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Permit • CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2003 -00533 call 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/8/03 SITE ADDRESS: 13181 SW CHELSEA LP PARCEL: 2S102DB 04200 SUBDIVISION: CHELSEA HILL ZONING: R -12 BLOCK: LOT: 019 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: 1 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: Replacing gas water heater. FEES Owner: Description Date Amount PRUETT, DAN 13181 SW CHELSEA LOOP [PLUMB] Permit Fee 10/8/03 $72.50 TIGARD, OR 97223 [TAX] 8% State Tax 10/8/03 $5.80 Total $78.30 Phone : 503 968 - 2293 Contractor: OWNER • REQUIRED INSPECTIONS Phone : Misc. Inspection Final Inspection Reg #: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Issued By: Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Plumbing Pe�r> �. `cation FOR OFFICE USE ONLY , �t�e Received {' Plumbing N II DateBy:,. 6 j9 Permit No.1\0O3 - � 5 CIt Of Tl and Planning ppr v.l Sewer y g OCT 8 2003 DDate/By: . Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 %KY 5 3T5 ?FA0 Post - Review Land Use Internet: www.ci.ti arP.1Ill f?ING DIVISION ' 4- ° 'l' ' I Date /By: Case No.; g ■ �,�,. e'I I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 �'" ' Name /Method: Supplemental Information. :Vt ; . -,, ( f 1TYPEnUF4WURK !;'z..'. - ":<; 4.: _ „ _,. AA5:'_�FEtt.SCFIEDUtiE -( for' t ,' speciatinforinatonlise ; checklis "t) i VZ ❑ New construction ❑ Demolition Description 1 Qty. 1 Fee(ea.) I Total Addition/alteration/re lacement Other: i2; . ` "W % ` New 1= & 2=famiiy dwettiugs i�t ;ism`= i .,s "'.L kf7?"� r i e , rr•4: a :$ ^'F:� w :']- a'T &S ' Yeas p , .;} .a4 9:k' e._. CATEGORY .CONSTR'UGTION, ' loclud each�utili connection SFR (I) bath 249.20 ® 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00 ❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 , hr•z„ir JOB<SI-TEANFORIVIATION and LO@ATION 'ii: . , Fire sprinkler - sq. ft.: Pa•e 2 W '� ;x _ ..„„.. 3�u; Job site address: )�� 1G5/ 6((.� CiEcLSFd� (_ g = =;�� o" �';E:M:.`4�;�A.. s ..�SiteLtfitit'ie`s: ,rix'�� „�.,,�:<.. �; Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: DrywelUleach line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 btl/ im-1- C-ln�( s €-a Le Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) Page 2 _ . _ 4.41 =', ,7- ;> °F txtu w : _, ',. : ` : :: ;DESCRIPTIONwOF:WOkK" ,F_, ; Ym :,r - t.- re;or a <' '' Absorption valve 16.60 (.2 ft, / Backflow preventer Page 2 • / C � � � � 1 L � ( Backwater valve 16.60 �a-, \R_ l,[/ C.1 Clothes washer 16.60 >I Dishwasher 16.60 4 U. R ,. _ ;'n.':!1,. Drinking fountain 16.60 PROPERTYzOWNER..w . =5 ��e 115lOTYANT;�'�,��i �°.,r�° :. `��`' � Ejectors /sump 16.60 Name: bi\ vJ l?fLiA. -CA-t- Expansion tank 16.60 Address: k 3 k S l Si,) (` (, e ( S e4 . Lc Fixture /sewer cap 16.60 City /State /Zip: f1 44 ,,, i , ) it__ �' z„,__ Floor drain floor sink/hub 16.60 Garbage disposal 16.60 Phone: ( g6, y- a i 9 3 Fax: Hose bib 16.60 ® ="APPLICANT =. ' - _ < ; a; ,:t / ; _„ v ^ =v ';CONTACT -EERSQNk k Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 City /State /Zip: Primer 16.60 • Roof drain (commercial) 16.60 • Phone: Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 ._rs ..`° n 'CONTRACTOR.:- ' . ,, ,. 5:• . Urinal 16.60 Business Name: 0-7,o-y\ jjt - , Water close 16.60 Water heater / 16.60 Address: Other: City /State /Zip: Other: " ;::::-N:;„ ,: �;;:• ,; *: Phone: Fax: : .. t ,.. :Md ,.,- {: :, ,�. r ix�,:�,, Rla'tn"6i'ti �PermiflFe`e's,�.�s. Y � §�% :{;,:,„�;. CCB Lic. #: Plumb. Lic. #: Subtotal $ Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 '73 . SO Signature: Date: Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ ./ l (Please print name) TOTAL PERMIT FEE $ •, l Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i; \Dsts \Permit Forms \P1mPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information ' Fee Schedule: Residential Fire Suppression Systems: 'E'&Iea ' ' ,� .,E_ . �r- ..� •..,�,., ��. - ... � �,E � Square Permit Fee:_ Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer 3,601 to 7,200 $220.00 ewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuationi,,. •., Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each $ 0.00 or fraction thereof, to and - -<.�;; ry additional 10 "` '`° F'izture or'Item �, ,t ' 4?`- MiqtYa 4,F,A(0, MAW, including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. u,; °K t ` ", vfi r a " ' E ,Quantity by (Fixtur e)AWoi k Pei formed' Comments regarding fixture work: 1.iture � Aiit ", t , % j• f „ v z Replace � . "`g arss«r f aaitt it" New , " '�Movedj 1 1 g . @apped Baptistry/Font Bath - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" • -3" -4" Car Wash Drain Garbage Domestic *Note: If the fixture work under this permit results in an Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley • - Commercial • - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet • Urinal • Other Fixtures: is \Dsts \Permit Forms \PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 ' INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 0 -S AM PM BUP Location 131 fi ` � -/ 1 L � 5,�a, �!' � Su ite ME C Contact Person 1 CW 1 Pr.J Z Ph (�/� - z Z3' ap 3 - (Zj.513 3 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: (9/F-7.5-- I /� ELR Crawl Drain 1 / 7 Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear . Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof A „ Other: Final 400 P ASS PART FAIL PLUMBING Post & Beam Under. Slab Rough -In Water Service • Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: herr � %�t�l' 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 LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 111 Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF T1ARD • 24 -Hour BUILDING'°' Inspection L143 -` 175 INSPECTION DIVISION . Business Line: 5 111t MST BUP Received Date Requested l I —/ D AM PM /6 /" BUP Location f 1 181 Suite MEC Contact Person Ph ( ) 6 Ff - z 2.39 PLM 3 – D 0 LS 33 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear IN \ L 4(02-1 „ t v �\� Framing V V Insulation d Drywall Nailing �/ Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling 1 �` Roof Other: � " d�� � C.— { Final ; � • P T FAIL LUMBI, 0 • Post &am Under Slab Rough -In • Water Service — Sanitary Sewer fu , _� V . Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Ot -- . SS PART FAI MECHANICA Post & Beam \ Rough -In - Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL • Service Rough -In UG /Slab Low Voltage • Fire Alarm Final Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 111 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ) A ADA �l v� Approach/Sidewalk Date WI u Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL