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10300 SW MEADOW STREET-1 i �I is moav3vi MS 00£OL 1: r: I I 0 _ a C'7 O m f' W 1 10300 SW MEADOW ST -r, , « CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BLIP --- A_Datr tRequested �'�/ AM —PM _ BLD _ — Location- GU .S4! 14.00 Suite MEC 7- 3 Z-.-- Contact Parson Ph �-(��– �Y 2�"� ALM Contractor_ __ Ph _ SWR - ---- BUILDING------ Tenant/Owner ELG Retaining Wall ELR _ Footing Access: Foundation FPS -- Fog Drain Crawl Drain InspecK n Notes: --'—' Slab __ — SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear O Framing �_ 41'-'n a (e 4✓�_ ev 4 dt.*lalr�N✓/ Insulation Drywall Nailing — Firewall Fire Sprinkler _- G A S e Fire Alarm Susp'd Ceiling - - Root Misc: ---- Final PASS PART FAIL. - - PLUMBING Post&Beam Under Slab Top Out Water Service _ Sanitary Sewer Rain Drains _ Final PASS PART FAIL Post&Beam - Rough In Gas Line - -- S-oke Dampers Fi S PART FAIL _ ELECTRICAL IL Service F Rough In N UG/Slab Low Voltage Fire Alarm i Final _m PASS PART FAIL SITE J Backn!!!r'rading - Sanitary Sewar Storm Dram [ ]Reinspection fee of 3 required before next inspection. Fay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ]Please call for rainsFection RE: [ ]Unable to inspec!-no access ADA }.� Approach/Sideway ,� Date /_'�-0/ Inspector 1""-r _ _Ext�� Other —�_ Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site. /' CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hdur I601pection Line: 639-4175 Business Line: 639-4171 — IBUP Date Requested �� AM- L/PM _ BLD Location CGU 5,v Al-we,d``✓ s,1' Suite MEC Contact Person2 _ Ph Cdr �Z. Z ' PLM _ Contractor ✓' Ph SWR BUILDING Tenant/OwnerELC Retaining Wall r .__ --- ELR �7 Footing Access: Foundation FPS - Fig Drain SGN Crawl Drain Inspection Notes: ---- Slab _ SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Frarning Insulation Drywall Nailing 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 --- PASS PART FAIL MECHANICAL Post&Beam Rough In Gas Line Smoke Dampers s �^� l Final PA PART FAIL Y q / cTRIC --�- -- Rough In UG/Slab Low Voltage �- F' 20 PASS ART FAIL W Backfill/Grading —` -- S3nitary Sewer Storm Drain ( ]Reins[-ection fee of J required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line i ]Please call for reinspe,�non RE: 7—_��( l Unable to Inspect-no access ADA Approach/Sidewalk Date _ — 0 Inspector Ext Other -— - Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site. CITYO F T I G A R D ELECTRICAL PERMIT RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT 0: ELR2001-00187 13125 SW Hall Blvd.. T'loard, OR 97223 (503)6394171 DATE ISSUED: 7/5/01 SITE ADDRESS: 10300 SW MEADOW ST PARCEL: 1S135CC-01800 SUBDIVISION: THE MEADOW ZONING: R-4.5 BLOCK: LOT: 007 JURISDICTION: TIG Prolect Description: Installation of restricted energy for HVAC system. A.RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: AUDIO&STEREO: INTERCOM &PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: X DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: r -QTAL#OF SYSTEMS. Owner: Contractor: SUDENGA, CHARLENE M WESTERN PACIFIC HVAC 10300 SW MEADOW ST 1120 SE 23RD CT TIGARD, OR 97223 GRESHAM, OR 97080 Phone: Phone: 503-481-4822 Reg#: LIC 134606 FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 7/5/01 $75.00 2720010000 Elect'I Final 5PCT CTR 7/5/01 $6.00 2720010000 Total $81.00 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 4. 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 952-001-0010 through OAR 952-0(M0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246-1987. Issored by Permittee Signature J ID OWNER INSTALLATION ONLY C9 — -J The Installatinn is being made on property I own which Is not Intended for sale. lease,or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. FLEC'N: _ DATE: LICENSE NO: Call 639-4175 by 7:00 P.M.for an Inspect!en heeded the next business day Electrical PerinitApplication Datereceivrd: 7 0/ Permit no.: —ev City of Tigard Project/appl.no.: Expiredate: City u(Tixar,/ Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: B ecciP t no.: Y _L_ Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval _ U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/r,placement U Other: - U Partial Job address: f o 1,00 5 0 Vwk%V- +- Bldg.no.: Suite no.: ITax map/tax lot/account no.: Lot: _Block; Subdivision: Project natne. Description and location of work on remises:V Estimated date of cons letion/inspection: fO 1 .lob no: Fee max Business rams: —h— C,�> ;r_ H �/ ( Description (ea Total no.lna — New wsidandal-single or males-family per Address: �l�b S 2-_,-, C d►.rlurtglaN.lnctndrssfiachivltrrge. City: State:O 7.IP: Serd:rYrebderl: 1000 s .R.or leas 4 Phone:N -4 LZ. Fax: Email: — q CCB nu.: 4 b o Each additional 500 sq.ft.or pion thereof Elec.bus,tic.no: �� ' Limited energy,residential 2 City/mctrolic.no.: t3 p[2e-:, Li mi ted energy,non-residential 2 teach manufactured home or modular dwelling Signature of suE!!ising electrician(required) Datc _ Service and/or feeder— _ 2 Sup.elect.name(print): I License no: Services or feeders-Installdion, alteration or relocation: 200 amps or less 2_ Name(punt): 201 amps to 400 amps _ 2 _ - - -401 amps to 600 amps Mailing address: - 501 amps to 1000 amps 2 _ City: Stale: ZIP: Over 1000 amps or volts 2 Phone: Fax: I E-mail: Reconnectonl �- owner installation:The installation is being made on property I own Temporary services or feede"- which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation: 200 amps or less 2 ORS 447,455,479,670,701. ].01 amps to 4f10 amps 2 Owner's si nature: Date: 401 to 600 ams 2 Branch eircnite-new,alteration, or extension per panel: Name: A. Fee for branch,-rcoits with purchase of Address: service or feet_r fee,each branch circuit 2 City: State: ZIP: B. Fee for branch circuits without purchase IL -- of service or feeder fee,first branch ci.cuit: - 2 R Phone: Fax: E-mail: Each additional branch circuit: F- listimlimlMbc.(Senlce or feeder not Included): fA O Service over 225 amps-commercial U Health-care facility Each pump or irrigation circle — 2 O Service over 320 amps-rating of 1&2 U Hazardous location Each signor outline lighting 2 .J familydwellings U Building over 10,(100 square feet four or Signal circuit(s)or a limited energy panel, (n U System over 600 volts nominal more residential units in one structure alteration,or extension* _ - 2 U Building over three stories U Feeders.400 amps or more •Ikscrition _ W U(kcupam load over 99 persons U Manufactured structures or RV park FAch additional Inspectlon over the allowable In any of the above: U Egres0ightingplan U Other Per inspection r Submit_rets of plans with any of the above. Investigation tee_ The above are not applicable to temporary construction service. Other Cleati Not all jurisdictions wcep credit cards,pkae call jurisdiction for mom information. Notice:This permit application Permit fee..................... U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ „ j Credit card number: —_�__.___ within 180 days after it has been State surcharge(89b)....$Expires accepted as complete. TOTAL .......................S /= Now of cordMIXFoss on credit card $ Cardholder elpature Amounty- 440-4615(611)(WOM) Electrical Permit Fees: Limited Energy Fees: ' TYPE OF WORK INVOLVED-RESIDENTIAL ONLY Complete Fee Schedule Below: —Restricted Energy Fee...................................................... $75.00 _ Ilumber of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-per unl• 1000 sq ft or less $145 15—T 4 ❑ Audio and Stereo Systems Each additional 500 sq ft.cr portion thereof $3340 1 ❑ Burglar Alarm I-Imitod Energy $75.00 T v Each Manufd Home or Modular Garage Opener' Dwelling 3&vire or Feeder $90.90_ 2 Services or Feede Heating, entilation and Air Conditioning System' Installation,alteration,or ation 200 amps or less $80.30 2 Vacuu Systems' 2.01 arnps to 400 amps \— $ 2 401 amps to 600 ampsu 2 Other 601 amps to 1001 amps 2 ❑ --- � -- ----� Over 1000 amps or volts 2 Feconnect only 2 ONLY Temporary Services or FeedTYPE OF ORK INVOLVED -COMMER IALInstallation,alteration,or relocatFee for eac system.......................................................... $15.00 200 amps or less _ 2 (SEE O 918-260-260) 201 amps to 400 amps _ _ $100.30 2 401 amps to 600 omps —.Y $133.75 2 Check T pe of Work Involved: Over 600 amps to 1000 volts, see"b"above. Audio and Stereo Sya.ams Branch Circuits Boiler Controls New,alteration or extension per panel a)The fee for branch circuits ❑ with purchase of service or Gluck Systems Feeder fee. Each branch circuit _ _ $6.65 —� 2 Data Tolecommunication Installation b)The fee for branch circuits wtthouf purchase of service Fire Alarm Installation or feeder fee. First branch circult $46.85 AC i Each additional branch circuit $8.65 ❑ Miscellaneous C� �nstru talion(Service or feeder not included) Each pump or Irrigation circle $53.40 ❑ ntercom an aging Systems Fsch sign or outline lighting $53.40 Siynai circuit(s)or a limited energy panel,alteration or extension _ $75.00 Landscape Irrigati Control' Minor I abets(10) _ $125.00 ❑ Medical Each additional inspection over the allowable In any of the above Nurse Calls Per inspection �- $ 50 _ _ 62.50 InPlant $73 75 ❑ Outdoor Landscape Lighting" n, Fees; Protective Signaling f, Fater total of above fees / $ ._.-- - l_- G Ther --- U) 8%State Surcharge $ _Number of Systems „J 25%Plan Review F ' No licenses are required. Licenses are required for ail ottwr installations m See"Plan Revjpe section or $ front of a tkm. —. _ Fees: W Total Balance Due $ ----- Enter total of shove feesEl Trus'Tru::A,count 0_ 8%State Surcharge : Total Balance Due : -- i:\dsts\forms\etc-fees.doc 10/09/00 CITY OF TIGARD MECHANICAL PERMIT (DEVELOPMENT SERVICES PERMIT#: MEC2001-00232 1;1125 SW Hall Blvd.,Tigard,OR 97223 (503) 639-4171 DATE ISSUED: 'IS13 1 PARCEL: S135CC-01800 SITE ADDRESS: 10300 SW MEADOW ST SUBDIVISION: THE MEADOW ZONING: R-4.5 BLOCK: LOT:007 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: 1 VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: _ FUEL TYPES _ 0 - 3 HP: DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: 930.00,E BTU 15-30 HP: REPAIR UNITS: FIRE DAMPERS?: 30-50 HP: WOODSTOVES: GAS PRESSURE: 50+ HP: CLO DRYERS: FURN < 100K BTU: 1 _—AIR HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of 60,000 Btu furnace, ductwork, and gas piping Owner: FEES SUDENGA, CHARLENE M Type By Date Amount Receipt 10300 SW MEADOW ST PRMT CTR 6/25/01 $72.50 2720010000 TIGARD, OR 97223 5PCT CTR 6/25/01 $5.80 2720010000 Total $78.30 Phone: — - Contractor: WESTERN PACIFIC HVAC 1120 SE 23RD GRESHAM, OR 97080 _ REQUIRED INSPECTIONS Gas Line Insp Phone: Mechanical Insp Reg#:LIC 134608 Heating Unt Insp Final Inspection L r n to UThis permit is issued subject to the regulations container: in the Tigard Municipal Code, State of Ore. Specialty Codes and all other licable laws. All work will be done in accordance with approved plans. This permit will expire rk is not started within 180 days of issuance, or if work is suspended for moreMan 180 days. ATTE. .JN: Oregon law requires you to follow rules adopted in the Oregon Utilit 'Wotificatio enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. Yo may obtain co 'es of e e ules or direct questions to OUNC by calling (503 246-9189. Iss By: �4 Permittee Signature: Call(503) 639-4175 by 7:00 P.M. for Inspections needed the next buscess day Mechanical Permit Application ` Datereceival: 4-2S-0/ Permitn0JAILCLOW-00277- Citfy of Tigard Project/appl.no.: —_ Expire date: Cityq/Tigard Address: 13!25 SW Hall Blvd,Tigard,OR 97223 Date issued: BY: Receiptno.: Phone: (503) 639-4171 -- _ Fax: (503) 598-1960 Case rile no.: Payment type: Land use approval: Building permit no.: rNJ &2.family g or accessory U Cummercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/mplacement U Other: milli� Job address: Indicate equipment r;,mtitics in boxes below.Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ I.ot:~� Block: Subdivision: — ,See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City/county: Y T71P:Description and location of work on premises, 11 tet{= 1-- Fee( .) To1a1 Est.date of completion/inspection:_ beam Res.od Res.onl Tenant improvement or change of use: / r ' Is existing space heated or conditioned?U Yes U No Air handling unit CFM — Air conditioning(site plan rrequ reT)) Is existing space insulated?U Yea U No terauon of existing system _ 1"IlLWE 111KRIM III MIL "I Boiler/compressors Business name: r L State boiler permit no.: HP Tors BTU/II Address: 1/ZC_7 S£ L i smo aamperes Tuctsmo a detectors _ City: / Stalr,p ZIP: eat pun (site plan require _ Phone:�/ /-k Fax. E-mail: oats rep ace urnac urner -- Including ductwork/vent liner Yes U No , CCB no.: 1 y(� nsta rep ac re oeate eaters-suspcnaecr City/metro lic.no.: Ory U�(� (� _ _ wall,or floor mounted Name(please print): ant fora lance of oar than furnace Absorptionunits _ BTU/H Name: IkIzu P_;.:.) L.7) Chillers,_ _—___ HP Address: Compressors ^ tip _ Av rornaenta ex aaralt-a'�n vent ton: City: _ State: ZIP: _ Appliancevant Phone:Lt -G Fax E-mail: rycrex aunt _ Hoods,Type res. rte est�mat hood fire suppression system Name: a, t!vf e 5uV1 a _ ---�- Exhaust fan with sinrle duct(bath fans) Mailing address: Q lro,woz, Exhaust s stem_apa_n ram tca�n it AC IWI G u r Sta _ nR and lets) Tout S lfo Ty City: t te ZIP:'tZ z NuOil Fa : E-mail: er outlets each additional ov (schematic regurre 1) Number of outlets Name: W16i WA appliance or egalpment:-_- Addtess: Decorative fireplace City: _ State: ZIP: Insert-type Phone: Fax: I E-mail: Woodstovelpcllet stove — r: Applicant's signature: ate: Name(print}; tlacs�_ Notice:This permit application Minimum Permit J— inimumm fee Not all itniedictiom sempt cndit card,,plem roll Jwisdiction for rmtre information Notice: ................ 7� Ll Visa U MasterCard m ....... .......s _ expires if a permit is not obtained Plan review(at r ' ) unlit card nu nber — —/ _L__ within 180 days ager it has been t tpirr.nt cardholState surcharge(11%).... -` Name der es eMnvn on crafit circ-� accepted as complete.lTOTA ,_.....................$ Grdholder cigtanrre Amowl -- 71- '3U)r )_ 440.417(IYOtYCOM) -- !5�.' MECHANICAL PERMITFEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: T/'TAL VALUATION: FEE -------�--_ v�_ Description ^i--_ Pubs Tt;iz� $1.00 to=5,000.00 A Minimum fee$72.50- Table to Mechanical Code �Y (�) Amt -. - 11) Fu goo to 100,000 BTU 55,001.00 to$10,000.00 $72.50 for the first$5,000.00 and including ducts 8 vents 14.OU $1.52 for each additional$10n.00 or 2) Furnace 100.000 BTU+_ -- fraction thereof,to and Indudin® includingd cis d vents 17 40 $10 000.00. Floor Fum $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Indudin v nt _ 14��0 $1.54 for ezrh additional$100 00 or 4 Suspende heater,wail healer -frstion thereof,to and Including ) 14 00 _ $25 0.00 or floor nfed heater _ _ $25,001.00 to$50,000.00 $3'/9.%0i the fist$25,000.00 and 5) Vent no included in appliance permit $1.45ch additional$100.00 or - 6.80 fractioeof,to and Including 6) Repair nits $50 000.010 12.15 �! $50,901.00 and up $742.00 for lh �dlbonal $50,000.00 and Check all t.apply: Boller Heat Air $1.20 for each $100.00 or FurItems •11,see or� Pump Cond fraction th-edfootnotes low. Comp_ -- - 7)<3HP; sorb unit _ - - - to 100K T U 14.00 ASSUMED VALUATIONS PER APPLIANC -W)-5 P;absorb Value Total unit 1 to 500k BTU 25.60 Description: QtyEa nt 9)15 HP;absorb -� Furnace to 100,000 BTU,including 955 unit.1 1 mil BTU 35.00 ducts&vents _ - _ 10) -50 HP;absorb Fumace> 100,000 BTU Including 1,170 unlit mil BTU 52.20 -_ ducts 3 vents _ ---- 11 50HP:absorb Floor furnace Indudin vent 955 u >1.75 mil BTU _ 87 20 Suspended heater,wall heater or 955 1 )Air handling unit to 10,000 CFM floor mounted heater 10.00 _ Vent not Included In applicance 445 13)AIr handling unit 10,000 CFM+ mtil 17.20 Reoalr units 805 -. 14 on-portable evaporate cooler Y r <3 hp;absorb.unit, 955 10.00 to 100k BTU - 15)V t fan connected to a single duct 1 3-15 hp;absorb.unit, 7110 6.80 101k to 500k BTU --- 16)VentIon system not Included in 15-30 hp;absorb.unit,501k to 1 2,310 eppllapermit 10.00 mil.BTU _ 17)Hood se ed by mechanical exhaust 30-50 hp;absorb.unit, 3,400 10_00 1-1.75 mil.BTU 18)Domestic Innerators >50 hp;absorb.unit, -- 5,725 17.40 >1.75 mil.BTU 19)Commercial tx dusMal type Incinerator :I Alr handling unit to 10,000 cfm 658 1 69.95 Air handling unit>10,000 dm 1,170 20)Other units,Ind ng wood stoves�� Non-portable evaporate cocler _ 656 10.00 Vent fan connected to a single duct 446 i)Gas plp'np one to f r outlets Vent system nct Included In 6 _ 5.40 appliance ermit .22)More than 4-per oube each) Hood served by mechanical exhaust 5th _ _ 1.00 Domestic Incinerator 170 Minimum Permit Fee$72. SUBTOTAL: � CL Cormercial or Industrial Incinerator 41590 T v - Other unit,including wood stoves, 856 %State Surcharge F. Inserts,etc. W Gas i I 1-4 outlets _ 380 28!S Plan Rev l Fee Int subtotal) Each additional outlet 63 Required for ALL rdal permits only TOTALCOMMERCIAL $ TOTAL RESIDENTIAL ERMIT FEE: : VALUATION: - � �L�ljllfti4M sna F.sa: 1 Inspections outside of normal bhshine s hours(minimum charge-two hmirs) $72.50 per hair. 2 Inspections for which no lea is sprint fly Indicated (minimum charga-half hour) $72.50 per hour 3 Additionel plan rovl"w required by ctha adds ime or;wAsions to piens(rr.,nMnurn charge-one-half hair)$72 50 oar hour `State Contractor Boller CoMiftatlon rsqulmd for unfb 3-2M BTU. "Reeleentlal A/C mqutns oft plan ehaMng plvemonf of unNt. I:\dsts\fomislmech-fees.doc 11111/00 s CITY OF T'G A R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00271 13125 SW Hall Blvd.,Tigard,OR 97223 (503) 6394171 DATE ISSUED: 6/25/01 SITE ADDRESS: 10300 SW MEADOW ST PARCEL: 1S135CC-01800 SUBDIVISION: THE MEADOW ZONING: R-4.5 BLOCK: LOT: 007 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSAL:;: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRP INS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace electric water heater with new gas water heater. _ FEES Owner: — -- Type By Date Amount Receipt SUDENGA, CHARLENE M PRMT CTR 6/25/01 $72.50 27200100000 10300 SW MEADOW ST 5PCT CTR 6/25/01 $5.80 27200100000 T'IGARD, OR 97223 Total $78.30 Phone 1: Contractor. PACIFIC CREST PLUMBING 14547 SE MEGAN WAY CLACKAMAS, OR 97015 REQUIRED INSPECTIONS Phone 1: Final Inspection Reg#: LSC 93869 PLM 26-513PB a oc f- =� This permit is issued subject to the regulations contained in the Tigard Municipal f•fide State of OR. m P 1 g 9 P W Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. ....i 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 reap rsbfiain-copies of these rules or direct questions to OUNC by calling (503) 246-1987. Iss d By: �Q�� Permittee Signature: �`'- Call (503 39-4175 by 7:00 P.M.for an Inspection needed next business y Plumbing Permit Application Date received: Permilno.: LNC'/—GOo�7/ City of Tigard Scwer permit no.: Building pertnit no.: Address: 13125 SW Hail Blvd,Tigard,OR 97223 Cilvoj7igard phone: (503)639-4171 I'roject/appl.no.^_ Expire date.: Fax: (503)598-1960 Date issued: By: Receipt no.: Land use approval: _ Cass file no.: payment type: I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/re.placement U Food service U Other. _ I*wri tlon (!t . Fee ea. Total Job address: /; �) (j 1 vl _ t New 1-and 2-family dwellings only: Bldg.no.: Suite no.: Tax map/lax lot/account no.: -- (includes IOOIt.roreachutllhvconneclMn) SFR(1)bath Lot: — TB ock: Subdivision: SFR(2)bath Project name: SFR(3)bath City/county: ZIP: 9 7- Z Each additional bath/kitchen Description rnd location of work on premises:l-g[g _ SkeutNltles: O, } Catch basin/arca drain Est.date of completion inspection: Drywells/leach lineltret,ch drain ` Footing drain(r,o.lin.ft.) _ Manufactured home utilities _ Business name: r,4 PA-Ja' tri __ Manholes Address: SF— Rain drain connector _ City: �' State:�, LIP: oy Sanitary sewer(no.hn.ft.) _ Phone: z S"7-(,Vb0 Fax: E-mail: Storm sewer(no.lin.ft.) CCB no.: 93869 1 Plumb.bus.reg.no: TQ Water service(no.lin.ft.) City/metro lic.no.: Fixture or kem: Contractor's representative signature: Absorption valve Print mune: Date: 70 t Back flow reveuter Backwater valve _ Basins/lavatory Nanie: Q_ Clothes washer Address: Dishwasher City: State: ZIP: Drinking fountain(s) Ejectors/sum Phone: Fax: E-mail: Expansion tank Fixture/sewer cap Name(print): L 1,P V1 e S%j dem q e, Floor drains/floor sinks/hub Mailing address: e-4 d(c9 Garbage disposal I bibb City: 3 ¢y State:f9 ZIP: Q 7 2 2'� Ice maker Phone: Fax: E-mail: — Interccptortgrease trate___ Owner installation/residential maintenance only: The actual installation Primers) _ will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _ employee on the property I own as per ORS Chapter 447. Sink(s),hasin(s),lays(s) Owner's si nature: Date: Sum MR IN 10 Im Tubs/shower/shower pan Urinal Name: — Water closet Address: Water heater City: _ State: ZIP: Other: Phone: Fax: E-mail: Total infomu+tion Not all Jurisdictions accep credit cards,please call jurivdiction for rrkne Notice:This permit application Minimum fee................$ _7t9_- d!_ U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ Credit card numb": ___ State surcharge(8%) _.$ Expires within IRO days ager it has been accepted as complete. TOTAI. .......................$ Name of cardholder as shown on credit card S CoOdder sisnnatum _ Artrotmt 4404616(ISAWCOM) 1 PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dvvetlinpn WI : FIXTURES individual QTY ea AMOUNT (includes all plumMng fixtures in PRICE TOTAL Sink 16.60 the dwelling and the firs'100 ft. QTY (ea) AMOUNT 18.80 for each utility connectlon) _ Lavatory One(1)bath =249.20 Tub or Tub/Shower Comb. 18.80 Two 2 bath 1350.00 Shower Only 18.60 Three(3)bath _ $399,00 _ Water Closet 16.60 SUBTOTAL Urinal _76_60 8%STATE SURCHARGE 16.80 PLAN REVIEW 25K OF 8UBTOTAIL Dishwasher _— — TOTAL Garbage Disposal 16.60 — — Laundry Tray 60 Washing Machine 18. Floor Drain%Fbor Sink 2" 1660 PLEASE COMPLETE: g„— — 16.60 4" 16.80 - Water Heater O conversion O like kind 16.60 Q nti b Work Pe�-- Fixture Gas piping requires a separate mechanical Type: New Moved Replaced ) Removed/Capped unit. _ - MFG Home New Water Service 46.to pink — MFG Home New San/Storm Sewer 46.40 LavalorY Tub or Tub/Shower Hose Bibs 16.60 Ccxnbinatien _ Root Drains 16.60 _Shower Only Drinking Fountain 16.60 rin/Sink: Other Fix'ures(Specify) 16.60 l ra — e _ 2" _ Sewer-1st 100' 55.00 3" Sewer-each additional 100' 46.40 4" — Water Service-1st 100' — 55.00 % WateAFIxtus Otheater Service ePch additional 200' 46.40 S Storrs 6 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 ' Cate Basin 1 _ Inspection of Existing Plumbing or Specially i 12.50 Re nested Ins Ions er/hr COMMENTSIREGARGABOVE: Rain Drain,single Iamily dwelling 65.25 -- Groase Traps 16.80 -- QUANTITY T9 AL _— Isometric or riser diagram Is.ref♦ulred 9 Quantity Toth Is >9 "SUBTOTAL — 814 fTATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL Required only if fixture t .total Is>9 VOTAL S "Minimum permit fee is$71 50+e%state surcharge,except Residential Backflow Prevention Device,which Is$36 25 r 8%state surcharge "All New Commercial Buildings require plans with Isometric or riser diagram and plan review i:\dsts\forms\plm-fees.doc 10/10/00