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9660 SW LEWIS LANE tC O? T O r m a r z m i i i I� 1 i 9669 SW LEWIS LANE CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-417E MST INSPECTION DIVISION Business Line: (503) 630-4171 BUIL --- -- ------ Received Date RenuesteAM_ 0P _____ BUP Location - i -------Suite--- ---- MEC -- _ ---- - Contact Person Ph (-----) 1�--�� PLM -� � Contractor . - -- -- -- Ph (- ) ----- - SWR ----- ----- y�--- � � BUILDING Tenant/Owner .�Z��,L]�-,�`�--��vi� ELC Footing U Foundation ELC Access: Ftg Drain ELR Crawl Drain - Slab Inspection Notes: SIT _ -__— Post&Beam Shear Anchors --- -- Ext Sheath/Shear _ Int Sheath/Shear Framing --------- - - -- - --- ----- Insulation Drywall Nailing --- --- - - - -- - - -_- --- - -- --- - - ---- Firewall Fire Sprinkler -- -- --- --- - ---- -- - -- - - -- — Fire Aiarm Susp'dCeiling - -- '_-�- - --- Roof Other. ----- -- -- -------- - Final /f PASS "" FAIL ----- - ---- --- - - - -- --- --- _—,� �� --- UM I ti -- — --- -- ------- _ Post& Beamer Under Slab - --- --- ----- -- - - ` , ' _.." - - ------ Rough-In Water Service ---- - - - - -- - - - - Sanitary Sewer j I Rain Drains - - -- - - ---- -- ---__-_� Catch Basin/Manhole Storm Drain Shower Pan Other: - `-- Final PA S$ PART FAIL MECHANICAL _....._-._-- Post& Beam - Rough-In -- --------- --- — --_ - - Gas Line Smoke Dampers --- --- ---- ----- - - - Final PASS PART FAIL ----- - _ -� -- -- ELECTRICAL Service Rough-In - UG/Slab Low Voltage -- - - - - Fire Alarm Final [l Reinspection fee of$.___e __required before next inspection. Pay at City Hall, 13125 SW Hall Blvd PASS PART TAIL ------------------ SITE _ [] Please call for reinspection RE:_ ____ _- --__- _ [] Unable to inspect -nn access Fire Supply Line / ADA Approach/Sidewalk Date j Inspector _ Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY 4F TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST -- INSPECTION DIVISION Business Line: (503)639-4171 BUP Received � Date Requested___ AM —.__ PM __.._— ____ BUP Location � 1llJ fma: le Suite MEC - ---- ------ Contact Person 4-- 1n_ _CL r_— —. Ph(_JU _) �3�1'� II?R� PLM _ Contractor _ � L1.1�3 (= � .t��_._--__ Ph(1. ) .Z37-" ��lu�� SWR ►v111�DY BUILDING TenanVOwner ___--�— —__ ELC Footi_ng---� --_— ELC -- Foundation Access: Ftg Drain (_ ELR _--- Crawl Drain SIT Slab Inspection Notes: -------� Post& Beam - Shear Anchors Fxt Sheath/Shear - Int Sheath/Shear Framing -- — - — - --- - ----- -__—_ Insulation Drywall Nailing - -- -- -- -- --- --- —- Firewall Fire Sprinkler -- -------- -- -- _ -----^ Fire Alarm Susp'd Ceiling --�- ----- — ---------_..-----_ Roof -- _--- Other. — `---- Final PASS PART FAIL — _PLUMBIN(1 _ - - ---- -- -- ---- - Post& Beam Under Slab --- Rough-In Water Service Sanitary Sewer - Rain Drains - --- .. - - - ----- - - --- - ---- ----- Catch Basin/Manhole Storm Drain - - _-- -- - --- -- - ---- ----------- Shower Pan Other- Final therFinal PASS PART FAIL MECHANICAL __ -- --- -- Post&Beam — Rough-In - - - -- - Gas Line Smoke Dampers --- -. _ --- - -- Final ,� _.BAT IEL-EcTril ------- - - —�. Service Rough-In -- _ - - --- Low Voltage - =:` larm Fi El Reinspection fee of$_ _ _—__-required before next inspection. Pay at City Hall. 13125 SW Hall Blvd. I�T FAIL SITE Cl Please call for reinspection RE: _—_- —_._ —_ __ Ll Unable to inspect-no access Fire Supply Line ADA _Ext Approach/Sidewalk Date Inspector Other C/ - -- - _-- Final DO NOT REMOVE this Inspection record frolp a job site. PASS PART FAIL CITY OF TI GA R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2004-00164 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/16/04 SITE ADDRESS: 09660 SW LEWIS LN PARCEL: 1S135CD-03300 SUBDIVISION: RUTH ZONING: R-4.5 BLOCK: LOT: 003 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HC,ME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAWS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS. SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 100 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replacing existing water. Less than 100ft. — _— Owner: _— FEES _ ORR, KAREN + LYNART Description Date Amount -- — 9660 SW I.EWIS LN 11'LUM131 Perniit Pee 4/16/04 $72.50 TIGARD, OR 9722.3 I fn\i 8 State surrh,ui 4/16/04 $5.80 — �Total $78.30 J Phone : 503-630-7895 Contractor: RESCUE ROOTER PO BOX 1728 WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone : 685-9050 Water Service Insp Final Inspection Reg #: LIC 127325 111-M 34-168 This permit is issued subject to the regulations contained in the Tigard Municipal Code, Mate of OR. 5,ecialty 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. ATTENTIONS Oregon law requires you to follow rules adopted by the Oregon Issued By: � < t f' / c �tJ__ 7 , /L Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next bushiess day Building Fixtures Plumbin Permit Applicatior F01116FICE USE ONLY Received � U Cit •of Tigard Pemut No. 13123 SW Hull Blvd.,Tigard,OR 97223 Plan Review Phone: 503.639.4171 Fax: 503,598.1960 Date/By: Other Permit No.: 24-Hour Inspection Line: 503.639.4175 Date Rendy/By uris� ® See Page 2 for Internet: www.ci.tigard.or.us Nolilied/Melhod: / supplcmentallnrarmotlnu TYPE OF WORK I'EE• SCHEDULE -' New construction Demolition For special lnjortnation use checklist. _ ❑ ❑ Desai tion Qty. Eu. Total ILAddition/alteralion/replacement ❑Other: New 1-2-fat illy dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 tRi-and i-tamily dwelling ❑Commercial/industrial SFR(2)bath 350.00 ----- tiFR(3)bath 399.00 ElAccessory building ❑Multi-family Each additional bath/kitchen 45.00 ❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities _ Job site address: (,�(00c) J_ e w;c ,ot, . Catch basin or area drain 16.60 City/Slate/ZIP v^ .. 2 Dry,.vell,leach line,or trench drain 16.60 ICLFooting drain(no.linear It: ) Page 2 Suite/bldg./apt.no.: IJ Project name: Manufactured home utilities 110.00 _ Cross street/directions to job site: �.� Manholes 16.60 ` Rain drain connector 16.60 Sanitary sewer(no.linear ft.:_) Page 2 -- Storm sewer(n3 linear ft.:_� Page 2 Lot no.: Water service(no.linear It.: Page 2 Subdivision: Fixture or Item _ Tax map/parcel no.: - Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 _y Clothes Backwater valve v 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 �.PROPERTY OWNER_ ❑ TENANT Ejectors/sump 16.60 Name: ►'r Expansion tank 16.60 Address: , Fixture/sewer cap 16.60 City/Stete/ZIP: Q y }-�- _ Floor drain/floor sink/hub 16.60 PtfxGarbage disposal 16.60 Phone:( - ( , � - Hose bib 16.60 APPLICANT [3CONTAC i' PERSON Ice maker 16.60 Business name: - _ Interceptor/grease trap 16.60 Contact name: A C :1� Medical gas(value:S ) Page 2 Address:• �-- L, Primer 16.60 City/State/ZIP: ' , a-_ Roof drain(commercial) 16.60 C� q I C Sink/basin/lavatory 16.60 Phone!( _ Fax' :(� �n 1 Tub/shower'shower pan 16.60 E-mail: Cl D jD _ Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: __ Water heater 16.60 Other: Address: ' _. Subtotal City/State/ZIP: - Minimum permit fee: $72.50 �t Phone:( ) ( ) _ Residential backflow minimum permit fee: $36.25 f/ PI bin Lic.no.: - Plan review (25%of permit fee) CCB Lic.: `� B _- - State surcharge(11%of permit fee) Authorized sig mturc TOTAL PERMIT F1if? Print name: Vi -RQ Date:L4 -t--i This permit application expires If a permit Is not obtained within 180 days after It has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I\auilding\Permi,stPLMF.PermitAppdoc 12103 440•4616T(IM2/COM/WEn) Plumbing Permit Application - City of Tigard Pagc 2 - Stipplemental Information Fee Schedule: Residential Hire Su •ession Systems: Site Utilities oty.Tree(ca) Total Square Footage:_ Permit Fee: ftarung drain- :" 100' - �- 5.00 0 to 2,000 -_ $115.00 -- - -- noting drain•each ndditional lU0' 46.40 2,001 to 3,600 $160.00 I 3,601 to 7,200 $220.00 - Sewer-1 at 100' 55.00 7,201 and greater $309.00 Sewer-euch additional 100' 46.40 Water Service-Ist100' 55.00 Medical Gas Systems: Water Service-each additional 100' 46.40 F Valuation: I Permit Fee: Storm&Rain Drain-Ist 100' 55.00 _$I.o0 to$5,000.00 MM nhrtum fee$72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 f'or the first$5,000.00 u.td$1.52 for each Qty. Fee(ea) Total additional$100.00 or fraction thereof,to and Fixture or Item including$10,000.00. �7ommercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Device ench additional$100.00 or fraction thereof,to (minimum permit fee$36.25) 27.55 and including$25,000.00. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for each additional$100,00 or fraction thereof',to Inspection of existing plumbing or and including$50,000.00, specially requested inspections-per hour 72.50 $50,001.00 and up $742.00 i':-the first$50,000.00 and$1.20 for Subtotal: each 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 accuratcK report fixtures could result in Increased_s_ewer fees*. uantil b Fixture, Work Performed Fixture Type: Replace _ New Moved Fxlntlnff Capped Conlmerlts regarding fixture work: --- Bath -Tub/Shower _. -Jacuui/Whirl ool -- - - Car Wash -Each Stall -Drive 77tru _ Cuspidor/Water Aspirator - Dishwasher -Commercial _ -Domestic _ Drinkin•Fountain �. ---------. - ___.--_ Eye Wash Floor Drain/sink T. 4,• - --- Car Wash Drain Garbage -Domestic Disposal -Commercial *Note: if the fixture work under this permit results in an -Industrial increase of st ver EDUs,a sewer permit will be issued and Ice Mach./Refri .Drains Oil Separator Gas statism fees assessed 'or the sewer increase must he paid before the Rec,vehicle Dump Station plumbing permit can he issued. Shower -Gang -Stall _ Sink -Bar/1-avatory Quantity Total -Bradley Isometric or riser diagram is required if fixture quantil; -Commercial total is>9. -Service Swimming Pool Filter Washer-Clothes Water Extractor Plan Review WaterCloset-Toilet I Plan review is required If fixture quantity total is_'I. Urinal Other Fixtures: _ i\auildmj`Permaj\PLM-PermitApp doc 3103