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Permit • r, � ' CITY OF TIGARD PLUMBING PERMIT a l � DEVELOPMENT SERVICES PERMIT #: PLM2001 -00079 �' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/14/01 SITE ADDRESS: 12208 SW SWEENEY PL PARCEL: 2S103AB -05300 SUBDIVISION: WALNUT GLEN ZONING: R -4.5 BLOCK: LOT: 011 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Finishing basement - add one sink FEES Owner: Type By Date • Amount Receipt STEVEN DURRANT PRMT CTR 3/14/01 $72.50 27200100000 12208 SW SWEENEY PLACE 5PCT CTR 3/14/01 $5.80 27200100000 TIGARD, OR R 97223 97223 Total $78.30 Phone 1: 503- 521 -9933 Contractor: OWNER REQUIRED INSPECTIONS • Phone 1: Rough -in lnsp 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 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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued ByT j . Permittee Signature: Cal�639 -4175 by 7:00 P.M. for an inspection needed the next busine day • • Plumbing Permit Application Date received: Permit no.: - D L ' ° g Ci of Tigard � 1 ` J Sewer permit no.: Building permit no.: f" Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT A & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration/replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: 1 ;_) ) kefiY\P.J Description Qty. Fee(ea.) Total N Bldg. no.: �Su ire nlo.: New 1- and 2- family dwellings only: (Includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: I ZIP: Each additional bath/kitchen if Description and location of work on premises: 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: Manholes Address: Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. tin. ft.) City/metro lic. no.: Fixture or item: Absorption Contractor's representative signature: Back flow flow valve Back preventer Print name: Date: 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 Fixture/sewer cap Floor drains/floor sinks/hub Name (print): Cam, kk(T(/Y\ Garbage disposal Mailing address: l',l: Slj,) e R.-- Hose bibb City- 1 p A< I S ZIP? 9 `�, Ice maker Phone:65 - C 1 s 4 G I Fax: (DY y - \ 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 per ORS C apter 447. \-1.-13 Sink(s), basin(s), lays(s) Owner's signature: Date:' t) Sump Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ 0 visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number. / / within 180 days after it has been State surcharge (8%) .... $ Expires TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6Mt10ACOM) PLUMBING PERMIT FEES: F , PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMp UNT (includes all plumbing fixtures in PRICE • TOTAL Sink 16.60 / l0 1 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 3" 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 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 Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL i?f. v 8% STATE SURCHARGE 5.4 "PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $.7 * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflo w Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. i:Wsts \forms\plm- fees.doc 10/10/00 I = 1 CI`. (3) - - b 91nts -slnn -has 7d — Sconc.e Lic1in4s I ctv•k °" X - oc 1�3 ors Wa \IS .. I S S S -cr Inn r 1 ' ' • U - Go-S ; P- P umbin5 4, / Ph- Fhore . - - - - 7 14- NeokVents in Cee tiny R vn - ReAurn A-ie. ceilin9 -' cE A. ' :. 4� 4 \ pa f - )° 1))4 r' 0 * G _ side i yob 1 r use,. - 011s1 - 044 5( CA 1 08 Sl4 Sweeneo PL x a rigart 0a, ?, � ' 0 4 ` � w r'u>t 5a3- loa�-�5 v. .� If .ell - so3 -,o& 7011 1 F R X • • .. - -- •,- - -/ ,,- • • GoS log . . � 1 G StovC. • )c a It I G . \ aka ranca • . ' Si of" i s or u►N' • SR a tack yard • CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested F- I AM PM BLD Location / ZZo $ Suite MEC Contact Person ! p( //t. (/ Ph (, 9 PLM ado / - bt) 0 7 / Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation 1' FPS Ftg Drain I �� i ,/ U r "� //, Ti2 0'i c-.t w-e Pt% Crawl Drain Inspection Notes: SGT Slab . SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service r . Sanitary Sewer Rain Drains 7 eij FASS PART FAIL M HANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Q - Other Approach/Sidewalk Date O / — / Inspector ' / ) L - i rcx ✓'e • Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. } ChM' OF TIGARD BUILDING INSPECTION DIVISION MST -- 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 Q Date Requested J —/,f AM PM BLD Location / Z 2-0 ir Sw 5 ew. Suite Contact Person Ph ?V frry PLM o 7 f Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab w\ �S SIT Post & Beam ( — 5 `� J . Ext Sheath /Shear �.d.� Int Sheath /Shear Framing Insulation o Drywall Nailing IAAA L .1 IC, It 9 --CVV' S d Fire wall - ,1 V I Fire Sprinkler Fire Alarm ,r p„� v� dLC_ Susp'd Ceiling n --� ,` l Roof ' !�Q 1 602-3 C f.��`� - �� ov Final V' 1 G� t,�,/1 ��� PASS PART FAI LAIN J J � LUMBI \AA - � - , o c - U � Z • . eam • Slab Top Water Service Sanitary Drains Sewer C - Rain Drains 41% 1 r ' f /) Final PASS or FAIL Post & Beam - p _ Rough In piCe ` S l Gas Line Smoke Dampers Final '62€-1(')- PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA � Approach /Sidewalk Date 31 ( . i Inspector / 6 1 v v� Other E Xt Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.