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Permit A-- ~ CITY OF TIGARD PLUMBING PERMIT "I DEVELOPMENT SERVICES PERMIT #: PLM2002 -00491 '� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4 DATE ISSUED: 12/26/02 SITE ADDRESS: 13185 SW PACIFIC HY B -1 PARCEL: 2S102C6 -00302 W SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: C -G BLOCK: LOT: 033 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing fixtures: sinks, 1 commercial, 1 service. FEES Owner: Description Date Amount ALADDIN MOTOR INNS BY BENZENISTE, IRVING [PLUMB] Permit Fee 12/26/02 $72.50 10155 SW CAPITOL HWY [TAX] 8% State Tax 12/26/02 $5.80 PORTLAND, OR 97219 Total $78.30 Phone : Contractor: MODERN PLUMBING 11120 SW INDUSTRIAL WAY TUALATIN, OR 97062 REQUIRED INSPECTIONS • Phone : 691 - 6166 Rough -in Insp Final Inspection Reg #: MET 00002486 LIC 87906 PLM 34 -250PB 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: , i " Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures c p ._y,,_ — 0034t), Plumbing Permit Application OFFICE USE ONLY Date received: f v v I0 ) w Permit no.: +! gD.. —. ot,i/q/ t C ity of Ti and 1 -. J i J g� �� / C n Sewer permit no.: Building permit no.: Address: 13125 SW Ha[Q t Q� BED City of Tigard Phone: (503) 639 -4171 ` Project/appl. no.: Expire date: Fax: (503) 598 -1960 DEC 1 n 200 Date issued: By:�� Receipt no.: Land use approval: Case file no.: Payment type: OF TIGARD :' iii OF PERMIT 0 1 & 2 family dwelling or accessory oommercialJindustrial O Multi- family 0 Tenant improvement 0 New construction . Addition /alteration/replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: '' 1)5 t • .'-'7'.4-' TAG F (c, 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: (Block: I Subdivision: SFR (2) bath Project name: eara'v G a O , rS Qjrti. t<.€ r � ( SFR (3) bath . City /county`t %c1q (` 1, y I ZIP: 2 I Each additional bath/kitchen Description and location of work on premises: Site utilities: tP fr o. t y' () pYP. , ' Y E & - Catch basin/area drain Est. date of completion/inspection: 30 - O Drywells /leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name 0d e 0 rp V) ". • t Manholes Address: 1 1 1'. (' SlR) = in USi & 01-L4 Rain drain connector City: T o fi.( t.r' I StatoNLI ZIP: (j' j) ( Sanitary sewer (no. lin. ft.) Phone:)?, (I) (01‘ (P I Fa >J, 01-(011E-mail: Storm sewer (no. lin. ft.) CCB no.: R 9 9 O (o Plumb. bus. reg. no3 j)O d Water service (no. lin. ft.) City/metro lic. no.: � Fixture or item: Contractor's representative signature. kl r G klid i f onali A valve Back flow preventer Print nam4Lj ' Rue - Os K Dote: 1_ - - e Backwater valve 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 OWNER Fixture /sewer cap Name (print): Floor drains /floor sinks/hub address: Garbage disposal Mailing 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) . 1 i employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) '2— , . "2 // , (v0 33.30 • • Owner's signature: Date: Sump ENGINEER Tubs /shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: t► Phone: Fax: E -mail: Total Minimum fee $ . Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application ° 0 Visa 0 MasterCard Plan review (at %) $ / / expires if a permit is not obtained State surcharge (8 %) .... $ 6 Credit card number: within 180 days after it has been Expires TOTAL $ '7 30 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 \A AP() 1 16.60 ) I _ , 0 0 the dwelling and the first100 ft. for each utility connection) QTY (ea) AMOUNT Lavatory II �� 16.60 tD 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" 16.60 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 ij Y �I 0 Of 5h ' K I 1(a0 Garbage Disposal 11 �� 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 62.50 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 ,, 3 , 0 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 Backfiow - Prevention Device, which is $36.25 + 8% state surcharge. ** Ali New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. • i:\dsts \forms\plm - fees.doc 12/26/01 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 _ _ Suite MEC / Contact Person f�. c Ph ( ) 69/-6 7 PLM i ' d 59( Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall A � 1 c_71 Fire Sprinkler P _/ Fire Alarm � �_� _ _ WOW - - _�� Susp'd Ceiling Roof / • Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Man , e Storm Drain Shower Pan Other: PA PA S S 4IrA 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ADA Approach/Sidewalk Date � Inspector d' 2 Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested I 7 AM PM BUP Location / 31 Suite MEC l /q Contact Person G Ph ( ) 6,9 - / 4 P PLM — d 0 4 ` Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Crawl Dr ain /�(/ f' - ELR Crl Dr (/ 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 Other: Kir � Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan O• • S PART FAIL HANICAL 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 I Inspector ,, 2n Ext Other: Final DO OT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (. 19 -4175 INSPECTION DIVISION Business Line: ..J9-4171 MST BUP Received - Date Req sted O = AM P BUP Location / 3 / Suite - CD4 .2002-'0 Contact Person Ph ( )628Y .a-q Contractor Ph ( ) SWR BUILDING Tenant/Owner - -� ELC Footing Foundation ELC Access Ftg Drain R Crawl Drain Slab Ins • ection Notes: SIT Post & Beam Shear Anchors a_- �� 4 ` (7/ Ext Sheath/Shear Int Sheath/Shear Framing Insulation 2 — S lN� �s - O_ArCA — • Lis Cr. ) Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling /1 j Roof _ �4 f' AVS 7 / • / /A- [ A i / - Other: Final RT FAIL Post & Beam Under Slab Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: F' T FAIL Post & Beam Rough -In Gas Line • • .e Dampers C*0215 PART FAIL EL CTRICAL 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 ❑ Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA 7°2/WO Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL