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Permit C ITYOF TIGARD PLUMBING PERMIT Av4Pg' #: PLM2002 -00403 : I �� DEVELOPMENT SERVICES DATE ISSUED: 10/21/02 I� 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 SITE ADDRESS: 16465 SW ROYALTY PKWY PARCEL: 2S11566 -02500 SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 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: 50 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Repair of approximately 50 feet of sewer line. FEES Owner: Description Date Amount RAGOZZINO, FRANCES B 16465 SW ROYALTY PARKWAY [PLUMB] Permit Fee 10/21/02 $72.50 KING CITY, OR 97224 [PLUMB] Permit Fee 10/21/02 $0.00 [TAX] 8% State Tax 10/21/02 $5.80 [TAX] 8% State Tax 10/21/02 $0.00 Phone 1: Total $78.30 Contractor: LOVETT EXCAVATING INC 17385 SE TODD LN GLADSTONE, OR 97027 REQUIRED INSPECTIONS Phone 1: 503 - 504 - 2847 Sewer Inspection Final Inspection Reg #: LIC 125507 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 Is d By: / �':��/ / l •% Permittee Signature: a (503) .. -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures ` ` Plwt�birig Permit Application ,, OFFICE USE ONLY . � � C of T Datb received: 4 0, � p. Permit no.: P,.,yjkal e t, 443 r I Address: 13125 SW Hall Blvd, Tigard, OR 97223 Sewer permit no.: Building permit no.: City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: ■ Fax: (503) 598 - 1960 Date issued: By: ' Receipt no.: Land use approval: ((\ Case file no.: Payment type: TYPE OF PERMIT & 2 family dwelling or accessory ❑ Commercial/industrial O Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: l b L6 S _SW K O ° J P ,e1J y Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: Y / / New 1- and 2- family dwellings only: Tax map /tax lot/account no.: (includes 100 ft. for each utility connection) SFR (1) bath Lot: (Block: ( Subdivision: SFR (2) bath Project name: SFR (3) bath City/county: ( ZIP: Each additional bath/kitchen Description and location of work on premises: �eit?2rr 2 #f'.4)r Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells /leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: Q 1, F CG vor ` 1.,..s Manholes Address: 7 $S S E 1 - L Al Rain drain connector - City: (rr-1 i )..s /or r Stater I ZIP:17 D 2..7 Sanitary sewer (no. lin. ft.) SO . j Phone: 505/ z $'/ 7 [Fax: [ o35tE -mail: , Storm sewer (no. lin. ft.) CCB no.: / 2c c 0 - 7 Plumb. bus. reg. no: Water service (no. lin. ft.) • • City/metro lic. no.: Fixture or item: Contractor's repre entative signature: A , ,\___ Absorption valve . -4 Back flow preventer Print name: . -- Vv` r p l& Date: to -2 -62 -- Backwater valve -4.3 CONTACT PERSON Basins /lavatory t Name: Clothes washer Address: Dishwasher City: (State: (ZIP: Drinking fountain(s) Ejectors /sump Phone: Fax: E -mail: Expansion tank OIVNER Fixture /sewer cap Name (print): Floor drains/floor sinks/hub Mailing address: /6 y65" SA) Cop f -Pk " Hose bibb disposal Hose bibb City: (Sta f e: ZIP: Ice maker Phone: ( Fax: (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) a3 Owner's signature: Date: Sump -- ENGINEER Tubs /shower /shower pan Name: Urinal Water closet c k Address: Water heater 0 City: ( State: ( ZIP: Other: 1, Phone: Fax: E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ '7 • St Notice: This permit application Plan review at Q expires if a permit is not obtained ❑ visa ❑ MasterCard ( ) $ ° p Credit card number: / / within 180 days after it has been State surcharge (8% .... $ !S t $ Expires TOTAL $ 7 g . 30 Name of cardholder as shown on credit card accepted as complete. Cardholder signature Amount 440 -4616 (6/00/COM) PLUMBING PERMIT FEES: ' w PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) 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 Hose Bibs 16.60 Tub or Tub /Shower Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Other Fixtures (Specify) 16.60 Urinal 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 r 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 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 Backflow Prevention Device, which is $36.25 -+ 8% state surcharge. ** Ail New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. • i :\dstslforms\plm- fees.doc 12/26/01 CITY Of TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -41 MST - BUP Received Received Date Requested G v — L ■ AM PM BUP Location / 74 e,/ Suite MEC Contact Person ,� j /1 Ph (6 ) 77 , ..a PLM 4 i _�(2/(2- Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Ft Drain Foundation Access: w� ,�! � - - - i 9 ( ELR Crawl Drain Slab Inspection N • es: / SIT Post & Beam t ob Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof q; Other: Final y PASS PART FAIL CUMBlN. Post & Beam Under Slab Rough -In Water Service - ain • rains Catch Basin / Manhole Storm Drain Shower Pan Other: PART FAIL ANICAL 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 El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA � � 'Z� Approach/Sidewalk Date 2 Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL