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` CITY OF T I G A R D __ PLUMBING PERMIT _
\ DEVELOPMENT SERVICES PERMIT M PLM2001-00331
13125 SW Hall Blvd.,Tigard, OR 9"223 (503) 639-4171 DATE ISSUED: 8/6/01
SITE ADDRESS: 12345 SW HAI-L BLVD PARCEL: 2S102AA-03301
SUBDIVISION: TIGARD TERRACE APT. ZONING: CB
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: 'ALT GARBAGE DISPOSA1_-: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: P1 FLOOR DRA"NS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: -SF RAIN DRAINS:
SINKS: URINALS. GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: 20 'ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft.
Remarks: repair apprcximaoely 20'sewer line.
FEES
Owner: —� ------ --- --
-- -- — Type By Date Amount Receipt
GREENVIEW INVESTMENTS, INC PRMT CTR 8/6/01 $72.50 27200100000
5229 SE HILL_ RD 5PCT CTR 8/6;'01 $5.80 27200100000
PORTLAND, OR 97267 --
Total $78.30
Phone 1
Contrdctor:
APOLLO DRAIN 4 ROOTER SERVICE
2208 NW BIRDSCr�LE #8
GRESHAM, G,t 97C'30 tZEQUIRED INSPECTIONS
Phone 1: 239-8801 Water Line Insp
Reg #: LIC 00049418 Final Inspection
PLM 26-533pb
This permit is issued subject to the regulations contained in the Tigard NPRinicipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will he done in accordance with approved plans.
This permit will expire if work is not started within 180 clays of issuance, or if work is suspended gar more
than 180 days. ATTENTION: Oregon law reauires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth 'n OAR 9`'42-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by ca!!in (503) 246-1987.
Issued By: C� f �� ; ->_ ,�1 �' Permittee Signature: /
G � —_moi-.� __ _
Call (503)639-4175 by 7:00 P.M.for an Inspection needed the next bu SAeSS day
Plunibmi g Permit App ' anon W
"Daterecei"ved: (0/0i Pernitno.: �JZlYJ1 -Gl y
A� ICity of Tigard
Sewer permit no.: Building permit no.:
Addr•es. 13125 SW Halt Blvd,Tigard,OR 97223 ---
City of Tiger i Phone: (503) 639-4171 Project/appl.no.: Expire date: ---
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Cace file nP.. _ Payment type:
U 1 &2 family dwelling or accessory U Conmlcrcial/industrial tca.rily 'U Tenant improvement
U New construction U Addition/alteration/replacement U food seri ice U Other:
�
Job address: '2311 /-Jp-kk 1.,, Description _ . .ee(ea.) Total r
7---- Npw 1.and 2-taniily dwellings onii:
Bldg.no.: Suite nu.:
Tax ma /lpx lo_Uaccount no.: — `---- (includes IU011.for each urillq,ce.nn-.tionl
P SFR(1)bath
Lot: Block: Subdivision: T SFR.(2)bathe
Project name: _ SFR(3)bath
�-- _ ZIP: Each additional hath/kitchen
City/county: 'Tr qi2
Description and local ion of work en premises:_�:c�•r Qc�w;5 SiteutflfNwe:
—� Catch basin/area drain I
Int,date of cr.mpletion/inspectirnl: - Drywells/Icach line/trench dr_in _—
I 1 Footing drain(no. lin. ft.) -
Manufactured home utilities
Manholes — -- _ ---
Address: ;�a Uu�F !lir.� r ,r a S�I. l *r 4: _ Rain drain connector _
City: G."r s�w.,,� — state: ZIP: Sanitary sewer(no.lin. ft.)
Phone: 239 pq p Fax: • _ E-mail: Storm sewer(no.lin.ft.)
CCB no.: `AI'll I Plumb.bus.reg.no: Water service(no. lin. ft.)
City/metro lie.no.: :P (v/ _fir Fixture or Item:
Absorption valve
Contractor's representative signature: �__
Back fl-�w preventer _
{Tint name: + �- - frtic 4'' L C) Backwater valve
1 Basins/lavatory
Name: Clothes washer
—— _— Dishwasher —
Address: _
- --- Drinking fountain(s) _
City: — State: 7tP: - Ejectors/sump
Phone: Fax E-mail: _Expansion tank
Ak —
Fixture/sewcr cap _
Name(print): Floor drains/floor sinks/hub —
Mailing address: Garbage dis sal
- Hose bibb
City: —� -_ State: ZIP:_ _ Ice maker —
Phone: --- Fax: —� Tmail: Interceptor/grease truce_
Owner instal lation/residential maintenance only: The actual installation Primer(s) _
will be made by me or the matntenau-^ 'd repair made by ,y regular Roof drain(commercial)
employee on the property 1 own as per ORS Chapter 447. Sink(s), astn(,,), ays(s) _
Owner's A nature: Date: Sump
Tubs/shower/shower pan
Name: Urinal -
- — Water closet
Address: _ Water heater
City: '�_ State: ZIP: Other: - — —
i
Phone- Fax: — E-mail: Total
Nei all Jurisdictions xcept eredlt cards,please call Jurisdiction rex more inrexmati11 Minimum fee................$
Notice:Phis permit applictainn _
U Visa U MasterCard expires if a permit I's not obtained Plan review(at — %) $
Credit card number � within 180 days allei it has been Stale surcharge(8%)....$ _ U
E!,pirce
--- — accepted as complete. 'TOTAL .. ..................$ 7 E 3
Name----of car.lh-old as a own on ued-fl cad
_ S _
Cattawider signature — A mrnmi 44W616 taW'COM)
PLUil.' LING ;HERMIT !SEES:
-' PRICE TOTAL If New 1 and 1-famlly dwellings only
FIXTURES individuate_ QTY- ea AMOUNT I (includes all plumbing fixtures in PRICE TOTAL
Sink 11'.60 the dwalling and the first100 ft. CTY (ea) AMOUNT
th 60- _for each_2!11!!y
vat -
Laory - _- One 't bath ro249.20
Tuber Tub/Shower Comb- - 16.60 Two 2 _bath --------- $350^0_
Shower Only _--- 16.60 Three 3 bath - $399.u0 _
Water Closet --~ 1660 SUBTOTAL
Uriral 16.60 8%STATE SURCHARGE
DiGhwasher 16,60 _ PLAN REVIEW 25%OF SUBTOTAL - --
! garbage Disposal 16.60 TOTAL
Laundry Tray i - 16.60 -'
Washing Machine 16,60
Floor Drain/Floor Sink 2" _ _ 1h.60 PLEASE COMPLETE:
4- -- - 16.60 -
-
Q Ilke kind 6 u0 Quantity b Work Performed
Water Heater O conversion i - --
Gas piping requires a separate mechanical Fixture Type: New Moved Roplaced Remuvedl
hermit. _ _ _ Capped_
r
Home New Water Service 46.40 Sink
Lavatory
Home New San/Storm Sewer 46.44 Tub bi anon crverBibs16.60 Combinaiion Drains 16.60 I_Shower Onlying Fountain 1660 Water Closet
1150 Urinal
Other Fixtures(Specify) - _ Dishwasher _
__ Garba a Disposal _
- Laundry Room Tray -�
- - - - - -- Washing Machine
Floor Drain/,Ink: 2"
Sewer- I st 100' 55.00 3„
Sewer-each additional 100' 46.40 -� 4" _
Water Service-Im t00' 55.00 Water Hcale—
Water Service-each additional 200' 46.40 Other Fixtures
Shrm 8 Rain Drain-1st 100' 55.00
SU rrm 8 Rain Drain•each additional 100' 46 40 — --
Ccmmercial Back Flow Prevention Device 46.40 - - -� _--
Residential i;ackflow,Prevention Device" 27.55 --- - -�
16.60
1 Ca tch Basin
In•ipection 1 Existing Plumbing or Specialty 72.50
Re uestetrispections _ per/hr COMMENTS REGARDING ABOVE:
Rain Drain,si-i.ale family dwelling 1,5.25 —
Grease Trans — 16.60 ^-- —
`! QUANTITY TOTAL _ _-
Isome.,ic or riser diagram Is required If
Ouantlty Intal is >0 (,/ ----
'SUBTOTAI-
----- - - -'--
8%STATE SURCHAF:GE ---- --
"PLAN REVIEW 25%OF SUBTOTAt
Required onlyit Ilxlure i�total is`9
TOTAL
'Minimum permit fee is$72 50.e%state surcharge,except Residential Backflow
Prevention Device.which is S36 25•B%state surcharge
"All New Commercial B-.-ildings require plans with Isometric or riser diagram and
plan review
1:W9ts\forms\plm-fees doc 10/10100
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 ------
Q UP _
Date Requested U _ AM PM.�GC�. BLD _ T
Location Z _ Suite — MEC
Contact Person1� Ph A3 C7 - ��'��' % PLMt 3
i_
Contractor ph SWR
BUILDING Tenant/Owner ,mac- 2c, —ELC
Retaining Wall ELR _
Footing Access: v
Foundation FPS
Fig Drain SGN ------__�_
Crawl Drain Inspection Notes
Slab
Post&Beam / -- SIT -- - —
Ext Sheath/Shear (p C y1�
Int Sheath/Shear ��-
Framing
Insulation - -- -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: _ -- - ---t— - —--- -
Final
PASS PART FAIL
PLUMBING rr
Post& Bearn -
Under Slab - !
Top Out -
Water Service
r ary ewer
.Baip ra ns �'<�G ------ ------
AS PART _
IWEUHANICAL G.
Post& Beam --
Rough In i
Gas Line -- - �- —
Smoke Dampers
Final --------
PASS PART FAIL
ELECTRICAL_ ----
Service
Rough In -
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Sturm Drain ( )Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ) Unable to ease call for reinspection RE: Inspect-no access
Fire Supply Line ( )
ADA
Approach/sidewalk O Date { Ins for r
Other �.r—Inspector. `e csdt, Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the limb site.