -- --- Primer 16.60 City/State/Zip _ _ Roof drain commercial 16.60 Phone: Fax: Sink/basin/lavato 16.60 E-mail: i Tub/shower/shower pan 16.60 CO�ETO Urinal _ 16.60 - Water closet 16.60 _ Business Name: ;, Water heater 16.60 - Address: Z" 40_Binm.t' W. Other: Cit /State/Zi Stlti%tnL� ° C`Yj��. �� Other: Phone:amu? -�3 (1 Z. Fax:60S N"sus)/ � PlumbinR Permit Fees* Subtotal S CCB Lic. #; J Plumb ic.#: - Minimum Permit Fee$72.50 S Authorized L- Residential Backflow Minimum Fee$36.25 Signature: _ � Da`•e: - Plan Review 25%of Permit FeeS - K�/�/i /t P?k -el State Surcharge(8%of Permit Fee) S -- __ -� (Pleas print narne) TOTAL PERMIT FEE J.$ ;Notice: This permit application expire%Its permit Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or 180 days after it has been acrepted a%complete. riser diagram for plan review. •Fee methodoingc%et hi Tri-County Building industry Set vice Board. is\Dats\Perrnil Forms%PlmPermitApp.doc 01103 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information - Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ca) Total Square Footage: Permit Fee: Footing drain•I"IW' 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-Ist 100' 55.00 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service-1st 100' 55.00 Medical Gas S stems: Water Service-each additional 100' 46.40 Valuation:_ Permit Fee: Storm&Rain Drain-Ist 100' 55.00 $1.00 to$5,000.00 Minin.um Ice 72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.O9 and$1 52 for cacti additional$100.00 or fraction thereof,to and Fixture or Item Qty. Fee(ca) Total 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 2Ermit fee$36.25 27.55 and including S25,000.00. 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 $50,101.00 and up $742.00 for the first$50,000.(0 and$1.20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing existing fixtures? It' "yes",please indicate work performed by Fixture. Failure to accurately report fixtures could result in increased sewer fees`. uaotit b Fixture Workl'erformed ('onuncnls regavding fixture work: Fixture Type: Replsce New Moved Existin __j:!pLcd — — —T Ba tist /Font Bath -Tub/Shower -Jacuzzi/Whirlpool _ — -- — --- --- Car Wash -Each Stall —_—_�.-- -Drive Thru _ Cuspid r[Water Aspirator ------ Dishwasher -Commercial -Domestic _ Dri-tkin Fountain Eye Wash --- ___ — _ --- --- —-- Floor Drain/sink -2" -3" - -4„ Car Wash Drain *Note: If the fixture work under this permit results lit an Garbage -Domestic Disposal -Commercial increase of sewer EDLJs,a sewer perntil will be issued and Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refri .Drains plumbing permit can be issued. Oil Spp ".s Station _ Rec.Vehicle D imp Station —_ Shower C ang -S,►II � Sink -Bt r/t avatory -Brtdley - -Commercial -Service Switruninit Pool Filter Washer-Clothes Water Extractor _ Water Closet-Toilet _ Urinal _ Other Fixtures: i:\Dra\Permit Forms\PlmPemitAppPg2 doc 01103 i I CITY OF TIGAR[D 24-flour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVIPION Business Line: (503)639-4171 MIST -- -- - _ BUIP Received _ Date Requested,-,.—_q_- 3 AM.6,k'GM ---- BUP -- - - _ Location Suite MEC Contact Persor, —_-_— -- Ph(----) PLM Contractor Ph(-) _ _ SWR _BUILDING Tenant/Owner _ _— _ — ELC Fo_ oting ---- - --------- --— Foundation ACCQSSELC FAccess. Drain Q ,� Crawl Drain '� / �C ELR Slab Insp Post&Beam Inspection Notes: SIT Shear Anchors — ^ ----- Ext Sheath/Shear - Int Sheath/Shear - -- ---- Framing - --- Insulation Drywall Nailing -_-__ Firewall -- _ -- Fire Sprinkler -- --- Fire Alarm Susp'd Ceiling Roof - Other:_ ------. —. -- Final -- .---- -- ' ------- PASS PART FAIL -- P_L_UMBING � Post& Beam --_ ----- Under Slab Rough-In - ---- --- ary ewerD "— am�rains� Catch Basin/Manhole — ------- Storm Drain Shower Pan Ot --- - - - PA PART FAI_ NI - -- - --- ---. HACAL _ Post& Beam _ — Rough-In Gas Line - - -- - Smoke Dampers _. Final --- -- PASS PART FAIL bECTRlCAL Service Rough-In -- _----- - _ UG/Slab --- ------- Low Voltage — — ire Alarm Final ---- Final Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd PASS PART _FAIL _SITE— _ 0 Please call for rei spect.on RE —._ Unable to inspert-no access Fire Supply line ADA Approach/Sidewalk Date- -- -� Inspector-- / Ext------...-- Other: Final DO NOT REMOVE this Inspectlur: rocord from the Job site. PASS PART FAIL.