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Permit iw CITY OF TIGARD PLUMBING PERMIT I DEVELOPMENT SERVICES PERMIT #: PLM2001 - 00043 ► -a �l • - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/29/01 SITE ADDRESS: 09870 SW JOHNSON ST PARCEL: 2S102BB 01600 SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R -4.5 BLOCK: LOT: 019 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: UNK FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: 4 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 391 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Site utilities plumbing work for construction of a new parking lot. FEES Owner: Type By Date Amount Receipt ST ANTHONY PARISH PRMT CTR 10/29/01 $260.60 27200100000 9905 SW MCKENZIE ST 5PCT CTR 10/29/01 $20.85 27200100000 TIGARD, OR 97223 PLCK CTR 10/29/01 $65.15 27200100000 Phone 1: Total $346.60 Contractor: FLOWLINE EXCAVATION & UNDE 12685 NW NEWELL PL FOREST GROVE, OR 97116 REQUIRED INSPECTIONS Phone 1: 503 - 992 -7473 Storm Drain Insp #: L IC 87649 Misc. Inspection Reg 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 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 y-obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issue By: #_• 17 fj / / /L!: J- Permittee Signature: _ _. /r Call (503) • • • -4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application Date received: f .1 / / Permit no.: p ew i 93 "''''''t Ohl' of Tigard I / " ��� � ` City Sewer permit no.: Building permit no.:S � / a 00c/ - Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 ^7 Date issued: By:1j,Receipt no.: //�� � Land use approval: C� 7 - / 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 SCHEDULE (for special information use checklist) Job address: 4,1O / mot 6T. 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.: / (, L. (6000 SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath . Project name:. t.. ,�`( focerAt pize...w..,- (q { „ ) (11 0 3 3 (D1J SFR (3) bath City /county: - > 1 ,0 N . I ZIP: 01223 Each additional bath /kitchen Description and location of work on premises: cc .x%1,.._ Siteutilities: , (/y or A nju) �' IC- tt.IT� 1.-r)-( Catch basin/area drain 'T Est. date of completion/inspection: Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: // T) Manholes Address: Rain drain connector _ _ City: I State: ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) 311 1 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: D Backwater valve CONTACT PERSON Basins/lavatory Name: Jr- 1 "l C5i—<_. t Clothes washer Address: 6Ll t , ()g ?4 _Dishwasher Y c l�� I eR. I 411'2 ) 1 _ fountain(s) City: Y State: ZIP: Ejectors sump Phone: ' .— 1 Fax:223- /62D1 E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): .% A `( l 1" Floor drains/floor sinks/hub Mailing address: 1 .t„..) Nl Garbage disposal City: " 1 ,�R-© I ORJ 41 / ZZ Hose bier Ci Sta te: ZIP: 3 Ice maker Phone: ( -4l1 q 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 Tubs/shower /shower pan _ Name: (�D� ,05�G 4 c11'C Z� � W aI Urinal �, ` ter closet Address: 3j - yUs3y�+(li 1. + Water heater City: '2g4Z-ri j State:AR__ ZIP: 1122 I Other. Phone: / -- U U ( I Fax: 2,0g -5- t E -mail: Total Not . all jurisdictions accept credit cards, please call jurisdiction for more information Minimum fee $ Not This permit application Plan review (at %) $ Cl Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / State surcharge (8 %) .... $ Expires within 180 days after it has been TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount - 440 -4616 (6/00 /COM) PLUMBING PERMIT FEES: :•,' • ,x . °• t f ,.,,, EPRICEi ' ,TOTAL New wand >2 = family, „9, )Y ;. . ° ° = 6 ° % In 4411 I im6in tfiictures in giP TOTAL FIXTURE (i ndividual),'- --- T ' � ,. w - fot `s :( : AMOUNT =�. ( d p 9 Sink 16.60 the d�weilingia th "Id 1. ft , , E . -QTY (ea AMOUNT ;, ' 4n for eachiutlllty cofineCtion i z,,, --: " `: _ :, :z.- !. , .». `,. &, ii:14 : Lavatory 16.60 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 '' ' `3 " ` .` Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL "' ] ? '_ .5 - Garbage Disposal 16.60 TOTAL,, , „ . . Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 * ' .,u;,; - ' ; ` Quantity: by; Work`Perfoimed ;. -,- Water Heater 0 conversion 0 like kind 16.60 �. >'�� �Type . e ' � =, � Gas piping requires a separate mechanical Fixture` ;y New ,. ; Moved' , w' , : 4 ?Repiaced:; Removed! ... r' ; f Capped . permit. ,e, ., t .. MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory 16.60 Tub or Tub /Shower Hose Bibs 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 4,144.e Isometric or riser diagram is required if , ;:`. - <; r ,,' "`; _: Quantity Total is >9 : °".,". .. ... ' `,,'.s `^ '`";: ' *SUBTOTAL 4444'6'0 5 ; `rt . 8% STATE, SURCHARGE ' ;';;30p: _ �" ^psi iti tH E **PLAN REVIEW 25% OF SUBTOTAL <:4 : � ' , u, �;�,. . Required only if fixture qty. total is > 9 , , ':.a`s', .. ;�`? : m? � : TOTAL : ,.:"':,47- _ ,'. $ * 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. IP • is \dsts \forms\plm- fees.doc 10/10/00 • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM PM BUP Location 9 fP 70 (" . 4 h � Suite MEC Contact Person Ph ( ) PLM l — Oc0 q2 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain 45" 99 )( "et 11 - ‘ - Slab pecfion 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 Other: /J Final PASS PART FAIL PLUMBING' - f y Post & Beam / Under Slab Rough -In Water Service jjjpr Sewe'b Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Fina S P FAIL - - - ICAL _ 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 0 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date Inspector / abee Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL