8870 SW MAPLELEAF STREET lee.ilS peleldsW MS 0188
m
a�
cn
ea
m
as
CL
ea
a �
oc 3
co N
� o
J_ c0
m
W
J
8870 SW MAPLELEAF ST
CITY OPTIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639.4171 _
BUP
649 --
Date Requested PM BLD _
Location O Q Suite MEC
Contact Person _ Ph �' � 5 �7 PLM �raa�Co -
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ^^ ELR
Footing ACC
Foundation " '' FPS
Ftg Drain
Crawl Drain Ina n o es: —
Slab SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing —
Firewall
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
T FAIL
UM i
Post&Beam
Under Slab
er S
Ran ra ns
ASS ART FAIL
G ANICAL
Post& Beam - -- -— ----
Rough In
Gas Line -
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL -- r
Service _
Rough In
UG/Slab _
Low Voltage
Fire Alarm
Foal
PASS PART FAIL
SITE
Barkfill/Grading -
Sanitary Sewer
Storm Drain [ i Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspechlon RE:— [ )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.
CITY OF TIGARV ____ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT 0: PLM2001-00067
13125 SW Hall Blvd.,Tigard, OR 97223 (503; 639-4171 DATE ISSUED: 03107!2001
SITE ADDRESS: 08870 SW MAPLELEAF ST PARCEL: 1S135AA-01200
SUBDIVISION: TOWN OF METZGER ZONING: R-12
BLOCK: LOT: 021 JURISDICTION: TIG
CLASS OF WORK: ALT 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: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 280 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation. of 280 feet of water line.
FEES
Owner: -----
Type By Date Amount Receipt
ALLISON, M DEAN + DOROTHY D PRMT CTR 03/07/2001 $101.40 27200100000
c/o ALLISON, ANNETTE C 5PCT CTR 03/07/2001 $8.11 27200100000
8870 SW MAPLELEAF ST
PORTLAND, OR 97223 Total $109.51
Phone 1:
Contractor:
ROOT EXCAVATION
108245 E OAK ST
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Phone 1: 503-638-3447 Water Line Insp
Reg#: LIC 134498
PLM 3-433PB
a
oc
rN
J
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
m Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
c7
W This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
J
ihan 180 days. ATTENTION: Oregon law requires you to fallow 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) 240 100
Issued By: �(�iCsL � r Permittee Signature:
Call(503) 639-4175 by 7:00 P.M.for an Inspection needed the next busin ss day
Plumbing Permit Application
City of Tigard Datereceivea:, o
/ / Permitno.((MV1
&Gblt ,7
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City of Tigard phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date ismed: By: ere4pt no.:
Land use approval: Case tle no.: Payment type:
fff I A 2 family dwelling or accessory U Commercial/industrial. U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U Food service U Other:
MUM
Job address: c6c6-7 0 Ste) CYC r)t Crop es � . feet".) Total
Bldg.no.: _ —1Suio.:� New 1-and 2-ta ly dwellings only:
(Includes 10011.for each oa!Mv connectloa)
Tax map/tax lot/account no.: SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath - ----
Project name: SFR(3)bath
City/county: ZIP: Each additional bath/kitchen
Descri on and 1 ation A work on premises: ) _ Siteutllitles:
C)} �►� q t<���_ '- Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drain
Footing drain(no.lin.ft.)
Manufactured home utilities
Business name: +- LX C U(,.A\ Manholes
Address: 10`QLVt) L, CVAK ` �' Rain drain connect)r
City: K, Statci`tt l ZIP:�"j' -L't- Sanitary sewer(no.lin.ft.)
Phone: Fax:7 qy- eds 4 4 E-mai1: Storm sewer(no.lin.ft.) _
CCB no.: — Plumb.bus.reg.no: -y-3 3 EN Water service(no.lin.ft.)
City/metro lie.no.: �'I t j '� �� ti. �� Fixture or Item:
Contractor's representative signature: Absorption valve
Pont name: ate: •1 _�I Back tow preveMcr
Backwater valve
Basins/lavatory _
Name: t !AXClothes washer _
Address: — Dishwasher
City: State: ZIP: Drinking fountain(s)
Phone. - Ejectors/sum
-fit( Fax: E-mail Expansion tank _
Pixture/scwer cap -
Name(print): I S GV1 Floor drains/floor sinks/hub
lhn:cMailing address: p tri q I r� Garbage di_�osal
Hose bibb
City I r-��:=Fax;
State�1 ?.{P: 122 3
Ice maker
Phone: E-mail Interue tor/ rease tri
X Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
to employee on Ute property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
F- Owner's signature: Date: _ Sump
H _
D Tubs/shower/shower pan _
m Name: Urinal
0Address: -- W atei closet
W Water beater
-� City: _ State: ZIP: _ Other:
Phone: Fax: I E-mail: V Total
- — -� Minimum fee.. $
Na all Jurisdictions accept credd�cards,Akar call jurisdiction for more intonnation. 'Jotice:This permit application
O Visa l]MasterCerrl expires if a permit is not obtained Plan review(at _ %) $
Cr-tit card number:_ -. 1.--L— within 190 days after it has been State surcharge(8%, ....$ . R
Name of cardholder as shown on credit cud
F.xpircaccepted as complete.
s TOTAL .......................$ /O 9 S/
i _
Cardholder alp mure Amowtt 1101616(WWOM)
PLUMBING PERMIT FEES:
PRICE TOTAL Now I and 24MIlly dwegings
FIXTUFMjIldividuaee_�_ QTY _cgs) AMOUNT pnCluda all plambing flxtur»s In PRICE TOTAL
Sink 16.60 the dwelling and the flnt100 ft. QTY (a) AMOUNT
Lavatory 16.60 cwe Ooh l OOnnation 249.20
1)both
Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00 �—
Shower Only 16.60 $399.00
Water Closet 1660 _ SUBTOTAL —
Urinal 16.60 e%s.rATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal Y 16.60 V vTOTAL
Laundry Tray 16.60
Washing Machine 16 fi0
Floor Drain/Floor Sink 2" 1680 PLEASE COMPI ETE:
-Tj -_- 16.60
�4" '6.60
Water Hater eO conversion O like kind 16.60 Quantl b Work Perfotnited
Gas piping rewires a separate mechanical Fixture Type: New Moved Replaced Removed/
Ca
pped
MFG Home New Water Service 4640 Sink
MFG Home New San/Storm Sewer 46.40 Tub or _ --_
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 1660 Shower Only
Drinking Fountain 1660--- Water Closet
1660 Urinal _
Other Fixtures(Specify) Dishwasher
Garbage Disposal _
-- Laundry Room Tray
--
Washing Machine
Floor Drain/Sink: 2"
Sewer-1 st 100' 5500 3"
Sewer-each additional 100' 46.40 _4"
Water Service-1st 100' 55.00 Sy J-0 Water Heater
Other Fixtures
Water Service-each additional 200' ! 46.40 Q (Specify)
_ r
Storm&Rain Drain-1st 100' — — 55.00
Storm 6 Rain Drain-each additional 10V 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55 -
Catch Basin 16.60
Inspection of Existing Plumbing or Specialty 72.50
Requested Inspections perthr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 _ _ —
Grease Traps 16.60
QUANTITY TOTAL
L Isometric or riser diagram Is required If
Quantity Total Is >a
C "SUBTOTAL
I) 8%STATE SURCHARGE —
"PLAN REVIEW 25%OF SUBTOTAL
0 _T Required only If fixture qty total is>e
a TOTAL $
U
J
'Minimum permit fee Is$72 50+696 state surcharge,except Residential Backflow
Prevention Device,which Is$36 25+8%state surcharge
""All New Commercial Bultdings require plans with Isometric or riser diagram and
pian review.
I:\dsts\forms\pim-fees.doc 10/10/0u