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Permit CIT OF TIGARD PLUMBING PERMIT r; DEVELOPMENT SERVICES PERMIT #: PLM2001 -00623 I I I ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/28/01 SITE ADDRESS: 11670 SW 98TH AVE PARCEL: 1 S135CD -01800 SUBDIVISION: GREENBURG HEIGHTS ZONING: R -4.5 BLOCK: LOT: 001 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: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 310 ft DISHWASHERS: RAIN DRAIN: ft Remarks: 310 ft. water service. FEES Owner: Type By Date Amount Receipt VISTA NORTHWEST, INC. PRMT CTR 11/28/01 $147.80 27200100000 PO BOX 91459 5PCT CTR 11/28/01 $11.82 27200100000 PORTLAND, OR 97291 Total $159.62 Phone 1: 503 - 531 -0505 Contractor: CANBY PLUMBING 805 NE 4TH AVE ** CCB EXPIRES 8/2/200 REQUIRED INSPECTIONS CANBY, OR 97013 Phone 1: 266 -2091 Water Line Insp Reg #: LIC 33572 Final Inspection PLM 3 -7PB 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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued By: f _ / Permittee Signature: A Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day FROM : CANBY PLUMBING INC. 96 PHONE NO. : 5032662091 Nov. 28 2001 09:57AM P01 —. S rs:� 2 4..A. - t'-e 1--Y r ''\ Plumbing Permit Application -- - t -•�- -- Date received: Permit no.: A. ", th • City o `gard Sewer penult no.: • Building permit no.: --° Address: 13125 S H Blvd, Tigard, OR 97223 �pj laxplrodate: cuy o( 1'iaard Phone: 503 639.4171 CM Receipt ax: ( 03) 598 Date issued! Case file no.; Payment type: Land use approval: _. — .� - TX1'k Olt' �'T:ItMIT 0 I (&. 2 family dwelling or accessory Cl Commercial/industrial C] Multi - family Cl Tenant improvement 1 0 New construction Q Addition/alteration/replacement Cl rood service O Other: ' JOB SUE 1N 1'OItMAT10N FEE SCHEDULE (t' special information use checklist) Ylaaaa;ti . on ��1 Total Job address: u � ` ew • an -fa y , welf ngs on y3 Bid :. no.: `Suite no ": - — (lpcludee 100 ft, for each utility connection) Tax ma tax lot/account no.: _ _,_ SFR (J) bath _� Subdivision: — • (2) bath - Lot: Block: :. (3) bath • __„— Project name: is , G a • + alonal brio tc n �� City/county: scr pt d l o work premises: /A2 ZIP: . III Description and location of wor on p 1�'ft�� f� °� i` Site utilities! B—. J Catch basin/area drain Dtyweli. each drain Est date of corn •letioNins • tier: - coring i s n, l i t --- EIIIOIIIIOIIIIIIPIII IIAT \iRING CON112NefOlt . Manufactured home utilities, Business name: . r i .L ��t Manho ea � � ' un • run connector MI Address: :/ ► arn ttary sewer no. . •) �- City: e `i►� �� " term sewer (no. iin. ft) -- Phone -. „ : no. in. ft.) _>ril� CCB t10 : ,� Plumb. bus. reg. no: 3 – 7 Fixture or (term: - Cit /metro lic. no.: � �� i Abso •lion valve Cps tot's re • rt*.sentstive al: nature: // i.i,� . _ e ack ow P reventer � Print name: ;, a i it Date: // . ' Backwater valve ('ONT PE SON Basins/lavatory, , := Clothes washer . Nauaa: Disbtwas el MI 1=1161 Address: Drinkin :�ount�la n � _ — Cl _ State: ZIP: ectors/stimp Pax: E -mail: : panslon tank _ Phone: Fixture/sewer cap 1Iopr draintt/floor sinks/hub /� �" aJa o d _A- Madill: address: e Hose blbl 2 Y State: L�� i ��P Ice maker -_--- ._..... � NM I . City: _ � -/ �' a t!'T In _reasetra _ Owner 7Y� Owner instsklat on/residential maintenance on y: The actual installation Primer(s) 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 , = Instills), si signature: Date: Su . _ _ Owner's gn _ ub s to wer /sh p an LNGINLlJi Urinal — � --a:�- Name: -- .w t ' stet closet ------ " stet • eater Address: - ZIP Other state: E-mail: Total Phone: Pa"' Minimum fee $ Not et JusisdlodtAn no cm t cads. P 1µ" c r urtsdlat i o n f m t t ° ti N o ti ce : ... . s vomit application Plan review (at `fo) $ --� - -- O Vila U Mu►«G expires if a permit is sot obtained Bute sarchat (846 within 180 days after it has been ,I,OTA $ cadre and a+moa r' e'�P"�' accepted as complete. ~. '" - r4 m of cazdbolder LIZ:n t• m a t acrd s 440461e (6■00/Ct7M) Amouet 5V:5 Z , -14/2_ Plumbing Permit Application Date received: I ( -).__-O ( Permit no._}l) j / _ 3 , City b �1 I . Cit of Tigard 4 ;l ( `J Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City ofTigard Phone: (503) 639 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By:?a Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ I & 2 family dwelling or accessory ❑ CommerciaUindustrial ❑ Multi family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist) Job address: (l /437( 5 C(c6 At.) f_... Description Qty. Fee (ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: I ZIP: Each additional bath/kitchen Description and location of work on premises: /n15775"u 4 rioA) Site utilities: OF Catch basin/area drain Est. date of completion/inspection: Drywells /leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: 1 V1 (N U ` Manholes Address: 8Qf N I.. L.�'r(.� Rain drain connector City: ( R../ S tate:01I ZIP: Cl -7 0 I Sanitary sewer (no. lin. ft.) Phone: 3(p(p -ap 9/ I Fax: I E -mail: Storm sewer (no. lin. ft.) 335`M. I Water service (no. lin. ft.) S 10 CCB no.: Plumb. bus. reg. no 3 -`� hS City /metro lic. no.: Fixture or item: Absorption valve Contractor's representative signature: Back flow preventer Print name: Date: Backwater valve CONTACT PERSON Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) • City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Name (print):�f��- jars r q.,T' Floor drains/floor sinks/hub Garbage disposal Mailing address: 7( 2/ Y Hose bibb City: �� 7 I State: I ZII67.Z c / Ice maker i Phone5T /_ Fa>,yS 1,7/Iel Lmajl: Interceptor /grease trap 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) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: • Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Notice: This permit application Plan review (at _ %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 0 Expires TOTAL $ / 59- Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00 /COM) PLUMBING PERMIT FEES: F PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL - Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT - 16.60 for each utility connection) Lavatory One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 _ Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San /Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3' Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 ' Water Heater S c.-,3 6 Other Fixtures Water Service - each additional 200' 46.40 9(2 _ 8-6 r ( Specify) . Storm & Rain Drain - 1st 100' 55.00 - Storm & Rain Drain - each additional 100' 46.40 _ Commercial Back Flow Prevention Device 46.40 - Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 - Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per /hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 _ *SUBTOTAL / c 8% STATE SURCHARGE , * *PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty total is > 9 _ TOTAL $/ -,( -- * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. is \dsts \forms \plm- fees.doc 10/10/00 CITY OF TIGARD BUILDING INSPECTION DIVISION j 24 -Hour inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date - 3 Date Requested ! ( U AM PM BLD Location 1 /' 7 C 6 7 9 ` L Nyy Suite MEC Contact Person Ph / 22. (' Q / PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain r.11. SGN Crawl Drain Ins on Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Drywall on Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab 4 To Out ter SeTVtt;e> Sanitary Sewer Rain Drains 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 PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk T C/ Other Date 1/ — T _ Inspector eswe. Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.