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Permit CITY TIGARD PLUMBING PERMIT 4 s DEVELOPMENT SERVICES PERMIT #: PLM2001 -00055 DATE ISSUED: 02/26/2001 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134AC-05600 SITE ADDRESS: 10998 SW 109TH AVE SUBDIVISION: HART'S LANDING ZONING: R -4.5 BLOCK: LOT: 027 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 0 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install backflow prevention device for irrigation system. FEES Owner: Type By Date Amount Receipt BERKHOEL, PHILIP J 5PCT CTR 02/26/2001 $2.90 27200100000 10998 SW 109TH AVE PRMT CTR 02/26/2001 $36.55 27200100000 TIGARD, OR 97223 Total $39.45 Phone 1: Contractor: TAN MAI LANDSCAPING 2514 SE 67 AVE PORTLAND, OR 97206 REQUIRED INSPECTIONS RP /Backflow Preventer Phone 1: 503-775-3202 Final Inspection Reg #: LIC 12431 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: ' 111 �� _ . , 1 Permittee Signature: ,Call ( 13 .39-4175 by 7:00 P.M. for an inspection needed the next business day .r . Plumbing Permit Application Date received _ j ` i �" 1 Permit no.: t UR .0 1 --• SS .4 , City Ci of Tigard { b ' P Sewer permit no.: Building permit no.: - Address: 13125 SW Hall Blvd, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 F 001 Date issued: By: I Receipt no.: Land use approval: tMrAUli1TY DEVFt_UPMUII Case file no.: Payment type: TYPE OF PERMIT Pk & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ • w construction t= Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist) Job address: I pal C I p 001, A-ft . 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: IBlock: I Subdivision: ( a, "Dior -01 SFR (2) bath Project name: SFR (3) bath City /county: 'jl A I ZIP: Each additional bath/kitchen I Description and location of work on premises: Site utilities: c tI V v SyS1'E'* . 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: i ' 11Pt t...A4DSt. .IN f 1 NI Gl • Manholes Address: lam} �^E, j "rte. I J' Rain drain connector City: QrQ I State: 0'04 ZIP: al , 1, . Sanitary sewer (no. lin. ft.) Phone: sA =115 - Fax: I E -mail: Storm sewer (no. lin. ft.) Plumb. bus. re no: Water service (no. lin. ft.) MN L k 12 } g' Fixtur_c_or -item: �� [ City /metro lic. no.: �j ^ t h5 fi • 'sorption valve ' ■ IIII` ; I- 'tir_ , - Contractor's representative signature: 4/ 111, 'c L Back flow prevent �"'IEW ..r : 2 Print name: ; ate t Date: — - 0 :. ckwater valve II v ' CONTACT PERSON Bass • 6 • Name: rt'( -'tJ Mprk Clothes washer I Address: di ! ( 17c.‘ Ne Dishwasher Drinking fountain(s) ■ Mt City: Pp41j State: ZIP: 2(5-10 E Phone: 1 S- 3 2.../.)9._ Fax: E -mail: Expansion tank OWNER Fixture/sewer cap _N ION Name (print): VIA . p (t \\_ $£mil! 06.6.>- . Floor drains/floor sinks/hub IIII i Mailing address: 0 ' , ‘0 , .c H bi disposal Hoo se se bibb IMII`M. EEIIIBMILMIIIIIIIIIIIIM State: ZIP: Ice maker Phone: Fax: 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: Ill City: State: ZIP: : ter: Phone: Fax: E -mail: . Total _ _L r Not all jurisdictions accept credit call Notice: •. rm application s, please call jurisdiction for more information. tion Minimum f $ _ �to �� - O Visa 0 MasterCard expires if a permit is no o.tained • review (at _ %) $ Credit card number / / within 180 days after it has been State surcharge (8 %) $ '- E b , Expires -1 ), accepted as complete. TOTAL L\ S - Name of cardholder as shown on credit card , $ Cardholder signature Amount - d4t9•4616 (6100ICOM) 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 Lavatory 16.60 for each utility connection) 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 1 6.60 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 ( I Quantity by Work Performed Gas piping requires a separate .�echa ;cal Fixture Type: New I Moved I Replaced I 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 p is 72.50 + 8% state surcharge, except Residential Backflow Prevention Device. which is $36.25 + 8% state surcharge, * New Commerciat rutidln require plans with isometric or riser diagram and plan review. is \dsts \forms\plm- fees.doc 10/10/00 QT. ( OF TIGARD BUILDING INSPECTION DIVISION 6/MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 34 AM PM BLD Location /6 f ff 5 / G f 4 Ad! Suite M Contact Person Ph o - GoS.S Contractor Ph 7 7) ZG Z.1 SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL 1043 5:171. C I Post & Bea Under Slab Top Out Water Servic Sanitary Sewer Rain Drains Fin S PART FAIL CHANICAL 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 T Otheoach /Sidewalk Date ��(v Inspector �\ v C Ext3 Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. h + e BUP - Building Permit ELC - Electrical Permit 4 Inspection Description Date Passed By 4 Inspection Description Date Passed By Footing /Setback Underground cover Foundation walls Wall cover Footing drain Ceiling cover Waterproof bsmt walls Electrical rough -in Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing 4 Inspection Description Date Passed By Firewall Low voltage Tilt -up panel Electrical final Masonry /Reinforcement Framing MFG - Structure set -up MEC - Mechanical Permit Insulation 4 Inspection Description Date Passed By Drywall nailing Post/beam mechanical Suspended ceiling Gas line Engineered soils Mechanical rough -in Welding Lab Final Fire damper Concrete Lab Final Duct work Bolting Lab Final Smoke detector Fireproofing Lab Final Mechanical final Structural observation Final inspection <=PLM Plumbing Permit 4 Inspection Description Date Passed By BUP — Fire Protection System Permit Plumbing underslab 4 Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP /backflow preventer Fire alarm final Rain drain Storm drain Water service SIT - Site Permit Sanitary sewer Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final 3 /Ll%1) ✓ 6 Sprinkler supply lines Sprinkler underfloor /slab Catch basin /Manhole SWR - Sewer Permit Engineered soils 4 Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS * CITY TIGARD PLUMBING PERMIT A DEVELOPMENT SERVICES PERMIT #: PLM2001 -00055 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/26/2001 PARCEL: 1 S134AC -05600 SITE ADDRESS: 10998 SW 109TH AVE SUBDIVISION: HARTS LANDING ZONING: R -4.5 BLOCK: LOT: 027 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 0 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install backflow prevention device for irrigation system. FEES Owner: Type By Date Amount Receipt BERKHOEL, PHILIP J 5PCT CTR 02/26/2001 $2.90 27200100000 10998 SW 109TH AVE PRMT CTR 02/26/2001 $36.55 27200100000 TIGARD, OR 97223 Total $39.45 Phone 1: Contractor: TAN MAI LANDSCAPING 2514 SE 67 AVE PORTLAND, OR 97206 REQUIRED INSPECTIONS RP /Backflow Preventer Phone 1: 503-775-3202 R Final Inspection Reg #: LIC 12431 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: kb �� , ,�_,� Jib Permittee Signature: Call ( 13 .39-4175 by 7:00 P.M. for an inspection needed the next business day