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15070 SW 92ND AVENUE-1 a Q V a U) ca n� cl a c 15070 SW 92"" Avenue CITYO F TI ICA R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2002-00381 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/24/02 SITE ADDRESS: 15070 SW 92ND AVE PARCEL: 2S111DB-14100 SUBDIVISION: LAUNALYNDA PARK. BLOCK: LOT: 028 ZONING: R-4.5 ---__ JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: TYPE OF USE: SF MOBILE. HOME SPACES: OCCUPANCY GRP: R3 WASHING MACH: BACKFLOW PREVNTRS: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: _ FIXTURES. LAUNDRY TRAYS: CATCH BASINS: SINKS: SF RAIN DRAINS: LAVATORIES: OTHER FIXTURES: GREASE TRAPS: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE. ;0 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace 50'water line. Owner: _ FEES LACEY, THOMAS R fPRMT ype BY Date Amount Receipt t 15070 SW 92ND AVE CTR 9/24/02 $72.50 27200200000TIGARD, OR 97224 PCT CTR 9/24/02 $5.8027200 200000 Phone 1: Total $78.30 Contractor- 3 MOUNTAINS PLUMBING PO BOX 386 SHERWOOD, OR 97140 REQUIRED INSPECTIONS Phone 1: 503-925-1342 Water Line Irsp Reg #: LIC 141187 Final Inspection PLM 34-368PB 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: 1 -��-4 Permittee Signature: _ Call (903)639-4178 by 7:00 P.M. for an Inspection needed the next business day Building Fixtures Plumbing Permit Application, OFFICE.USE ONLY City of Tigard Date received: a.Y Q y Permit no.: hP014 - d U Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.: City of Tigard Phone: (503) 639-4171 Project/appl. no.: Expire date: Fax: (503) 598-1960 Date issued: BReceipt no.: Ladd use approval: Case file no.: Payment type: I &2 family dwelling or accessory ❑Cornmercial/industrial ❑Multi-family U Tenant improvement New construction ddition/alteration/replacement O Food service ❑Other: MUM Job address: S 0 7 O .4 t� `j is ^" ✓� ✓C Description Qty.J Fee(ea.) Total Bldg. no.: Suite no.: New I-and 2-family dwellings only: Tax map/tax lot/account no.: (includes 100 ft.foreach utility connection) Lot: Block: Subdivision: SFR(I)bath Project name: j ori, SFR(2)bath �°' � SFR(3)bath City/county: I 1 5 C41, Z w4",r ZEach additional bath/kitchen Description and location of workn premises: Site utilities: W`l{" )` -vi Lt I VIS ^� Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drain Footing drain(no, lin.R.) Business name: Manufactured home utilities 3 r h v 0 £tri Manholes Address: i 0 0 Rain drain connector City: (,t,ti o.�� State: Ort ZIP: e i 0 Sanitary sewer(no. lin. R.) Phone: 9 2 S-- /1 'L Fax:tj I -� h oly E-mail: Storm sewer(no. Iin. ll.) — CCB no.: j/ g7 Plumb.bus,reg. no: Water service(no, lin, ft.. p 5- City/metro lic.no.: pity 0 00 06316 Fixture or Item: Contractor's representative signature Abso tion valve Print name: ,� ( Back flow reverter r' ate: -2 mz Backwater valve tPERSON Basins/lavatory Clothes washer "Address: Dishwasher — Drinking founlain(s) State: ZIP: Ejectors/sump I'ax: E-mail; Expansion tank fixture/sewer cap Name(print): Floor drains/floor sinks/hub Mailing address: Garba w disposal City: State: close bibb 7.IP. Ice maker Phone: Fax: E-mail: Interceptor/greasetra Owner instal lation/residential maintenance only: The actual installation Primers) will be made by me or the maintenance and repair made by my regular Roof r�air(commercia) employee on the property I own as per ORS Chaplet 447, Sink(s),basin(s),lays(s) owner's si nature: _Date: Sump Tu S/shower/shower pan Name: Drina _ Address: Water closet Water eater City: State: ZIP: Other: ---- Phone: Fax: E-mail: ota Nm all juriuliclione accept credit arde,please all)uriedicllon for mm info mstion Minimum fee................ $ S'f. G ✓cam �� I visa U Maslcrc'ard Notice This permit application plan review(at "/o) S _ a expires if a permit is not obtained Credit cad umbar, y!1 5 ).1 -i 3 r y -U I J u V State surcharge(8%).... S _�''b 0 �1,�.�,�_ "--� -- — :ages — within 180 days after it has been ams nrcar lde�aa lhown o u�.rd—� accepted as complete. TOTAL........................ S 19 30 - d eis rurc —.- S Amooei x111.1616(6I(NMc0M) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-fantlly dwellings only: FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 f1. QTY (e;,} AMOUNT rY 16.60 _ - for each utility connection) Lavatory - One 1 bath _ $249.20 Tub or Tub/Shower Comb, 16.60 _ Two 2''bath $350.00_ Shower Only 16.60 Three 3 bath $399.00 Water Closet 10.60 - - --- _ _ Urinal 16.60 - SUBTOTAL8%a STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%.OF SUBTOTAL Garbage Disposal 16.60 - TOTAL Laundry Tray 16.60 -` Washing Machine 16.60 1 Floor Drain/Floor Sink 2- 16.60 3" - - 16.60 - - PLEASE COMPLETE: 4" 16.60 Water Heater O conversion O like kind 16.60 Quantity 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 -Lavatory Tub or Tub/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 Tray Washing Machine Floor Drain/Sink: 2" Sewer-1 at 100' 5500 3„ Sewer-each additional 100' 46.40 4" Water Service• 1st 100' 55.00 Water Healer Water Service•each additional 200' 46.40 Other Fixtures Storm&Rain Drain•1st 100' 55.00 (Specify) 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 62.50 Requested Inspectionsper/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 _ QUANTITY TOTAL Isometric or riser diagram Is required If Quantity Total Is a a 'SUBTOTAL ---- __ B%.STATE SURCHARGE "PLAN REVIEW 25%.OF SUBTOTAL Required only II fixture qty total Is>e TOTAL a Minimum permit fee Is$72 50•8'Y state surcharge,except Residential Backfiuw Prevention Device,which Is$36 25•899 state surcliarge "All Now Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. 1\dsls\fonns\plm-fees.doc 12/26/01 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Line: (503) 539-4171 SUP Received _ - Date Requested- AM-__ PM BLIP _ Location 5 o :zU �j �= Shite _ MEC _ G —- - - — Ph ) `j PLM Contact Person �OZ�� _ Contractor --- Ph ( ) _ _ SWR _. r DING Tenant/Owner - ___ _- _ ELCg ELCounation Access: , c /4r�, ELR -- - Ftg Drain l J Crawl Drain - SIT - Slab Inspection Notes: Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other:_- Final T FAIL - AAl®r Warn Under Slab Rough-In Vvate�tvt�:> S-ani ary�ewer Rain Drains Catch Basin /Manhole Storm Drain Shower Pan *NMMEA PART FAIL _ NICAL _ - Post&Beam _ Gas Line Smoke Dampers -_-_----_- - - --- ------ ----------------_.._�.-- Final PASS PART FAIL - -- - -�-�- ELECTRICAL --- -- - - - -- -- --- -- --- - Service _ Rough-In _�---_ --- --- --- -- - - UG/Slab Low Voltage ------ ------- -- Fire Alarm Final �� Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 5W Hall Blvd. _PASS PART _FAIL Unable to Inspect-no access Please call for reinspection RE: _ F] Fire Supply Line -7ADA Date-<� -`--�t� Inspector 1t - Approach/Sidewalk Other: ..--------- - Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL