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Permit CITY OF TIGARD PLUMBING PERMIT 1 ' 4 /I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00113 � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/31/03 SITE ADDRESS: 08205 SW HUNZIKER ST D PARCEL: 2S101 BC -00200 SUBDIVISION: ZONING: I -L BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: 0 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: 3 GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 3 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Remove and replace existing fixtures: (2) lays, (3) water closets and (3) urinals. FEES Owner: Description Date Amount US NATURAL RESOURCES INC c/o KNEZ REALTY GROUP LLC [PLUMB] Permit Fee 3/31/03 $132.80 ATTN: JOHN S KNEZ SR [TAX] 8% State Tax 3/31/03 $10.62 TIGARD, OR 97223 Total $143.42 Phone : Contractor: MARXMEN PLUMBING INC 9665 SW 163RD AVE BEAVERTON, OR 97007 REQUIRED INSPECTIONS Phone : 579 Rough -in Insp Final Inspection Reg #: MET 00001112 LIC 102432 PLM 34 -161PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Issued B , � ' Permittee Signature: U �•'� t1 %! Call (503) 639 - 4175 by 7:00 P.M. for an inspection needed th ne t business day Building Fixtures _ FOR OFFICE - USE ONLY Pl�l�bin Per 1 1 UIl Received . Plumbing d ��� Date /By: / / /,a I r Permit No.P Mc O3 CYO / City f Tigard Planning Approval Sewer y g Date /By: Permit No.: 13125 SW Hall Blvd. MAR 3 1 2003 Plan Review Other Tigard, Oregon 97223 Date /By: Permit No.: Phone: 503- 639 -4171 Fax: 06TX 41 EROAR D Post - Review Land Use //gi � y �,,, ttiv I Date /By: . Case No.: Internet: www.ci.tigard.or.BUtLDING DIVISI a r J Ii Contact Jurist: ® See Page 2 for 24 -hour Inspection Request: 503 - 639 -4175 ` Supplemental Information. Name / Method: �G t ri.;u:` ; FEE * SCHEDJL Eg fors ectal information;yse,clieck �.� �,.� _ i ..�` s ,.�•: ��, �TYEE.OF �WORK�_ z. _s_ � �� �: , .. �.,� � ) z-& ❑ New construction ❑ Demolition Description I Qty. I Fee(ea) I Total ❑ ri P n - z�•$�� H r c Asa . Addition /alteration/replacement El Othe � ( l -v--$4,, c am ity h ry ll -. , % -, ; ;i . ,- 4 a WE:2 1 - Inc udesi , < t fo eac ttitIl ,i0 iiiiYL. �. b Ogitla i ektkGORY.OF `CONS ROCTION -Zt . fkg SFR (1) 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 a..,�_��` Fire sprinkler s ft.: Page 2 " >;;�; a, .� -� JOB SIT�E°lI1VFORIVIA'I'# #ION and LOCATION '�� p q .t. :: s N� Sit .iJtiltttes d i :" � 3 q� Job site address: S`6S9 1.6 0 ZtkRh S • ° n U Catch basin/area drain 16.60 �j Suite #: Bldg. /Apt. #: Drywell /leach line /trench drain 16.60 Project Name: •. 4 K'2r Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 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 Flxtute or Item Lt roan ,. .. ` r. , , _ , T DESC•RI IMIST=OF W,OM ., 4 E7,1,,. . Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ' /EROPERTYUWNER ° „ t &ANT€ ,, :' ... Drinking fountain 16.60 Ejectors /sump 16.60 Name: S Li kk 4 (IT }'� ' � Expansion tank 16.60 • Address: Z o S ,1,� 1, .1^ / I e.0 1 f' Fixture /sewer cap 16.60 City /State /Zip: T yzIANN Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 i Li iAPPLICANT ..;; , :, `. 'CONTACT PER - SON ', Ice maker 16.60 Name: ) j A-2X k . 6 IA Interceptor /grease trap 16.60 Address: c-Q q(p q S,uu , t Cp 3 Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip:v�?� Q2�r Roof drain (c al) 16.60 Phone:$ ^224 Fax: 3a33- ';' -a°2 l Sink/basiri6avatog z. 16.60 3- -2,a/.O E-mail: Tub /shower /shower. pan 16.60 _.. „_. Urinal "5 16.60 4su�`"�"�A. � ;,k��,�� -. F `'' a `CONfTRA'CTOR_ . � :` >. ��`�, >A„ .. ��., .. . Y`'~ }. :, Nf, Po Business Name: )LL Arot,IA.I -1).) T. (wt/4C, Wl,\ Water closet 16.60 yg , ,Pd Water heater 16.60 Address: ?6 4 s' ..C4d /4.3 /�-6/E Other: R.e"..t ay.. e ` e.s .r City /State /Zip: Ai-E - � ,4 g7DM1/ dg- 9200 7 Other: Phone: .5 9 ea :2-472 Fax: ` P'MO ; ' :. :Elumbrng P,ermrt Feest* 1°. a F' Subtotal $ /� e ? , �,� CCB Lic. #: (3„ i , q I Plumb. Lic. #: 61 -'i6/ Ps Minimum Permit Fee $72.50 $ Authorized �� � /i /?d /O 3 Residential Backflow Minimum Fee $36.25 Signature: 1► t Date: Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ /4 , 6 02.i (Please print name) TOTAL PERMIT FEE $ f V 3, V t.. 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\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ems.. t .Fee1ea Total z.`.�'�s Site iJtd►t�es, ,.� Y�� ( f ) � Square;Foofage: , ,. PermitFee:_ 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 - Valuati Re 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 Total: additional $100.00 or fraction thereof, to and - yr` , FIXtUI e0[ Iteltl �r= t; : . Qty z f Fee (ea) s VOW! .. , r 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 *. '. i, s aQuanttty by1(Frxture) W Comments regarding fixture work: ,Fixture Type � Replace C `son ' . ;;.Moved E sting .Cappedt.�= 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 *Note: If the fixture work under this permit results in an Garbage - Domestic 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\P1mPermitAppPg2.doc 01/03 CITY OF TIGZ BUILDING I n spection Line: -'n7 INSPECTION DIVISION • Business Line: (503) 639 -4171 MST BUP Received G Date R quested -- 7 AM PM BUP P' Location o 0 5 Suite MEC Contact Person Ph ( ) c, PLM < 3 —06 f Contractor Ph ( ) S ! �Z�� SWR BUILDING Tenant/Owner ELC . Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Fire wall - Fire Sprinkler Fire Alarm / Susp'd Ceiling , i Roof Other: Final PASS PART FAIL • PLUMBING / _ /. . r 1 _ Post & Beam /r/ /4// '.A9 Under Slab Rough -In Water Service 4110%, Sanitary Sewer Rain Drains Catch Basin / Manho i'I / Storm Drain �/ Shower Pan Other: _ r afRij PAR _ '/ HANICAL Vir .4e / eiv Post & .Beam / Rough -In Gas Line Smoke Dampers Final • PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Ej Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: nable to inspect — no access Fire Supply Line ADA ]� 677/ Approach /Sidewalk Date / i Inspector Est Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL