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Permit CITY TIGARD PLUMBING PERMIT A * 4 4i DEVELOPMENT SERVICES PERMIT #: PLM2001 -00128 A II DATE ISSUED: 4/2/01 13125 SW Hall Blvd., T OR 97223 (503) 639 -4171 SITE ADDRESS: 14555 SW 128TH PL PARCEL: 2S109AD -07600 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: OTR 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: Installation of residential backflow prevention device. FEES Owner: Type By Date Amount Receipt WESTLAKE HOMES INC PRMT CTR 4/2/01 $36.25 27200100000 PO BOX 69326 5PCT CTR 4/2/01 $2.90 27200100000 PORTLAND, OR 97201 Total $39.15 Phone 1: 675 -0495 Contractor: TERRA -SOL LANDSCAPING 21685 SW HEDGES DR TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone 1: 692 -6389 RP /Backflow Preventer Reg #: LIC 00005019 Final Inspection 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 • . • • uspended for more than 180 days. ATTENTION: Oregon law requires you to follow rule. - ∎op by th- Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -00 0 throu• • A R •52- 0001 -0080. You may obtain copies of these rules or direct questions to OUN • by calling (50. 246 -1987. By: � �� g rir� Issued B ��/ C- Permittee Signatu e: �� Call (503 39 -4175 by 7:00 P.M. for an inspection need • • the next busine - s day - " - - Plumbing Permit Application Date received: '' 01 Permit no.: 1... /10422/-1004 '^ ` ° j �; City of Tigard Sewer permit no.: Building permit no.: - Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 to Project/appl. no.: Expire date: Fax: (503) 598 -1960 I lt/ Date issued: By: I Receiptno.: 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 S('IIEDULE (for special inforn ation use checklist) Job address: / 56 J St.(� i Zg + 111 L--- 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 D scription and locationvo 0 premises: Site utilities: 644,E P OLAJ -- -.E- V--X/...b Le 1171 O N g s -tvOkJ 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: Z, -- - _., 14,441 i l9c()S 1.4100 r Kt (-I Manholes Address: .1 $S 'u) j zhM) ct as 012.-- Rain drain connector City:Tj A) k.,/ft T 1 q I Statqt_IZIP: q7,2 Sanitary sewer (no. lin. ft.) Phone: (- (O (O.1 Fax: _ - . "1: Storm sewer (no. lin. ft.) CCB no.: cj (, C I Plu • 1 t u • • • . no: Water service (no. lin. ft.) City /metro lic. no.: q 3 4 Fixture or item: Contractor's representative signatu „NIL . i Back flow preventer p Print name: Agromvaiurd Date: 2 : ac wa er v. ve 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 Fixture/sewer cap Name (print): (ZC,� ,y_ �`11Z� Floor drains/floor sinks/hub Mailing address: Garbage disposal Hose bibb City: I State: I ZIP: Ice maker Phone: I Fax: I 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: I E -mail: Total 2/ Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ d tIJ Notice: This permit application ❑ Visa ❑ MastetCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8%) $ . O Expires TOTAL $ (Z 9 . l 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. 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 3" 166.60 0 PLEASE COMPLETE 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 - Other Fixtures (Specify) 16.60 Urinal _ 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 BUILDING INSPECTION DIVISION ` 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST ? BUP Date Requested L / Z.) AM I I J 1 PM BLD Location / t s S Sw /24-"6t 1 ( Suite MEC Contact Person Ph Cf /— Ci D S it / -G v / ZJ' Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab Post & Beam Ext Sheath /Shear Ina Sheath /Shear i ,(� 7 R0 _ 0 O 6 ^ (� ` 1 ' - Q _ Framing Li1�, (�(J J�i'1� r, l" w�.�� Insulation Drywall Nailing AL. Firewall Fire Sprinkler ` — L Fire Alarm Susp'd Ceiling Roof Misc: Final _E4SS BART FAIL CI LUMBIN0-3 Post & Beam Under Slab Top Out Water Service b„,. , Sanitary Sew 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 Other Date 41 Inspector Ext � Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. 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 rou . h -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 ME C - Mechanical Permit Insulation Drywall nailing � Inspection Description Date Passed By Post/beam mechanical Suspended ceiling _ Gas line Engineered soils Mechanical rough -in Welding Lab Final Concrete Lab Final Fire damper Duct work Bolting Lab Final Fireproofing Lab Final Smoke detector Mechanical final Structural observation Final inspection _ Plumbing Permit BUP - Fire Protection System Permit 4 Inspection Description Date Passed By 3' 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 4/23/0 ✓ 3 — Fire alarm final — Rain drain _ Storm drain Water service SIT - Site Permit Sanitary sewer 4 Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank — Foundation walls Plumbing final 41 WO A JIB Sprinkler supply lines (:4 Sprinkler underfloor /slab Catch basin/Manhole SWR - Sewer Permit Engineered soils _ 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 DEVELOPMENT SERVICES PERMIT #: PLM2001 -00128 `�''�" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/2/01 SITE ADDRESS: 14555 SW 128TH PL PARCEL: 2S109AD 07600 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: OTR 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: Installation of residential backflow prevention device. FEES Owner: Type By Date Amount Receipt WESTLAKE HOMES INC PRMT CTR 4/2/01 $36.25 27200100000 PO BOX 69326 5PCT CTR 4/2/01 $2.90 27200100000 PORTLAND, OR 97201 Total $39.15 Phone 1: 675 -0495 Contractor: TERRA -SOL LANDSCAPING 21685 SW HEDGES DR - TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone 1: 692 -6389 RP /Backflow Preventer Final Inspection Reg #: LIC 00005019 b 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 ' . • uspended for more than 180 days. ATTENTION: Oregon law requires you to follow rule . - pop by th- Oregon Utility Notification Center. Those rules are set forth in OAR 952- 0001 -0I 0 throu• 4 • A R •52- 0001 -0080. You may obtain copies of these rules or direct questions to OUN • by calling (50; , 246 -1987. Issue�.By: `� y C JUL ' GfS 'LL)/414,a Permittee Signatu e: r a& L� (u Call (50 9-4175 by 7:00 P.M. for an inspection need - • the next busine s day