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Permit ti C ITY OF TIGARD PLUMBING PERMIT i DEVELOPMENT SERVICES PERMIT #: PLM2001 -00205 IIi 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/18/01 SITE ADDRESS: 12355 SW 114TH TERR PARCEL: 2S103AB -06300 SUBDIVISION: WALNUT GLEN ZONING: R -4.5 BLOCK: LOT: 021 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: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Irrigation backflow prevention device. FEES Owner: Type By Date Amount Receipt TRACY, DAN &SHANNON PRMT CTR 5/18/01 $36.25 27200100000 12355 SW 114TH TERRACE 5PCT CTR 5/18/01 $2.90 27200100000 TIGARD, OR 97223 Total $39.15 Phone 1: 503 - 603 -0586 Contractor: OWNER REQUIRED INSPECTIONS Phone 1: Final Inspection Reg #: 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. ai „I � � Permittee Signature: L j ______ _ 1.A\ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n` business day a Plumbing Permit Application Date received: .j ' ' :',/ Permit no.: / H p /.. p ,2 DS .4 City of Tigard and A. �� l l `•r 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:4A Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT 1 & 2 family dwelling or accessory ❑ Commerci. 'ndustrial ❑ Multi- family ❑Tenant improvement New construction 7, Additio . teratio placement ❑ Food service ❑ Other: JOB SITE Job address: INFORMATION FEE SCHEDULE (for special inforn ation use checklist) i � P355 Sw // 7' "7-,Gf/Ya,e-2 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: Vl/a._vt e.(,(- C2,o'U SFR (2) bath Project name: s prj - h f e.s- S,, 4 may, SFR (3) bath City /county: n c tt ' T I ZIP: 97 a-?3 Each additional bath/kitchen Description and location of work on premises: 9ravt t t 6 t`eZf d Site utilities: Catch basin/area drain Est. date of completion/inspection: S 3/ c'/ Drywells / leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: d A/E4 Manholes j Address: Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) i Phone: I Fax: I E -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 _ ('ONTACI. PERSON Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank I S Fixture/sewer cap Floor drains/floor sinks/hub Name (print): Sfria. irlDr) Qom, Tj _ Ge� Garbage disposal Mailing address: / .3 5 S cSi <J / / tare WZ_ I ZIP: g 7 ems City: 7 Hose bibb 'j 9 ec s-y�{ State: On I ZIP: �a 3 Ice maker Phone: 273 03 oSg I Fax: I E- mail:ds t► a_a(6)7ft"U 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 p •• ??' I own as per ORS hapter 447. Sink(s), basin(s), lays(s) Owner's signature: `4J . ,. ,7r/ . mo d ate: �i -'/ 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 Minimum fee $ Zlv . Z- Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ a 2 , q a Expires TOTAL $ 2 9 . !S 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 Lavatory 16.60 for each utility connection) One (1) bath $249.20 Tub or Tub /Shower Comb. 1 6.6 0 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 3" 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 Water Service - each additional 200' 46.40 Other Fixtures (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 CITY OF TIGARD 24 -Hour BUILDING Inspectiot;taine: (503) INSPECTION DIVISION Business Line: (503) - 171 MST BUP Received Date Reque to � AM PM BUP Location /' S.S �� / � "/ / ' T c Suite MEC Contact Person Ph ( ) PL c60 /- 66? S Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access. Ftg Drain /11 J ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors L�( W.,26,71 Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler �� r/Wi F ire Alarm ` / .L _� ' s / Susp'd Ceiling - -- Roof %.1.01111111M111111014.4 /,or ■T VIM Other: - Final / PASS FAIL (1 MBING 7 t3st & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other:1c G FLOCS Finar (24 PART FAIL ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final 9 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line r ADA Approach/Sidewalk Date • Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL r CITY OF TIGARD BUILDING INS &ION DIVISIO • MST 24 -Hour Inspection Line: 639 -4175 B usiness Line: '639 -4171 BUP Date Requested 7 AM PM BLD Location / 2 3 5.5 Sw //t( 7 ✓ Suite MEC Contact Person Ph 5'3 ga 333 PLM -- Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain 6.ih+e" SGN Crawl Drain In ction Notes: Slab SIT Post & Beam Ext Sheath /Shear Ina Sheath /Shear ' � / c / 1/ /t' Framing ' � _ l _ Insulation • Drywall Nailing 71-'49 �' efe (-e Firewall �) / / Fire Sprinkler � h S // or y 6/ 4 b /-+L (J c p� �'cr•c i Fire Alarm -� o � Susp'd Ceiling � p'? ✓i t -A_ Or 144 •' `1 "^ µ +.-k. Roof a Misc: 13-e_ fa c`' y r a eAs Final ?) / " PASS PART FAIL 7r''0 lor'1� 6 bir,',��, crn C 4er e - r;u -t Lu - ctry ,4,,,/ T&1 Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rai Drains -- rnal ASS P d ikep MECHANICAL \r.• 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 Date 7— /1 o In spector �� ) 1, G Fri ✓ . Other Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •