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Permit 4 •C. " r,< CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00042 DATE ISSUED: 2/2/2005 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11735 SW HAZELWOOD LP PARCEL: 1S134BD -01700 SUBDIVISION: ENGLEWOOD NO.2 ZONING: R -4.5 BLOCK: LOT: 105 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: 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 preventer. FEES Owner: Description Date Amount OLBERDING, KENT 11735 SW HAZELWOOD LP [PLUMB] Permit Fee 2/2/2005 $36.25 TIGARD, OR 97223 [TAX] 8% State Surcharl 2/2/2005 $2.90 Total $39.15 Phone : 503 - 590 - 4607 Contractor: OWNER REQUIRED INSPECTIONS Phone : RP /backflow preventer Plumbing final 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699. 1 17, Issued By: Permittee Signature: � ,,. �� —r Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t •e next business day r. B Fixtures E ETV ED Pl thibing Permit Applicatd.n FOR OFFICE USE ONLY , City of Tigard ®� n Received /� 13125 SW Hall Blvd., Tigard, OR 97223 FEB' 6r �V ' DateBy - 'U� permit t7 / _ Plan Review Phone: 503.639.4171 Fax: 503.598.1960 uniF I ) Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 CITY ®F T 1 I ��� 1 ' Date Ready /By: Iur s 0 See Page 2 for Internet: www.ci.tigard.or.us BT TILDJN 1 1 S - Notified/Method: Supplemental Information . . # ° , •v. - <;a'„'.� , ,;; , �- . t�sf ;> x "v >•c" z^r,. „t.� ,�<`�'r, ,�x :: z °.rr „�e;:� e, �^ ��,7: ; »�,�,.im:. k'f .r.�. ,,t,. �, ', J'.; . . " +: a " h» `"fi ,:i"�', u, w: u. .Fi n f G° ::. ggaiVr . t :. 'a. . : "." , �, ;,.. ' ;_ 4 T YPE:,O a W Oz w7 4 ..� ,. , � i `' s. s ' 4 ,T , 4EE.. .S.CHEDUI E ❑ New construction ❑ Demolition For special information use checklist Description Qty. Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ' °:17�;:'` .'e:. ° ;. @l: _4� ;�r'4 �tz�.` »,:�e; .�4.�5:'<�` - "€:s"� ��;�a�i�i �e �,'.�a��,•�,� �= �; %3s; :a�'95�a:LL,: ��,.xi•:rvn�.: :;fi < < „•._ , „ a Vic*; tt15RX OE CONSITRUCTIOIY s " : . �E 1 � SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building El Multi-family SFR (3) bath 399.00 ID Master builder Each additional bath/kitchen 45.00 ❑ Ot her: ;; ; fir s•a r ;x #.» Er t -° x °.,« , Fire sprinkler ( sq. ft.) Page 2 `� ' ,x , TO ' S =E FO TI IO Att A T�OCt =TIONt °� i A -x 1v . ,,::" :a_F.. Sa .ibis.,,,,,,. ,a;.. „,„, : -.;:s� - ..",...c:.", '' ,,•..�, „,, „"tom.,:, >, , ". ..a :"'s'' S ut Job site address: ) 173S S' ' • e woc O Catch basin or area drain 16.60 City/State/ZIP: e-SC?tf`a.„ C_:Q- Ci-Tate Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: J Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 • Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no, linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Ki: ?c g' °:tr, ": :m °_.: » �•...� ; Absorption valve 16.60 g T s Z � + � " � DX+ S O k Vt OR �*r r I 's G- s,... ,. ,....:. Wi t. v .r ,v , : _4 5 ": . ' ..iw � - Backflow preventer / Page 2 1, 0 / �,' `�L(�L (/ Backwater valve 16.60 Clothes washer 16.60 Dishwasher Ejectors /sump 16.60 16.60 ..� ,<F,: ; • ;, a, =,t;= ,c ,_ •,' :: Drinkin fountain 16.60 I ', w 0 PROPER�''itda 12; 1:47 40 TE My ' ° g .?S r c, sra .+x m, ,.�._: •. k " � � ,Qaa r �� . � 't3^ Name: y - 1 4-- y - 1 4-- 1_, .e� k 0 )1,e( Expansion tank 16.60 Address: ) ( c `77e 9,A) ..e e .. r) & y � Fixture /sewer cap 16.60 City/State/ZIP: ; 2a . I .& © � 9.--2 a 3 � "' • Floor drain /floor sink/hub 16.60 '� Fax: Phone: (S�3) S-`7v ye 07 ( ) Garbage disposal 16.60 .- t r°P V 6WEI �, , s � al � t � : Hose 1 � . ;. .,. P CA TkV1 . » .„ 'CON ;T ERSQN , Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: ': ":'<rt Y.t w:a. _ „... fH,E,,.,a. Urinal 16.60 `� � 0 TR�CTOis: gi " i a f • �i ss i� � � :. ,. - x , :. rsK ..k °. ' - ;� ?4 .. ° ",k Water closet 16.60 Business name: 0 ,j / ( ) ( I &IL Water heater 16.60 ' Address: I I -Zc z ,,...3 ©o ct `p Other: City/State /ZIP: 0 '- 9 -7A -� Subtotal tS� r` Minimum permit fee: $72.50 Phone: (t . ) 0 9( 07 Fax: ( ) Residential backflow minimum permit fee: $36.25 . ( ,„A 5 CCB Lie.: Plumbin -no.: Plan review (25% of permit fee) Authorized signature: �� State surcharge (8% of permit fee) p b� A TOTAL PERMIT FEE Print name: �/,, 1 , Q bo j ,,,, Date: a • _ G This permit application expires if a permit is not obtained within 1� 1 180 days after it has been accepted as complete. �J *Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Permits\PLMF- PermitApp.doc 12/03 440- 4616T(10/02 /COM/WEB) Plumbing Permit Application - City of Tigard '' t Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: SlteE §atilltie�s' t ?s Qty § (Fee�(ea�. �; To a .° r V S ° 11ar:00tage, ,. M Permlt ee, 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 3,601 to 7,200 $220.00 Sewer - 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 ; _� � �, ..�, , �,..�•... > k;�;,M ; „.4 ��,.;.:_�,.,... Storm & Rain Drain - 1st 100' 55.00 VyaIuat1OI1 Pel mit s ee $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 additional $100.00 or fraction thereof, to and 41IntlYMP*1-01,11JL ria _ . (ea) ' 3K 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 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 * . , A6elt - tt,MSEE§ isgmtwoutifiimino-ioaaw FtxtureT'pe .{ r� , Rgl. a it Ex,st aprn Comments regarding fixture work: 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 Disposal - Commercial - *Note: If the fixture work under this permit results in an - Industrial Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink • - Bar /Lavatory Quantity Total -Bradley Isometric or riser diagram is required if fixture quantity - Commercial - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor - Plan Review Water Closet - Toilet - Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i.\ Building 'Petmiu\PLM- PermitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Ins ection Lone: (503) 639 -4175 INSPECTION DIVISION Bu' iness Line: (503) 639 - 4171 MST BUP _ Received Date Reque ted ppp a t( _ `, AM PM BUP Location �' ' 0- 0'zX Suite MEC Contact Person `P Ph ( ) 7 7 PLM4d _ ` 000 q Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation • Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: 0 SIT Post & Beam 1� /� ,,,, Shear Anchors �'[- ' ( A A `" 41.n � 1 Ext Sheath/Shear Int Sheath/Shear Framing Insulation •f k V �� � J � ( , 1 Tb Drywall Nailing �� v ��"� �` C v Firewall / ,,//�� Fire Sprinkler Wa I'uv cx���.� Fire Alarm Susp'd Ceiling Roof Other :' Final PASS PART FAIL -PLUMBING,' Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: r^ � � 11- V 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 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE -� Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date Q.) )) D Inspector C1 JL-) )11 v' Ext Other: Final DO NOT REMOVE this inspection record from the job site. - PASS PART FAIL •