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Permit 3 w / ?c.v ( • - ,t ' Ct.c Lf kackflaw CITY TIGARD PLUMBING PERMIT ° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00311 A. ' RP' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/22/2008 PARCEL: 2S102CB - 00100 SITE ADDRESS: 12850 SW GRANT AVE ZONING: R -12 SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION: TIG PROJECT: BROADWAY ROSE THEATRE CO Project Description: Interior plumbing. Floor drains: (3) 3 ". Other fixture: drinking fountain. 8/11/08 ADDED 100 ft. of sanitary sewer and 400 ft. of storm sewer. 12/3/08 ADDED (1) backflow preventer. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: M FLOOR DRAINS; 3 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: 2 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 8 URINALS: 2 GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: 1 SEWER LINE: 100 ft WATER CLOSETS: 3 WATER LINE: ft DISHWASHERS: RAIN DRAIN: 400 ft Owner: FEES TIGARD TUALATIN SCHOOL DIST. #23 6960 SW SANDBURG ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 7/22/2008 $348.60 [TAX] 12% State Surch 7/22/2008 $41.83 Phone : [PLUMB] Addl Permit 8/12/2008 $249.20 [TAX] 12% State Surch 8/12/2008 $29.90 [PLUMB] Addl Permit 12/3/2008 $46.40 Contractor: [TAX] 12% State Surch 12/3/2008 $5.57 WESTERN PLUMBING Total $721.50 9460 SW TIGARD STREET SUITE 101 REQUIRED ITEMS AND REPORTS TIGARD, OR 97223 Contact # : PRI 503- 639 -5296 FAX 503- 684 -9015 Reg #: LIC 2439 PLM 34 -29PB 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: — Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. gIl ! or 4ri iMe.c1 pee co 'tc r y &Iwo. <Fn. r CITY OF TIGARD ; . PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00311 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/22/2008 PARCEL: 2S102CB -00100 SITE ADDRESS: 12850 SW GRANT AVE ZONING: R -12 SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION: TIG PROJECT: BROADWAY ROSE THEATRE CO Project Description: Interior plumbing. Floor drains: (3) 3 ". Other fixture: drinking fountain. 8/11/08 ADDED 100 ft. of sanitary sewer and 400 ft. of storm sewer. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; 3 TRAPS: STORIES: WATER HEATERS: 1 • CATCH BASINS: 2 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 8 URINALS: 2 GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: 1 SEWER LINE: 40Q WATER CLOSETS: 3 WATER LINE: ft DISHWASHERS: RAIN DRAIN: 400 ft Owner: FEES TIGARD TUALATIN SCHOOL DIST #23 6960 SW SANDBURG ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 7/22/2008 $348.60 [TAX] 12% State Surch 7/22/2008 $41.83 Phone : [PLUMB] Addl Permit 8/12/2008 $249.20 [TAX] 12% State Surch 8/12/2008 $29.90 Contractor: Total $669.53 WESTERN PLUMBING 9460 SW TIGARD STREET SUITE 101 REQUIRED ITEMS AND REPORTS TIGARD, OR 97223 Contact # : PRI 503- 639 -5296 FAX 503- 684 -9015 Reg #: LIC 2439 PLM 34 -29PB 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332.2344. Issued By. i / ; Permittee Signature: 7/A/4. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. WESTERN PLUMBING 5036848015 08/11/08 12:30pm P. 001 r Pt ' P' Plumbing Permit Applicati L J . ' • „ . F!JR OFFICE USE`ONGY " 1 L ..... City of Tigard Received r�or J�, Penmr No K[ 13125 SW Hall Blvd., Tigard, OR 9722A U G 1 12003 Date/B "acte- r.,' •. Phone: 503.639.4171 Fax: 503.598.1960 Plan Revtaw TIGA1t�` Inspection Line. 503.639 4175 Date /By Other Permit No : Inspec www.tigard-or.gov CITY OF TI ARD Date Ready/By: Juns y Notified /Method 1. I See Page i for 'ti � y . - y�' 0 fa F s ,. t . a .. z "I .•• "�ti is"t§i.4v t y ,i:..a n d'4* „. a' 1 �, - " ,.. Supplemental Information -47 , a ❑ New construction ❑ Demolition For Mal information use checklist. r u txt Addition /alteration /replacement Description Q� Ea Other: Total ❑Oth t ,; ,, f. New I- 2- family dwellings (includes 100 ft for each utility connection) . fit I,, * '' ,,. „ lit t ' ' i-, ,6 ` SFR (I) bath i 249 20 ❑ 1- and 2- family dwelling — E Commercial /industrial SFR (2) bath 350.00 El Accessory building ❑ Multi-fatally SFR (3) bath _ 399 00 ❑Master builder 111 Other: Each additional bath/kitchen 45 00 F,m •; .. ,tr ? t i " "r 0;<, S I :� . Fires sprinkler itri ,- 1:: `. r ".�y�� G � ' 1 `s ' _ 3 "'- � r � p sq. Page 2 lob site address: / r' Site utilities `0 S �� % 1l 1, ifiAA Catch basin or area drain City /State /ZIP: jj c / CT 16 60 Drywell, leach lure, or trench drain 16 60 Suite /bldg. /apt. no J Project name: '� � � �� Lk i Footing drain (no linear ft. 11 . 1 ) Page 2 Cross street/directions to job sic. /I Manufactured home utilities 110 00 Manholes 16,60 Rain drain connector 16 60 Sanitary sewer (no linear ft.:/Of)) _ Page 2 Storm sewer (no. linear ft -AC)) Page 2 Subdivision. Lot no.; Water service (no linear ft,. `) Page 2 Tax map /parcel no.. g Fixture or item �� u :.s �' a e ` .ii °`",.•t'•^37�i& rpa41c ' + t' ' .„ ; >E Absorption valve 16 60 1 ; � � ' 4 r r 1 , aj C /�`�` Backflow preventer g . 6 <.i r)(1.(,1 J 8'd I (I ; t .. j I Page 2 ` ` t3 Backwate valve 16 60 Clothes washer 16.60 Dishwasher `a7''''( ,' a ,,• •u , T. i �. rt -r „ , ..-... 1660 a r 9 � _ i r , • ,. 6: l ;d i.e 3 1 :k„e � � � e., ter " qt r Drinking fountain .'iii./. 1660 Name: V Ejectors /sump 16 60 Address: Expansion tank 16 60 City / State /ZIP: Fixture /sewer cap 16 60 Phone ( ) Floor drain /floor sink/hub Fax 16 60 its t" lJ "',p,y,t ( } Garbage disposal •��4°k.'.�`Y�'s'A��` r r r s � v` "r� s r, r ,p �t� „ ,, ,,, ,,� ry�� i, 16 60 4 . .1 ,f .s' iq' +e3 adt, 'itY CIVelip Hose blb s 1660 Business name: lee maker 16 60 Contact name' Interceptor /grease trap 16 60 Address: Medical gas (value: $ ) page 2 Primer 16 60 City /State /ZIP: Roof drain (commercial) _ 16.60 Phone: ( ) I Fax : ( ) Sink /basin/lavatory 16.60 E-mail: Tub /shower /shower pail 16 60 niitui y t r N' w � "y`' :? e Urinal r _rr /e �" r' �a; v.� > 16 60 Business name: Western Plumbing, Inc. W ater closet 16.60 Water heater MI 16 60 Address' 9460 SW Tigard Avenue, Suite 101 Other City /State /ZIP: Tigard, Oregon 97223 Subtotal ra 7 Phone: (503) 639 -5296 Fax: (503) 684 -9015 Minimum permit fee' $72.50 Resrdential_backflow minimum permit fee $36 25 CCB Lie.: 2439 Plumbing Lic, no.: 3429PB Plan review (25% of permit fee) Authorized signature �� (� State surcharge (12% of ermit fee) ,Print name: Dana Jensen f 'FOTAL PERMIT FEE a D gigi ate: _4 � This permit application expires if a permit is not obtained within l 180 days after it has been accepted as complete. *Fee methodology set by Tri County Building Industry Service Board I 5 ui tdmuV'er doe 06/26/06 440- 4616TO 0 /02 /COx1AVen) WESTERN PLUMBING 6035849015 08/11108 12:30pm P. 002 ■ • , i , . Plumbing Permit Application - City of Ti Page 2 - Supplemental Information Fee Schedule: Residential Fire Su • ression kirk.; y` ,y r y 4" y ' ?s y �, k:y� - t? •1 . ` � { 4417 � .� .� S sterns ��' .,1��. , i411.11,14%11 , �W�iu ° , �� ci J: rc �(�� ? � � t� 6 � • �,��. t - eP�` fib, Footing drain - 1'100' 55.00 0 to 2,000 .ys4'�.: Footing drain - each additional 100' $115.00 2 001 t o 3,600 $160 00 46.40 Sewer - 1st 100' p 55 00 r 3,601 to 7,200 $220 00 Sewer each additional 100' )'c 7,201 and [eater $309 00 46.40 Water Service - 1st 100' 55 00 Water Service -each additional 100° 46 40 Medical Gas S stems is ,, : r �� Stone & Rain Drain - 1st 100' r OII t } �- alt ^ ' „ r r , Stone &Ram Drain - each additional 100�'� $1 00 to $5,000 00 Minimum fee $72.50 a�i n e ',. 46 40 1 Do $5,001 00 to $10,000 00 $72 50 for the first $5,000.00 and $1 52 for each t r ,, " ` , t i I t 4 4 %W 0 additional $100 00 or fraction thereof, a 1 to and Commercial Back Flow Prevention Device 46 40 including $10 000 00 Residential Commercial ac low Prevention Device $10,001 00 to $25,000 00 $145 50 for the first $10,000 00 and $1.54 for (minimum permit fec $36 25) 27.55 each additional $100 00 or fraction thereof, to Rain Drain, single family dwelling and iii $25,000.00. 65.25 $25,001 00 to $50,000.00 $379 50 for the first $25,000 00 and $1 45 for . Inspection of existing plumbing or each additional $100 00 or fraction thereof to specially requested inspections - per hour 72.50 and me[udinQ $50,000,00 Subtotal: of ; y� $50,001 00 and up $742,00 for the first $50,000 00 and $1 20 for L each additional $100 00 or fraction thereof Fixture Work: a ; i ii, ',i'. , ..as , . i.a i , r Are you capping, adding or replacing fixtures? if "yes ", r ' • `u' . f t i 1 s 3" -� fir Plan review is required for any of the following. t �� =.d�, 'iU please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in i sewer fees * . ❑ Any a , new commercial building with water service 2" and i ; .' vy 4 S tin V An .4citr if b f4}o s k M greater, except systems designed and stamped by licensed :, i � �^s- 1414 engineer, Baptistry /Font ❑ Any new exterior plumbing site utilities. Bath Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash Each Stall r] Any complex structure as defined in 0 AR918- 780 -0040 -Drive Thru Cuspidor /WaterAsprrator Su bmit 2 sets of plans with any of the above. Dishwasher - Commercial Domestic .} DnnkmgFountain , � Rana 11 aiatiP 1 } l nI a ). t + qw , tlairp.x.rgr g Eye Wash '. �� Vie , . buildings '.a ❑ Isometric or riser diagram is required for new build ngs Floor Drain /sink 2 " that meet the qualifications above. -3" 4 Comments regarding fixture work: Car Wash Drain Garbage - Domestic Disposal -Commercial - Industrial Ice Mach./Refrig, Drains Oil Separator (Gas Station) Ree Vehicle Dump Station Shower -Gang Stall *Note: di' the fixture work under this permit results in an Sink - Bar /Lavatory increase of sewer EDUs, a sewer permit will be issued and - Bradley fees assessed for the sewer increase must be paid before the - Commercial Service plumbing permit can be issued, Swimming Pool Filter - Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures. I v l,o idi„yo,,,,,.oLA.4-.r«,,,,tApr,ioo osnzior 'CITY OF TIGARD - PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00311 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/22/2008 PARCEL: 2 S 102 C B - 00100 SITE ADDRESS: 12850 SW GRANT AVE ZONING: R -12 SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION: TIG PROJECT: BROADWAY ROSE THEATRE CO Project Description: Interior plumbing. Floor drains: (3) 3 ". Other fixture: drinking fountain CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; 3 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: 2 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 8 URINALS: 2 GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: 1 SEWER LINE: ft WATER CLOSETS: 3 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES TIGARD TUALATIN SCHOOL DIST. #23 6960 SW SANDBURG ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 7/22/2008 $348 60 [TAX] 12% State Surch 7/22/2008 $41.83 Phone : Total $390.43 Contractor: WESTERN PLUMBING 9460 SW TIGARD STREET SUITE 101 REQUIRED ITEMS AND REPORTS TIGARD, OR 97223 Contact # : PRI 503- 639 -5296 FAX 503- 684 -9015 Reg #: LIC 2439 PLM 34 -29PB 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1 800.332.2344 Issued Bd Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. I WESTERN PLUMBING 5038849015 07/21/08 07:11am P. 001 • 1 � —0 1 rlunbing Permit Application ��` " , FOR, "OFFICE USE ONLY ' ,, h � �t;, " : City of Tigard �yc� , . q 13125 SW Hall Blvd., Tigard, OR 97223 KY 1 r1o�r� /^ s Permit No. �L�y��F��1 �„ � /'f q {. Plan Review [ Phone. 503.639.4171 Pax: 503.598.1960 l / ., Inspection Line: 503 639.4175 �� Vii' nv Other Permit No • TIGARD \�� i r� I. �, /0 �p� Internet: www.hgard -or gov �l� ` fi n v ` y�Y BI See Page 2 for ws. p" AN_ st4 ^i ✓ `yP r�S ' xm. r rtk / ,� I' �d /Method: ' . tF +�'-. �` �" `, t"pc 'u ' =w ; ,,� Supplemental Information 0 New construction ❑ Demolitiq}l,` s For a,ecial in ormarion use checklist. ►;i Addition /alteration /replacement ❑ Other Deceri uon �i r Ea Total ti ! a New 1- 2- family dwellings (includes 100 ft. for each utility connection) '' ' '.`', 1 ,'''' r °�, r0 � � r' 1 a 9,1 SFR (1) bath 249.20 ❑ 1- and 2- family dwelling L1 Commercial/industrial SFR (2) bath 350,00 ❑ Accessory building SFR (3) bath ■ ❑ Multi - family O 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: �� Van rc w, �yt 'e s.r�N�/ kl . } Fire sprinkler sq. ft.) Page r t� � , 1 t .,1'.u, m`, a�i `A % �t ?,, tt Site ( g 2 T s• �' p utilities Job site address: 1 ` L� Catch basin or area drain El 16 60 INEIKI City /State /ZIP t C 16 60 Drywell, leach line, or trench drain Suite /bldg. /apt. no.: Project name: `, r Footing drain (no Intent ft.: ice .. �! . i ) Paget Cross street/directions to job sic: ■) Manufactured home utilities 1 10 00 Manholes 16 60 Rain drain connector 16 60 Sanitary sewer (no. linear ft,• ) Page 2 Stalin sewer (no. linear ft.: ) Page 2 Subdivision: !Lot no.: Water service (no. linear ft.' _____) Page 2 Tax map /parcel no. Fixture or item — ',i14.14.4441° -' x'•° -i t a i > r ,..' Ft t'2t 's k ;; / lz a r Absorption valve I6 60 . ga P _ .;2 IA 14 '''14/11§1t4 1 Y a w � ' - � � �' F ..�. ;Es Backflow preventer Page 2 Backwater valve 16 60 EIIIIIIII6NuillIl'IbA Clothes washer � � ��u +al , 16 60 Dishwasher 16 60 st t� fr "' ` 6' i Dunkin fountain xi 's r.�;pF 4 r ooiiv 'a g 1660 I. Name: Electors %sump 16 60 Address: Expansion tank 16 60 Fixture/sewer cap 16 60 City /State /ZIP: Floor drain /floor sink/hub ) i 6.60 " Phone: ( ) ) ,� Fax ( ) Garbage disposal M. ' k d [�in�s r "d4's ##E n r 'i �. A tv ;(+ ik , r r .�xbti..,° v 16 i $ 0 a- "' Hose bib s `? > ; , ,7 : �0.Ett' : e„ c. ,, , r ' °` k 16.60 4,0: Business name: _ Ice maker 16.60 Contact name: _ Interceptor/grease trap 16 60 Medical gas (value: $ ) Page 2 Address: Primer r 16.60 City /State /ZIP; Roof drain (commercial) 16.60 Phone: ( ) Fax : ( ) Sink/basin /lavatory 16,60 /" �, . 1 ,./ r E -mail: Tub /shower /shower pan 1660 t/ r ,�� !. rf x fis oiut .t. ` i Iililla! ,'7 i , 16 60 ,,? -- ra era+ �0.f ,w a P .'t .: ww`;3"i lif; Water closet 16 60 LI Business name: Western Plumbing, Inc. Water heater 16 60 L Address: 9460 SW Tigard Avenue, Suite 101 Other: ► j City /State /ZIP: Tigard, Oregon 97223 ` Subtotal Phone: (503) 639 -5296 I Fax. (503) 684 -9 015 Minimum permit fce. $72.50 Residential backflow minimum permit fee: $36 25 CCB Lic.: 2439 Plumbing Lie, no.: 3429PB Plan review (25% of permit fee) —I Authorizes! signature j ! State surcharge (12% ofpermit fee) • L{ 1Z TOTAL PERMIT FEE , it �1^r�� 3 Print name: Dana Jensen Date:'' J+ �/`�� ' f ,. y7 'This permit application expires if a permit is not obtai d within �� — �`�� 180 days after it has been accepted as complete. ,' *Fee methodology set by Tri -County Building Industry Service Board, I areoldin 5LM.5fl, e A,,p,doo 0626/0 /p9g4 616'1(10 /02 /COM I Y // i /✓r / /WEB) O C11 9A a w `f /� �� -fir // / /Itir t/ V = 7 1J ` ( � A �Irr e r5 ,/,'"6z- A.:14 16 //J Cl/V Q� Plf ^ /L � st�i 3, �d iia___ WESTERN PLUMBING 5038848015 07122/08 07 :SBam P. 002 Plumbing Permit Application - City of Tigard • , Page 2 - Supplemental Information . F , Fee Schedule: Residential Fire Su 1 I cession S stems: y ,r .t ` W!';'' I Y t e1 1 1R "' 44.f 1 nl Y A. ` x� � - °x , v , � a FAr' t,r 4 ^r-±5 ','r�'� "a .. r ti t.. 4 4 t* .+ � .,� q , , i . 3^. -i. r :. P . i , 3 , # Ad.::... 5 .a t;' v 4,1 f 1m #im... , t, d_ �.. s' � r 6,,,,t i .. :_ ?� ,.! ,, F a ` air r 'A 4i Y,d + h i Jr CA Footing drain - 1' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46 40 2,601 to 3,600 $160 00 3 601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309 00 Sewer - each additional 100' 46 40 Water Service - 1st 100' 55 00 Medical Gas Systems: Water Service - each additional 100' 46 40 n, 2 .F r* ;. i' t' 'pv ' �, r , `v` 'r(�' °H ' X' y� 4 d + lt'; t ? l p u' e, ' s 'i,y��S.t;z �,i . irtj 3 7'r�'•�`ii Storm &Rain Drain - 1st 100' 55 00 $1 00 to $5,000 00 Minimum fee $72 50 Storm & Rain Drain - each additional 100' 46 40 $5,001.00 to $10,000 00 $72.50 for the first $5,000 00 and $1 52 for each i ' t k ,� fi r ; H° t - j "'i��,.r } additional $100.00 or fraction thereof, to and `` l z L ' , 4 i, including $10,000.00 Commercial Back Flow Prevention Device 46.40 $10,001 00 to $25,000 00 $148.50 for the first $10,000.00 and $1 54 foi Residential Backflow Prevention Device each additional $100.00 or fiaction 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 foi - each additional $100 00 or fraction thereof, to Inspection of existing plumbing of and including $50,000 00 specially requested inspections - per hour 72 50 $50,001.00 and up $742 00 for the first $50,000 00 and $1.20 for Subtotal: each additional $100 00 or fraction thereof Fixture W "r °,w4'^dw��; a nk , V.� '`'� ' h r„ j > Are you capping, adding or replacing I1'i'a s'X ' ?.. =A,4 L R ° tg fixtures? If "yes ", Plan review is required for any of the following please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and '' " ` n `' 3,0P, `i 6a i w drt $ usagktilW 6. 4d ' greater, except systems designed and stamped by licensed t , ,- t ,- u + r' r 07 engineer. Aitti L .. t e: i 4 ;.,„ f i „ ttn! ❑ Any new exterior plumbing site utilities. Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities Bath - Tub /Shower .■ i ❑ Any multipurpose fire sprinkler system, -Jacuzzi/Whirl ❑ Any complex structure as defined in OAR918- 780 -0040 -Each Car Wash -Each Statall ll -Drive Thai Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial -Domestic fir "` a W W , Ft ; .. , .� 1;., strai: >, •� s i ` : " , :d: s s 8:' a'Uh P= a:r w: Drinkin: Fountain ,i■ ❑ Isometric or riser d for ram is required new buildings E e Wash IM _ g y buildings meet the qualifications above. Floor Drain /sink - 2" � -- g -3„ V 1116111111101•1111111111111111 - 4 " Comments regarding fixture work: Car Wash Drain IIII Garbage - Domestic Disposal - Commercial ,40111.11 - industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower - Gang *Note: If the fixture work under this permit results in an - Stall Sink Bar/Lavatoiy t 4 increase of sewer EDUs, a sewer permit will be issued and - Bradley . fees assessed for the sewer increase must be paid before the - Commercial Immo plumbing permit can be issued. - Service 1 Illii Swimming Pool Fitter Washer - Clothes Water Extractor Water Closet Toilet � ' Other Ea � = t Nat - pip 1 � � ` t 5 - O ther Fixtures. ( �Y � l�Jf/7 I j/� ther � �x'r } i _.ri urt-s mac.- bcfYv , VfuildmµU+o,mit3 \PLNFPcrmu APp OW2211e \Q I PA' �f Ni . Accumulative Sewer Tally Parcel # 2S102CB -0100 Tenant Name: ROSE This SWR# n/a Site Address: 12850 SW GRANT AVENUE -, • -This PLM# PLM2008 -00311 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off #s count # value #s values Baptisery /Font 4 0 0 0 0 0 Bath - Tub /Shower 4 0 0 1 4 1 4 - Jacuzzi /Whirlpool 4 0 0 0 0 0 Car Wash - Each Stall 6 0 0 0 0 0 - Drive through 16 0 0 0 0 0 Cuspidor /Water Aspirator 1 0 0 0 0 0 Dishwasher - Commercial 4 0 1 4 0 -1 -4 - Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 1 1 1 1 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain /Sink - 2 inch 2 0 0 0 0 0 - 3 inch 5 0 4 20 3 15 -1 -5 - 4 inch 6 0 0 0 0 0 - Car Wash Drn 6 0 0 0 0 0 Garbage Disposal - Domestic (to 3/4 HP) 16 0 0 0 0 0 - Commercial (to 5 HP) 32 0 1 32 0 -1 -32 - Industrial (over 5 HP) 42 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Oil Sep (Gas Station) 6 0 0 0 0 0 Rec. Vehicle Dump station 16 0 0 0 0 0 Shower - Gang (per head) 1 0 0 0 0 0 - Stall 2 0 0 1 2 1 2 Sink - Bar /Lavatory 2 0 1 2 7 14 6 12 - Bradley 5 0 0 0 0 0 - Commercial 3 0 3 9 0 -3 -9 - Service 3 0 1 3 1 3 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer - Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet - Toilet 6 0 2 12 3 18 1 6 Urinal 6 0 3 18 2 12 -1 -6 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 17 _ 101 19 69 2 -32 Current Fixture Value -32 divided by 16 = -2.0 Current EDU 1 EDU = $ 3,100 Previous Fixture Value 0 divided by 16 = 0 0 Previous EDU Change -32 divided by 16 = -2.0 over (under) $ (6,200.00) --- ---''• Enter EDU Change Here - Notes- ***CREDIT""* \ Authorized Name /Signature: BRANDEN TAGGART Date: 7/22/2008 Building Division Note. The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. I \Building \Sewer Tally \SewerTallySheet -3100 xls 06/19/08 CITY OF TIGARD t ., BUILDING DIVISION ,, l PERMIT #: PLM2008 -00311 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 702/2008 Phone: (503) 639 -4171 m ii��lypiiy��9ill'' ri Inspection Requests (24 Hrs.): (503) 639 -4175 AL INSPECTION WORKSHEET FOR DATE: 12,412008 TIME: 7 :00AM PAGE: 11 SITE ADDRESS: 1280 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF TIGARD ELEMENTARY LOT #: 041 TYPE OF USE: PROJECT NAME: BROADWAY ROSE THEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3 ". Other fixture: drinking fountain. 0/11108 ADDED 100 ft. of sanitary sewer and 400 ft. of storm sewer. 12/3/00 ADDED (1) backf low preventer. OWNER: TIGARD TUALATIN SCHOOL DIST. #23, - PHONE CONTRACTOR: WESTERN PLUMBING PHONE #: E,03..639-5:216 Inspection Request Scheduled For: Date: 12/4/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 078789 -01 603.793.8015 N Corrections /Comments /Instructions: ck I i i,,PASS ❑ PARTIAL APPROVAL CANCEL n NO ACCESS FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: t G Dat e: ' Z I `, G ` f Phone #: (503) 718 - "4t 7 ' .....,,,,_. CITY OF TIGARD , . BUILDING DIVISION PERMIT #: PI_M2008-00311 13125 SW Hall Blvd., Tigard, OR 97223 it • ' DATE ISSUED: 7/22/2008 Phone: (503) 639-4171 aport01,■ • Inspection Requests (24 Hrs.): (503) 639-4175 .4.11 -11!. INSPECTION WORKSHEET FOR DATE: 12/2/2008 TIME: 7:00AM PAGE: 19 SITE ADDRESS: 12850 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF TIGARD ELEMENTARY LOT #: 041 TYPE OF USE: PROJECT NAME: BROADWAY ROSE THEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3". Other fixture: drinking fountain. 8/11/08 ADDED 100 ft. of sanitary sewer and 400 ft. of storm sewer. OWNER: TIGARD TUALATIN SCHOOL DIST. #23, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 60.639_5 I , ! Inspection Request Scheduled For: Date: 12/212008 Pour Time: Code # 4 /inspection Description Confirm # Contact # Message k . 399 Plumbing final 078677-01 503-793-8016 N N Corrections/Comme ts/lnstru tions: . i . - 6 r .& t-7 1 561 dil i - CtiAki )L t l - e . c / 42 -.JA4 ' 1_ .i■ , ,, A , i'......A ,' 4 ! LA II _ /_ ' ' ; ° C €1 13°62P1 ) ' .; taCtli V\ A 1 \) 4 ■ dif 1 I PASS 0 PARTIAL APPROVAL pi CANCEL fl NO ACCESS i , ipli A L pi CALL FOR INSPECTION ADDITIONAL FEES ASSESSED $ — Inspector: V Z;I: CIL,. 1 .2■/21D --.-' Date: . Phone #: (503) 718- 2-42 -- -..... CITY OF TIGARD (: (5_ BUILDING DIVISION PERMIT #: PLM200B-00311 13125 SW Hall Blvd., Tigard, OR 97223 07 DATE ISSUED: 7/22/2008 Phone: (503) 639-4171 t;'\ / / ) Inspection Requests (24 Hrs.): (503) 639-4175 ff.:44 IL INSPECTION WORKSHEET FOR DATE: 11/26/2008 TIME: 7:00AM PAGE: 32 SITE ADDRESS: 12850 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF TIGARD ELEMENTARY LOT #: 041 TYPE OF USE: PROJECT NAME: BROADWAY ROSE THEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3. Other fixture: drinking fountain. 8/11/08 ADDED 100 ft. of sanitary sewer and 400 ft. of storm sewer. OWNER: TIGARD TUALATIN SCHOOL DIST. #23, PHONE #: ■-- CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296 Inspection Request Scheduled For: Date: 11/26/2008 Pour Time: nifi ti Code # Inspection Description Confirm # Contact # Mes 399 Plumbing final 078539-01 503-639-5296 V 11/j Corrections/ 'min tructions: a CE '. . : 0 t --• , TSL- / \ 2,b r 1/ - OiLe LI-zi.,--e ikfeJ--Q-e sQs 'ke._ 4D — 1) cSkiz_ck 1 cr--- G----Ne S 1 ,1 , - ', .' , , ,____ • . 61-1,..,a_i IN 6 PASS • i PARTIAL APPROVAL 0 CANCEL lEI NO ACCESS 124ALL 7 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED \. E2tC- ll I . 2(,2 (6 Inspector: Date: Phone #: (503) 718-2-5/ f ` CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2000. 00311 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/22/2008 Phone: (503) 639- 4171u,��rynlp� "� I� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/19/2008 TIME: 7:00AM PAGE: 33 SITE ADDRESS: 1280 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF TIGARD ELEMENTARY LOT #: 041 TYPE OF USE: PROJECT NAME: BROADWAY ROSE THEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3 ". Other fixture: drinking fountain. 8/11/08 ADDED 100 ft. of sanitary sewer and 400 ft. of storm sewer. OWNER: TIGARD TUALATIN SCHOOL DIST. #23, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296 Inspection Request Scheduled For: Date: 9/19/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 076652 -02 503-692 -5070 N Corrections /Comments/ Instructions: 0 6t L L Gk-■.c-c-u- U� L v� 1..J ��'v S� ivy Lc, d-- 3 L . 1 .- 4-e/-k-4-1( Rcd Co p "re rT f �v a ✓'f` A—� 1 � C L, c,z, e,L-c. WI I c1,,q-- `LA ° J / (c, / r rL) Co "c�t - c c- �i.1 ✓ � 1 3 I i J I C.€ c ✓ ( I I? 7 Tr c ,/1 I PASS %PARTIAL APPROVAL ❑ CANCEL n NO ACCESS Il FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: v v\Y)\/S\ \ --.._ Date: ° S VA `, CI Phone #: (503) 718- CITY �� U�� . ^ ��m m m �.�m� m nn��m�ewm�� _ ~ . BUILDING DIVISION '� ' ~,~,�~..~...~" ~..°.~,.~~.. � PERMIT #: PLk42008.00311 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/23/2008 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 7 � 41 � INSPECTION WORKSHEET FOR DATE: 8/37/2008 TIME: 7:00Ak1 PAGE: 15 SITE ADDRESS: 12850 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF TIGARD ELEMENTARY LOT #: 041 TYPE OF USE: PROJECT NAME: BROADWAY ROSE THEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3" Other fixture: drinking fountain. 9/11/08 ADDED 100 ft. of sanitary sewer and 400 ft. of storm sewer. OWNER: TIGARD TUALATIN SCHOOL CV #23, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 505'G39 Inspection Request Scheduled For: Date: 8K2792008 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough-in 074717-01 503-639-5296 Y Corrections/Comments/Instructions: PASS 7 PARTIAL �� CANCEL � | NO _�� ' I I FAIL 7 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: � Date: �� (-�—� CY�� Phone (6O3>718' � �^�^^��_- .' � u � *_ � � .. ^ #: ` ' CITY OF TIGARD "' BUILDING DIVISION PERMIT #: PLM2008.00311 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/22/2009 Phone: (503) 639 -4171 1 "piulp j1l . Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/18/2008 TIME: 7:00AM PAGE: 22 SITE ADDRESS: 12850 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF TIGARD ELEMENTARY LOT # 041 TYPE OF USE: PROJECT NAME: BROADWAY ROSE'fHEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3 ". Other fixture: drinking fountain. 8/11/08 ADDED 100 ft, of sanitary sewer and 400 ft. of storm sewer. OWNER: TIGARD TUALATIN SCHOOL DIST. #23, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503.539 -5296 Inspection Request Scheduled For: Date 8/18 /2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 30 5 Plumbing under slab 074274 -01 503 -638 -5296 N Corrections /Comments /Instructions: 2 S i k O t--a C aK'rs 1 at c Nvg"T el---.4 6 lc S -1 C b {ter U e , 1 (, 41 g .4 C� vJ 2, LI " 3 o 3 i P UL S cL.. I 7-0 ,.k....., ArA -}-,`p , tivv it, S 1.I c (2R i DTI. ) I X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , j_ v . ■... ?TVL -,.__ Date: 4 F - ' 1 or) Phone #: (503) 718- 1 , - - . ° . . CITY OF �'�-~ ��m m m m^�m TIGARD . � . BUILDING DIVISION ' ` PERMIT ~~~°"~~~°^^~~~ ~°^°^~~"~="° PLNi2008-0031 13125GVV Hall 8lvd.. Tigard, DR97223 DATE ISSUED: 7y22n008 Phone: (503) 639-4171 Inspection Roque�o(24Hra.):(S03)63Q'4175 ^��W� «�J-. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 01 2/3OU8 � 7:00&h0 : 11 SITE ADDRESS: 12050 SW CLASS � YV Gg�NT�V� � SUBDIVISION: LOT TYPEOFUSE� � (�Fll��ARDELEK8ENTART #: O41 � PROJECT NAME: � BRC>ADWAY ROSE THEATRE CO DESCRIPTION: � |nte«|mrp|umbin§. F|mwrdroina (3) 3". Other fixture: drinking fountain. 8/11/08 ADDED 100 yL of PHONE sanitary *ov�ar and 4UD�. of storm sewer. OWNER: � PHONE #: llGAR0T\]ALAT|NSCM{)(}LQ|ST. CONTRACTOR: � � VVES|'ERNPLUKHB|N[� #: 503'639-5290 Inspection Request Scheduled For: Date: 8/12/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 306 P|umbingundmrn!ah 074O71'01 50,3-839-5296 Y Corrections/Comments/Instructions: • 9t PASS �l PARTIAL �� CANCEL �� NC}ACCESS �� u u [l FAIL El CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: (31\1+ /�JA i\~-&, Date: 54k21 (A) Phone #: (503) 718- _• .. . . . . . CITY OF TIGARD , BUILDING DIVISION A PERMIT #: RA20013:66311 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/22/2008 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 ,--Afal Ilk. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 8/7/2008 7:01 AIVI 22 SITE ADDRESS: CLASS OF WORK: 12050 SW GRANT AVE SUBDIVISION: LOT #: TYPE OF USE: CF TIGARD ELEMENTARY 041 PROJECT NAME: BROADWAY ROSE THEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3". Other fixture: drinking fountain. OWNER: PHONE #: TIGARD TUALATIN SCHOOL DIST, #23, CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296 Inspection Request Scheduled For: Date: . Time: 8//200B Code # Inspection Description Confirm # Contact # Message 305 Plumbing underslab 073084.01 503-639-5296 Y Corrections/Comments/Instructions: A 1 \ ,...- ,,,,--„C I 6..:S P 1 „A„.....k r, , A es, „ .0 4....A („....c ka_., U■ c..7S \ c...,k, 11.3 .,-\-c- e i p '1 - 37)-ror 3-... a,. 7 PASS I PARTIAL APPROVAL 7 CANCEL 7 NO ACCESS I I FAIL 0 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED Inspector: 0"1•A---ANN h-‘....--,,_ Date: Z 1 ) itT Phone #: (503) 718- .. , CITY OF TIGARD ...- BUILDING DIVISION . PERMIT #: PLM2008-00311 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/2212008 Phone: (503) 639-4171 404 Yi. Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 8/5/2008 TIME- • 7:00AM PAGE: 2A SITE ADDRESS: r2t350 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF. TIGARD ELEMENTARY LOT #: 041 TYPE OF USE: PROJECT NAME: BI-20ADWAY ROSE THEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3". Other fixture: drinking fountain. OWNER: TIGARD TUALATIN SCHOOL DIST. #23, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296 Inspection Request Scheduled For: Date: 8/5/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 30( Plumbing undorslab 073726-01 503-639-5296 Y Corrections/Comments/Instructions: C 0 i ...,, . A, \ \ <A-,v- (: ‘--4./C c I I PASS 1: PARTIAL APPROVAL El CANCEL El NO ACCESS 0 FAIL 7 CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED 1 Inspector: CSIA'vt■A-- 12*--a- Date: 1 \ c ) Oil Phone #: (503) 718- CITY OF TIGARD.. BUILDING DIVISION PERMIT #: PLM2008- 00:3'6'1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/22/2000 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE 7/23/2008 TIME: 7 :03AIv€ PAGE: 40 SITE ADDRESS: 128x0 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF TIGARD ELEMENTARY LOT #: 041 TYPE OF USE: PROJECT NAME: BROADWAY ROSE THEATRE CO DESCRIPTION: Interior plumbing. Floor drains: (3) 3 ". Other fixture: drinking fountain. OWNER: TIGARD TUALATIN SCHOOL DI #23, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503, 3x9..5296 Inspection Request Scheduled For: Date: 7/28/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Watea service 073259 -01 503 - 639-5296 N Corrections /Comments/ Instructions: av c SL- N� � , y �,.i. C - 1Th r �i C ✓° e-rr C Jf.N�c��c�J C ( 0 Ct✓ (, O &-' ce. .,,v , 3 ctc,� E . O l t 1/4_1) cA � c,t ) .�,5 �� r r .. -�c✓ ,e � ' S 3 71 7 7 c 3 Re r 1-- -w D Li e- �J v4 F,J A--k - S e, 7/204) /d Qs- �� a ■ A e t�o � t� <� �Ci` V �e &)-4 P -L i i -fie. PP. fi e v T l.AJ e .0 „„) c L." tJ -4- Oki 4'1 1/i V c- -t-e l l 1n. - 4 - t _ t , U 6 ✓ `<, � r f Q rnn i T 6 Ai e y l i r -4- i � b Po p to ±acv ,c -eloe tfcA e P.e. ✓1,4 rt'' C /� � '"'lp 1f-� bov / � -I�� eel u e e� S) P , [ [ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED f Inspector: t a Date: `"1.2-4 ` ato Phone #: (503) 718 - t,, s__ x`1 1110..4 - CITY OF TIGARD _ ;;:_ 5 .• BUILDING DIVISION '` PERMIT #: { l- M 2 ' °O.tr-_ 11 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639- 4171a9NN�i @II�I?�� Inspection Requests (24 Hrs.): (503) 639 -4175 �_� INSPECTION WORKSHEET FOR DATE: 7/2 TIME: PAGE: SITE ADDRESS: 2767) O ' --r CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME:`5r'oond6va..-j Ro'1c,.4-✓-C- DESCRIPTION: OWNER: isjrx..191(4U- k-o kv,jcL■a4 Qi -T 2-3 PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Lt) w4 54,4 e/-J -a. 4 b rm, Corrections /Comments /Instructions: cc.„ c s -k L 1,) - To Li i ..: J ' ct o -t ✓�. o f + �. P vt, a Le -' T o •C-fv"u , t -oast D6GVK, I Q I 3 d 3 LI O,fi 6 ts- _ /� /�/\ ��,1- e. To C 1.P 6 ; 1 ec Co L ✓c�c o !"� 1 � �►� � TL pfo v i /'A ko4 h J Lc.) . Zs An‘a 4 v-e) 4-. exn', a- ��- yt�etri P,a L\ VC A-r i { >✓� 1 t - r — ; l:Q tvk A_A c„3 0 To t° PASS VI PARTIAL APPROVAL ❑ CANCEL n NO ACCESS I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: crtA►3.A„1) \ \ fi lam Date: 7 12.2)6T.) Phone #: (503) 718- . •• WESTERN PLUMBING 609684901S 12/03/08 09:01am P. 001 Plum �` bins Permit Application ' �� 0 FOR OFFICE USE ONLY City of Tigard .t �� v ., ed �� .r: 3 /r Permit c. _ Ji 13125 SW Hall Blvd., Tigard, OR 97223 Er � s V''. i oir �L� � Phone: 503.639.4171 Fax: 503.598. ] 960 ` w TIGARD Inspection Line: 503 639 410 X O`4 , ) o y Other Permit No Internet: www tigard or.gov Notified/Method' . ` �C1 Date Ready/13y: luris ®Sec Page I fur ` fied/Method' h-z ,�,'+4T +"` ate "F v sir r �,. - j � Sup plem�ur�l Information v w:' �'�' iu t ug Iv �.1 � O -� r' +v. � , �� 04P-0,1-'''.3 i-. tiW4F.F: -� + :?.-d1• r-4*I. 56,.. •Y ,F 0 :-YU.N ' r �1 "`t` . f� y t i i f ,t 14'4o e} r ` ka 4 r F-7 i 3 y .1^ . 1,4. n.d..l+ .W , e .c._ +n. I ,sf t l,(. ,ok ¢i, -.4, rr .....: � i. , ID New constntction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total X Addition/alteration/replacement ❑ Other: New 1- 2 -famil dwellings (includes 100 ft, for each utility connection) al i �Ia i- , 'snf� r�i"a ', Ji OYZ• d? O 1 r r I s = G Ind r t S r :, .,i/,t..4r,,sY, :: ,, ., •:, a � a, tw, O ll .0, ,Y°r7 , t - ,. ',k }ep; , ' SFR (I) bath 249.20 ❑ 1 - and 2- family dwelling Commercial /industrial SFR (2) bath 350.00 E] Accessory building ID Multi-family SFR (3) bath 399.00 - Each additional bath /kitchen 45.00 ❑ Master builder ❑Other: terra *,r * "r rd X t 3 >,. ro �; - �, -;s Fire sprinkler ( sq. ft.) Pagc 2 r ,� C `•.� u ',•'a`�x`'t 4 > t �"t' a7 .. t �', , J' C�Tt �Q+•riii 01{1 °24s U �I�' l -diyr` ` ?Y'�� i�'tt�n�}}t rt. ''Y i-:�a rzu•: F a e s . ,a h..,1 -, t � ,r � s �.�.�rft t , f, J.a5i5a'ah� t�'?•ti'„";�: Site utilities Job site address. J i j_J (_ r(. /1 I% Q ft A Catch basin or area drain 16.60 City/State /ZIP: ( . 0 • _ F •)1 Drywell, leach line, or trench drain 16.60 Suite /bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 Si title. _ ae>: Cross street /directions to job sic: ( Manufactured home utilities 110.00 Manholes 16.60 - - - -- Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 {I Storm sewer (no. linear ft.: ) Pagc 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 j Tax map /parcel no.: Fixture or item ti j, r s^ 3w r u^ rh r Absorption valve 16.60 •t;,l , ,,,,a;' , , : er � , P ;> L 1 ,�, ` , ,, m., , .,, ..o.. ..0 Backflow preventer g Page 2 , Backwater valve 16.60 \. X \ / t " .,'AAA,. Clothes washer 1 16.60 �t -f-x. , *�,� r , Dishwasher 16.60 } 'j$° P W ��r ' �✓� ' f t ? j et t t u rt Drinking fountain - - t ;trw; 4;t.,, , '. ,)Z fx1L LUW , t... , e k - 'l i t- . „ , ;....4;,, , ,,?..., � rcr"; rS G t' `,i.,;sz '' ' Ejectors/sump 16.60 Name: 16.60 Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 • 1)'t dt i,FYg I�• 1 '(. ItU' ,. y . � T 1�. > t- {,.s�. Y th __- m,,, , ft ,, . , A l+ 4 I"a , t _ , ., , i 4 x t ,_?_r ( ,( n' � "�I4iv351,10?s( ,U` s -_ Hose bib 16.60 Ice maker 16,60 Business name: B Interceptor /grcasc trap 16.60 Contact name: _ Medical gas (value: $ ) Page 2 Address: Primer 16.6(1 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin /lavatory 16.60 { E-mail: - Tub /shower /shower pan 16.60 Ib�7 ,�AitS }�t rYd��N � Y 1A�k d letii X$Y , Urinal r. > :� ,,. ,'tw, , ,;- r i+kar :• Cjj'1`'1ti1,. ibis. f r Ct fr .y .� r ,� ra 16.60 4 ,:.r. .,.. i,4 �:..;.. 1 t. �.: Water closet 16.60 Business name: Western Plumbing, Inc. Water heater 16.60 Address: 9460 SW Tigard Avenue, Suite 101 Other: City /State /ZIP: Tigard, Oregon 97223 Subtotal Minimum permit fee: $72.50 Phone: (503) 639 -5296 Fax: (503) 684 -9015 _ Residential backflow minimum permit fee: 536.25 CCB Lic.: 2439 Plumbing Lic. no.: 3429PB Plan review (25% of permit fee) ' Authorized si nature / /�/�`cQ State surcharge (12%ofpermit fee) br:.} g o f `- j `"'`' 11 "TOTAL PERMIT FEE Print name: Dana Jensen r� 7 � t� 1 Date:- ) -.�1 � 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: U Normas1PLM- Ponnnnpt,.doc 06/26,06 9 4 0 -46 1 OT( 10 /02JCOMM'Ea)