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Permit CITY TIGARD PLUMBING PERMIT 4 or All i''' DEVELOPMENT SERVICES PERMIT #: PLM2001 -00029 13125 SW Hall Blvd., T OR 97223 (503) 639 -4171 DATE ISSUED: 01/29/2001 SITE ADDRESS: 14320 SW 100TH AVE PARCEL: 2S111 BA -02300 SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5 BLOCK: LOT: 029 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: 1 SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Scope of work for non - profit. Per Building Official, adjust permit fee. FEES Owner: Type By Date Amount Receipt JONES, VERNON G PRMT CTR 01/29/2001 $50.00 27200100000 COLLEEN D 5PCT CTR 01/29/2001 $4.00 27200100000 14320 SW 100TH AVE TIGARD, OR 97224 Total $54.00 Phone 1: Contractor: OREGON CITY PLUMBING 611 7TH ST OREGON CITY, OR 97045 REQUIRED INSPECTIONS Phone 1: 656 -8558 Rough -in Insp Top Insp Reg #: LIC 0002132 PLM 3 -20PB Final out Inspection EXPI RED 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 B .. Permittee Signature: V ,_ e. „I 0-- Call (503) y 7:00 P.M. for an inspection needed the next business day A . ' Plumbing Permit Application Date received: i _1 _ O 1 Permit no.:P a 00 , -000,91' , , 1 City of Tigard 4 4. ./ 1 � g 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 issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ 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: 1 4 3 2 v 4--J lot) Description Qty. Fee(ea.) Total Bldg. no.: I 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 loc ion of work on premises: ACC e % 61 t? Site utilities: /3 ,4r'f -'rj- P-- 'u,. 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: Oq.ey 2 , ry 1 . LD t o c.--T Manholes Address: J INN& (Awkvk ��( Rain drain connector City: In A.2.1 C. I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: (y -3'4 S 55 g I Fak: 1E-mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print name: Date: Backwater valve CONTACT PERSON Basins/lavatory Name: ` t L r Sa 7- 3 /.S �' Clothes washer '✓ t ✓AA , t '' �' Dishwasher Address: � e . 0 S , y t e..17''r� k-c%' Drinking fountain(s) City: i.Jt 5 r L.,,,.,,,,,„ I State: I ZIP: 4j% 70 6 D - Ejectors/sump Phone: ( 7 S`» Fax: E -mail: Expansion tank Fixture/sewer cap Name (print): .t.,.. Ova 1-0-.41.0 Floor drains/floor sinks/hub Mailing address: l ( 4 --1 1 .-to S c.v t ap1``'C Garbage disposal Hose bibb City: — 1 - 110,...k I State: I ZIP: Ice maker Phone: I Fax: 1 E -mail: 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: 1E-mail: Total '. Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Notice: This permit application Plan review (at — %) $ O Visa O MasterCard expires if a permit is not obtained Credit card number: / / State surcharge (8 %) .... $ Expires within 180 days after it has been TOTAL $ Name of cardholder as shown on credit card accepted as complete. Cardholder signature Amount 440.4616 (6/00/COM) PLUMBING PERMIT FEES: 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 I 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage D 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 Other Fixtures Water Service - each additional 200' 46.40 (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 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 O i -25-01 12 :19FH FROM SORRENTO CONS ?, INC. PO FROM : In -House Architecture FAX N©, 503 238 -8065 Jan. 24 2001 04:19PM P2 46' I ff�� , 1 4-AUN PRY USN ACON1 t p s J 1 , 1 14/AY ¶0 . i I. ' / ,..._,L c_ ........:2_L i ' Li iqrAe-I-0 li r-- 11 L ` M012 El., rOV,11,, 110NI 1-2001-0( mro. , 4 M. ,lC 1 Ohl. . 1 Od 1H Div .. T i4b. t? O 17 2.2-4