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Permit i PLUMBING PERMIT CITY OF TIGARD • 0 COM MUNITY DEVELOPMENT Permit #: PLM2009-00279 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009 Parcel: 2S 101 AD01300 Jurisdiction: Tigard Site address: 12750 SW 68TH AVE Subdivision: WEST PORTLAND HEIGHTS Lot: 33 Project: Clearchoice Project Description: Relocate (1) d/w and (1) lay. Cap existing d/w and lav location. Install (1) new lay. Owner: FEES HAMPTON BUILDING, THE LLC Quantity Description Date Amount 75 -796 HIONA ST HOLUAIOA, HI 96725 1 ea Dishwasher 10/07/2009 $25.02 PHONE: 2 ea Fixture /Sewer Cap 10/07/2009 $50.04 2 ea Lavatories 10/07/2009 $50.04 1 12% State Surcharge - 10/07/2009 $15.01 Contractor: Plumbing HARDER MECHANICAL 1 ea Medical Gas 10/07/2009 $72.50 2148 NE MLK BLVD. 0 12% State Surcharge - 10/07/2009 $8.70 Plumbing PORTLAND, OR 97208 PHONE: 503 - 281 -1112 . FAX: 503 - 287 -5284 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $221.31 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: a n ^ Permittee Signature: Av. )! VC 1J Q - 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. • - 0,CT-02-2009 09:39AM FROM- T-436 P.002/004 F-561 plumbing Permit ApplicatiO Building Fixtures CEIVED FOR OFFICE USE ONLY City of Tigard 0 C T 0 2 2009 Received Date/By: 94. Permit No.: 9 in2oaq to . 4 13125 SW Hall Blvd., , lt 223 - Plan Review N TigardO 97 2 Phone: 503.639.4171 Fax: 503.59LW Date/By: Other Pennitl_Lo.3AW 20 .-I50 I 5 Inspection Line: 503.639.4175 Cm OF TIGARD Dam Ready/By: I : 10 See Page 2 for TIGARD Internet www.tigard BUILDIN a." L.)..........,."G DIVISION NotitIceMethod: Supplemental' Inform/1'7n . ,.... Ae.,.41 " ' ' 41:5614e, .t:0-glAtOligl-M1,40...1Sioe!..1g*OW:ii.1.1:q*4.-.M.iir::2LL45 a ;I': '..,..;z4p7.!ts:ii -xe_-.:s" . :; • !ati • ',. , ...:,, :....4.i.„,- ....L.: :,...,- - J f:i 7. .., J . inv.,, , • 1 ov, . , .,. , ..- • - • -- - - - For special Wont:alien use checklist 0 New construction 0 Demolition - - :Description 1 s e - Ea Total Addition/alteration/replacernent _ 0 Other: New 1. 2-family dwellings (includes 100 ft. for each utility connection) 44t.r,:itlisilf4 T:014,#0:0".4.Nt.X.Strk. tk*Wrair:Mitt SFR ( bath 24920 ID 1- and 2-family dwelling rs g COMmercialfindustrial SFR (2) bath 350.00 , SFR (3) bath 399.00 ID Accessory building 0 Multi-family - - Each additional bath/Idtchen 45.00 D Master builder D Other: .. Fire sprinkler ( , sq. ft) Page 2 Sitalf-119.411;50iiter'sfiti-)sifoit-sigt-p-.7;whixpvtvr..4,...:iorfor4, sit.... Job site address: I "a7 5 0 tA5.)ia-t..j'-a,.._y- Catch basin or area drain 16.60 City/State/72P: P*1 )4. 0 OR ""/ - 7 2----i Drywcll, leach line, or trench drain 16.60 --- - - Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt_ no.: Project lune: t/E-4/Z C ht,IG.6 Dc-Nrai- Manufactured home utilities 110.00 Cross street/directions to job site: - - Manholes 16.60 -------- _ Rain drain cormector 16.60 Sanitary sewer (no. linear ft.; _) Page 2 , Storm sewer (no, linear it.: _.) Pagc 2 Water service (no. linear £L: ___) Page 2 . Subdivision: Lot no.: .----------- Fixture or item Tax map/parcel no.: as lc.) ■4r)Q , Absorption valve 16.60 - IM.InKA..7:. O''.6#1';',"#.P*1:Rjr:I414.niTgaillir;4:j B prevcnter Page 2 - a eLoc.A. 6. ' 1'n c LA. t2-e., Backwater valve 16.60 4. 6 Clothes washer 1660 • Pi. ir .LA ' ■ ait... e tot --t Dishwasher - 71 . q.. .,-..... Drinking fountain 16.60 141:1 - 1*.#7.TIE:101 •N.: ::Trid Ejectors/surly 16.60 • Narae: Pia-, - -. ,_ - &e._ PER-4.1 I . A.^ . Exprmsion tank 16.60 Address: Fbctusew cap . , .2 .. 1.666 - - City/State/ZIP: Floor drain/floor sink/hub 16.60 o.u4 Phone: ( ) Fax: ( ) Garbage disposal 16.60 :,.... Hose bib 16.60 P. : i ma 16.60 Business name: HA p_ ))/1 ee.414:41) PC Interceptor/geese trap 16.60 Contact name: k"& t -r- H , a s5 , ) ,„ y e vi .. Medical gas (value: $ /- Page 2 - 7,2 Address: 9, i Li g i a _ idu_e_ isz_yD. Primer 16.60 -..- -- City/State/ZIP: Roof drain (commercial) 16.60 R Ll..1 p okiri .,, 0 0/2_ , 4-- 262? - Sink/basin/lavatory Z 16.60 Z-rt:-C7 Phone: (593) i p....... , 1 ig.. Fax;; (aa ) As-7- ..6 Tub/shower/shower pan 16.60 E-mail: Ke>ertay& e... NAR-47F...P--enc Urinal 16.60 Artatrainikk . 00-141314 : iiireEMSTA 3 S .3 Water closet 1 Business name: Ft . ,c , ._ YAS-4-1+4n 4-44- Water hearer . 16.60 Address: „9.1 Li 0, N g. ts 1 1 s y v . ,_... Other: - Subtotal IS /ZIP P City/State: op_i- pre_ G13,700 - Minintum permit fee: $72.50 tet 7. ( Phone: (3) gig . i ) II Fax; (--523 ) i9 -- 595 4 _ Residential backflow minimum permit fee: $36.25 CCB Lic.: 6 Plumbing Lic. no.: pp, , .. - Plan review (25% of permit fcc) $7 1 State surcharge (12% of permit fee) lAre- Authorized signature: / , 9-4.714.0r0/ • TOTAL PERMIT FEE 1-Wr-5- [print nru4<awri..t. a co y., 6 „ 5 .4.... _ Date: / ti --- p_ - odi 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-Cotmty Building Industry Service Bova IABuiltling\Permita \PINF-PermitApp doc 12F27i06 4413-4616T(10/02/COMMEB) dP.1.31 = ZU 0 4- OCT -02 -2009 09:39AM FROM- T -436 P.003/004 F -561 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Schedule: Fee Residential Fire Sur . ression S stems: r , = .. , otilm T'' .7. ,. 0, iillt�� ,fit.�. •,.W'r IT E: � ♦,� ��7 y - ; {�. i � � � O�Qty:'i:� �;�Fee� Pax ,�aS -0. e;.�, j•�C,.f `�',;' �`" ��.. ��.�I 1 _ ,,, L 11. .-. .wL:,,, ':.1`•'..., : 1i x .4,.....,....- ■;lev4: i : -.,,i '- ',Far.,ir .. . ' . 55.00 0 to 2,000 $115.00 Footing drain -1'` 100' 2 001 to 3,600 $160,00 Footing drain - each additional 100' 46.40_ 3,601 to 7,200 $220.00 55.00 Sewer -1st 100' 55. 7,201 and :. , er $309.00 _ Sewer - each additional 100' 46 Water Service - 1st 100' 55.00 Medical Gas S yst ems - 'ys Y' "a+C4: T .d'i.t5' .f L , lr .gyp : . _�: : ��- - � fee• ���� +. �'.. Water Service each additional 100' _ 46.40 aliiatiou. i.' r.tiu` Je>►> •`i Storm & Rain Drain -1st 100' 55.00 - $1.00 to $5.000.00 Minimum fee $72.50 Storm & Ram Dram - 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 additional $100.00 or fraction thereof to and ,, , : ,. t ili iii: u' ;; i ; t ::: :. MI i ;�`s�' :Tr r : 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 51.54 for each additional $100.00 or fraction thereof, to (min ima m pcermit mn al rm 536.25) Device 27.55 and including $25,000.00. (muit f ee fe family dw ellin; 65.25 $25,001.00 to $50,000.00 $379.50 for the first 525,000.00 and $1.45 for Rain Drain, single family dw _ each additional 5100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per how 72.50 550,001.00 and up $742.00 for the first 550,000.00 and $1.20 for Subtotal: cash additional $100.00 or fraction thereof. ,,, tiyi4 c•1t Sry ma,nn fi�i y G'�. rm: -s .•{• In evie �` Commercial Fixture Work: ,;lPl w£o�!gsi�alla�io�ls.:<''::, Are you capping, adding or replacing 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. * ❑ Any new commercial building with water service 2" and accurately report fixtures could result in increased sewer fees ty _ greater, except systems designed and stamped by licensed ,. . , .4 - nre"WOrkilte`rfdtined ^" h�; {;�,� ~ � ,�# - :.Q>mphtY�'"t .. � engineer. t�'Fnctgre ,41.-: , ;i , g : s `-' �cL C ; � .1 �r 1:3 New exterior plumbing site utilities for any complex structure � �- : �.. -.C, ilPr;:;�o'ns'•:t �lkCrinpca .Adaeil � °� -, as defined in OA,It9i8 -780 -0040. B�tlstry/ - Tu - Tub/Showcr Bath - Tu ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whir�ool _ _ ❑ Any multipurpose fire sprinkler system. Car Wash - Each Stall ❑ Any complex strvcnrrc as defined in OAR9I8 780 - 0040. -Drive Thru Cu- .idor/Watcr As. irator Submit 2 sets of plans with any of the above. Dishwasher -Commercial - ,,,;, ,., „ ,�., t � mr L•4:•� rei � r �',� 9F:. '�f .Does e I 1 ; >�� .nV; sometr.><c o .00....►agraii1 s ,:, ira..,: Drinkin: Fountain ❑ Isometric or riser diagram is required for new buildings F Wash Floor Drain/sink - 2" that meet the qualifications above. - -4" Car Wash Drain _ Garbage - Domestic Comments regarding fixture work: Disposal - Commercial _ - - -Industrial Ice Mach./R.efri • Drains Oil Senor (Gas Station) Rec. Vehicle Dum • Station Shower -Gang - -Stall Sink - Bar t , • f *Note: If the fixture work under this permit results in an - Commercial y increase of sewer EDUs, a sewer permit will be issued and - service _ fees assessed for the sewer increase must be paid before the Swimming pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor __,-. Water Clo - To ilet Urinal Other Fixtures: is inktingw m ilimALpermilApp.doc 12127'06 CITY OF TIGARD - A1_ 6 0 2/q BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: Phone: (503) 639 -4171 ^ jn�pi Inspection Requests (24 Hrs.): (503) 639 -4175 ��. t. INSPECTION WORKSHEET FOR DATE: I O © i /6q TIME: PAGE: SITE ADDRESS: 121 51) (10 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: -- 2-(D6 ;5 CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message -4 1M C9a5 L b ® 162 -D I Corrections /Comments /Instructions: 06/1; 9 Re`4f/ ter -e.. hus =plc t. I , Rxty 15a J V *—UctnA a o/` (44-x, kik c eAf-to Z- b- n: , riP6l /2 d C 7GA-- wi9AJ. -G °' 1 t'Z i' J ' A�C�L z .. ' A_r( t/C/ '0/W rciz 7 ,t*i4 - 6. A-PFKP 1 :sfi n PASS 4PARTIAL APPROVAL ❑ CANCEL l NO ACCESS n FAIL n CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED / ( 6L11- Inspector: G(- e Date: /06k? Phone #: (503) 710 - 0 e° 65 6-vi, CITY OF TIGARD BUILDING DIVISION PERMIT #:�� ©Z �� 13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: Phone: (503) 639 - 4171 „ 'a , ��,���,Al � Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: l0/7 0 C, TIME: PAGE: SITE ADDRESS: I Z i 78 — b S t 6611-- CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: /0 /01 loi Pour Time: Code # Inspection Description Confirm # Contact # Message 3/Lc- M �(SP6 - e_ 1 Corrections /Comments /Instructions: PASS KPARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: . ;i, , , ��, �!.rI Date: L• /0 Phone #: (503) 718 - AO