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11620 SW NORTH DAKOTA STREET-1 IS VIOHVa NlaON MS OZ9 i H x a 0 z a N �D r r 11 420 SW NORTI I DAKOTA ST r CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00630 13125 SW Hall Blvd., 'Igard, OR 97223 (503)639-4171 DATE ISSUED: 12/18/03 SITE ADDRESS: 11620 SW NORTH DAKOTA ST PARCtL: 1S134CA-04200 SUBDIVISION: BURLWOOD NO. 2 ZONING: R-4.5 BLOCK: LOT: 015 JUR#601CTION: TIG CLASS OF WORK: REP 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 DRPiNS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATEP LINE: 30 ft DISHWASHERS: RAIN DPAIN: ft Remarks: Repair of approximately 30'of water service. FEES Owner: — Description Date Amount KEL.L.ER, SASCHA A +APRIL D IPLUMBI Permit Fee 12/18/03 $72.50 11620 SW NORTH DAKOTA ST TIGARD, OR 97223 [TAX]R"/"State Surr.har! 12118/03 $5.80 �=www==�J Total :78.30 Phone Contractor: APOLLO DRAIN +ROOTER SERVICE 2208 NW BIRDSDALE #8 GRESHAM, OR 97030 REQUIRED INSPECTIONS Phone : 239-8801 Water Service Insp Final Inspection Reg#: MET 00003082 LIC 49418 PLM 26-5331113 a aR M This permit is issued subject e regulations to thcontained in the Tigard Municipal Cc•le, State of OR. m t 0 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 sued-By: Permittee Signature: Call(503)/639-4175 by 7:00 P.M.for an Inspection needed the next usiness day Built ig Fixtures Plun 'ng Permit Ap,�licatioa RhC1V� Plumbing Date/B : �� lg OS Permit No.: I/'%V'4 City of Tigard Planning Approval S--wer Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/BPermit No.: Phone: 503-639-4171 "rax: 503-593-1960 Post-Review land Use ---' Intcniet: www.ci.tigard.or.usDue'By: Cue No.: Contact y� See Page 2 or 24-hour lrspection Request: 503-639-4175 Name/Method: �V I Supplemental Information. TYPE OF WORK FEE*SCHEDULE(for special Information use c-beemist) New construction ' Demolition _ Description Qty- IFee(ea.) Tota Addition/alteration/re_elacement Other: Now 1-R 2-family dwdllop CATEGORY OF CONSTRUCTION seluda 100 R fir each essgregNs11 1 & 2-Family dwellingSFR(1)bath 249.20 Commercial/Industrial SFR 2 bath _ � 350.00 AccessoryBuildi�_ Multi-Family SFR 3 bath 399.00 Master Builder Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire s rinkler-sq. ft.: PPSC 2 Job site address: Site Utilltlp Suite #: --Bldg./Apt.#: Catch br ;in/area drain _ 16.60 Project Name: Dr veil leach line/trench drain 16.60 Cross street/Directions to job site: Footing drain(no. linear ft.)- Pae 2Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 _ _ S sitar y sewer no. linear ft. Pae 2 Subdivision: Lot#: Storm sewer no. linear ft. Pae 2 T'ax ma /parcel #: Water service no. :inear ft. p 2 DESCRIPTION OF WORK Flit re or Its Absorption valve 16.60 Backflow preventer _ Pae 2 Backwater valve _ 16.60 Clothes washer 16.60 - Dishwasher 16.60 _ Drinkin fountain 16.60 PROPF�RTY 1WNB1t TENANT Drinking 16.60 Name: Expansion tank 16.60 _ Address: Fixture/sewer cap 16.60 City/State/Zip: Floor drain/flaor sink/hub 16.60 -- Garbage dis Dsal 16.60 Phone: Fax: Hose bib 16.60 fJ A VLICANT I 000RT-kc-TPERSON - Ice maker 16.60 Name: Interceptor/grease trap 16.60 Address: Medical gas-value: S Pae 2 City/State/Zip: Primer 16.60 4. - -- Roof drain(commercial) 16.60 Phone: _ Fax: Sink/_basin/lavato , 16.60 i' E-mail: Tub/shower/shower an 16.60 U) _ U) CONTRACTOR Urinal- 16.60 Water closet Business Name: E �(,)(�/� l.�/t A� 1 u /L 16.60 Water heater 16.60 p� Address: �a �)W 3lydsdau 54 - - Other: t, Cit /State/Zi ( S m J'�c 9 J� Other: uJu Phone:a)3 0- lP Fax _ Plu Perak Fm* CCB Lica 9 Ll t Plumb. LicA _ Subtotal S Authorized Minimum Permit Fee 572.50 S 7 L� 7. � Residential Backflow Minimum Fee$36.25 Signature: \� `a Date: -_� Plan Review(25%of Permit Fee) S _ State Surcharge g%of Permit Fee S (Please print name) TOTAL PERMIT FEE I S C Notice: This permit application expires If a permit Is not obtained within All new commerclal buildings require 2 seta of plans with isometric or Igo days after It has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri-County Building Indust,;Service Board. i Dsts\Permit Fomu\PlmPermitApp doc 01/03 r Plumbing Permit_A".iication - City of Tigard y. Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: _ Site UiiUtles Qtr• pee TOW Square EoYj Q . Permit Fee: _ Footing drain- I-100' 5500 0 to 2,000 $11500 Footing drain-each additional 100' 4b,40 2.001 to 3,600 S160 00 — 3,601 W 7,200 5220.00 Sewer- I st 100' 55.00 7,201 anndgreater S309.00 Sewer-each additional I lX1' 4640 Water Service- Is(100' 55.00 Medical Gas S stems• Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Thain-Ist 100' 55.00 S1.00 W 55,00000 Minimum fee$72.50 Storm&Ran(rain-each additional 10'm' 640 S5,001 00 to S10,000,00 572.50 for the first$5,000.00 and 51.52 for each additional$100.00 or fraction thereof,to and Fixture Or Item Qtr. A ea) Tetal including$10,000.00. Commercial Back Flow Prevention Device 46.4 SIO,Og1(x to 525,01)0 00 5149.50 for the first S10,000.00 and 51.51 for Residential Backflow Prevention Device each adpitional 5100.00 or fraction thereof,to minimum permit fee 536.25 27.55 and including S25,000.00. Rain Drain,single family dwelling 65,25 525,001 00 to 550,000 00 5379for the first 525,000.00 and S 1.45 for each1cl ditional 5100.00 or fraction thereof,to Inspection of existing plumbing or and udin S5550,000.00.Subtotal: s dally MOM inspections-per I72.50 550,001(10 and up $7 .00 for the first S50,000.00 and SI_20 f-or Subtobto tal: e h additional$100.00 or fraction thereof. Fixture 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*. amil tore Work Itwbrmed Co ents regarding fixture work: Fixture TrPr. New Mored Baptistry/Font Bath -Tub/Shower _ -Jacuzzi — Car Wash -Each Sull _ -[rive 11mru Cuspidor/Water Aspirator — Dishwasher -Commercial _ -Domestic — Drinking Fountain Ey-Wash _ Floor Drain/sink 2" 3^ -4" Car Wash Drain *Note: If the fixture work un er this permit results in an Garbage -Domestic d Disposal Commercialinerecse of sewer EDUs,s.sew rmit will be issued and -Industrial _ fees assessed for the sewillt increa must be paid before the NIce Mach./Refs .Drains plumbing permit can be issued. Oil Separator Gas Station Rec.Vehicle Dump Station Shower -Gang M -Stall 0 Sink -Bar/lavatory _ J -Bradley Commercial -Service Swimming Pool Filter Washer-Clothes Water Extractor Water Closet-Toilet Unnal Other Fixtures: i\Dsts\Permit Fortns\PlmPermitAppPg2 doc 01'03 CITY OF TIGARD 24-Hour BUILDING • Inspection Line: (503) 178 . INSPECTION DIVISION Business Llnv: (543) 71Mt3T 1 01 BUP Received F-X Date Requested —U.3AM _ P _ SUP Location Suite MEC Contact Person _ v L — Ph _ _V&i? "' PLM Contractor Ph(--) __ SWR BUILDING - Tenant/ er ELC Footing ELC Foundation Access: — Ftg Drain ELR Crawl Drain Slab Inspection Notes: _�.O O SR Post&Beam ____ Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing --- -- Insulation Drywall Nailing — — Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling — -- — Roof 11 Other: — Final PASS PART FAIL PLUMBING _ _ Post& Beam Under Slab Roug watp�Se�mvjjce�7 -- Sanitary Sower Rain Drains — Catch Basin/Manhole Storm Drain — ShowerPan Other: Fi --- SS PART FAIL MEAK_ANICAL_ Post&Beam Rough-In — Gas Line 1. Smoke Dumpers -- C Final PASS PART FAIL - — ELECTRICAL Service 0 Rough-In UG/Slab ;j Low Voltage Fire Alarm Final Reinspection fee of S_— required before next inspection. Pay at City Hall, 13125 SW Hap 81 11. PASS PART FAIL SITE F] Please cell for reinspection RE: U Unable to Inspect—no scows Fire Supply Line ADA Approach/Sidewalk Daft /0 V4� LR-- � � Other: Final DO NOT REMOVE this IelspeedeA ileeorr hen Me job S&L PASS PART FAIL CITY„ OF TIGARD 24-Hour BUILDING • Inspection Line: (503)6311.4175 , MST INSPECTION DIVISION Business Line: (503)639-4171 BUP Received ' t ` Date Re ested _ T AM.-. PM OUP Location �� Sf Suite MEC Contact Person _.. Ph( ) PLM &7_ '323 1 Contractor. _ Ph( ) _ SWR -� BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT __— Post&Beam Shear Anchors - Ext Sheath/Shear _ frit Sheath/Shear !•raming Insulation Drywall Nailing - - Firewall Fire Sprinkler - - -- Fire Alarm Susr'd Ceiling Roof Other: - Final PASS PART FAIL -- - MBIN y am Under Slab _ Rough-In Water Service --- - -- Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Sh an PA PART FAIL --- CIIANICAL Post R Beam Rough-In Gas Line Smoke Dampers - -- Firal N PASS PART FAIL _ --- - - ELECTRICAL ,J Service m Rough-In j UG/Slab W Low Voltage Fire Alarm Final El Reinspection fee of$ required before next i PASS PAP IT FAIL P - inspection. Pay M City Hell, 13125 3W Hall Blvd. SITE F-1 Pledse call for reinspection RE: -. Unable to Inspect-no access Fire Supply Lwq ADA „0 Approach/S'Iv,alk Osb lit> .5 - Id rapeor -- --iti;d Other: _ Final DO OT REMOVE this InspeWon record from filo fob sits. PASS PART FAIL