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Permit CITY TIGARD` i PLUMBING PERMIT *I � DEVELOPMENT SERVICES PERMIT #: PLM2001 -00531 `�'� t� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/23/01 SITE ADDRESS: 09350 SW TIGARD ST PARCEL: 2S102A6 -01901 SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: I -P BLOCK: LOT: 055 JURISDICTION: TIG CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B 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: ft WATER CLOSETS: WATER LINE: 40 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace approximately 40' of water service. FEES Owner: Type By Date Amount Receipt GREG DAVIDSON PRMT CTR 10/23/01 $72.50 27200100000 9350 SW TIGARD ST 5PCT CTR 10/23/01 $5.80 27200100000 TIGARD, OR 97223 Total $78.30 Phone 1: Contractor: BRUNER PLUMBING PO BOX 23985 TIGARD, OR 97281 REQUIRED INSPECTIONS Water Service Insp Phone 1: Reg #: LIC 81837 Final Inspection PLM 26 -445PB 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 Notifi _ ': - _ - ter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. Y. may obtain c. sies of these les or direct questions to OUNC by calling (503) 246 -1987. 1l,r;4 ! i Is ued By: • 1 2 , 1 4 Permittee Signature: Call (5 1 . 9-4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application R Date received: /D �3 L 0/ Permit W / -a153/ � `� Ci of Tigard � `J Sewer permit no.: Building permit no.: 44- - 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 ❑ 1 & 2 family dwelling or accessory .. = ommercial/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: 93 Sc S (,J T `writ S+. Description Qty. Fee(ea.) Total Bldg. no.: Suite n .: 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: a _ SFR (3) bath City /county: 77 ( I ZIP: 0, -7 z z, 3 Each additional bath/kitchen Description and location of work on remises: Site utilities: r erIc te e _ w Sp - 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: B i N to ` , !A Manholes Address: p,C , / p }c 2..3 98' S Rain drain connector City: 77A I State: o el ZIP: c) 7 Z 2-3 Sanitary sewer (no. lin. ft.) Phone: C/Z .5/y111 I Fax:62yi 2/7?I E -mail: Storm sewer (no. lin. ft.) e- CC B no.: e 97 g 3 "7 I Plumb. bus. reg. no: Z(.,- yy., p( Wad ce (no lin ft Q °� City/metro lic. no.: n moo t 6 h 3 Fixture or item: Absorption valve Contractor's representative/signature: L__....., Back flow preventer Print name: 4(/a , /4 /v Date: it, . ° / - Backwater valve • CONTACT PERSON Basins/lavatory Name: Clothes washer Address: Dishwasher Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank _ OWNER Fixture/sewer cap Name (print): 4 ,11- ) p Q, 7/4 V t ba0 J3 Floor drains/floor sinks/hub Garbage disposal Mailing address: 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) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: I Fax: I E -mail: Total n Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee' $ •�" s� Notice: This permit application Plan review (at _ %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: 1 / within 180 days after it has been State surcharge (8 %) .... $ V Expires TOTAL $ 7 .3 O Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/00 /COM) PLUMBING PERMIT FEES: • ~ U 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 ffrst100 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 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 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. ** AII New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. • i:\dsts \forms\pim- fees.doc 08/29/01 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested JO � AM PM BLD Location / 3 , � 57 Sui te MEC Contact Person / ( ° Ph oZ 7 --4//s7 PLM U 6 Contractor Ph SWR BUILDING Tenant/Owner 1, . �� ( j� _i ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath/Shear / Framing /) / � !C // (1.)0 71 � ✓✓ L`� /r' -- Insulation Q / Drywall Nailing / t4 C Q`/W i( L.c' R ✓o� ?70 fir' /'ems• �t�� � Fire wall Fire Sprinkler (f p Ce Ari `7 p,./r `404 7 A Fire Alarm Susp'd Ceiling `s Roof Misc: �)) h5" u r / 1.6 Gl -ei' c?' / ern at+, Final Z" / k cyL PASS PART FAIL C 7 �� - A PLUMBING Post & Beam Under Slab Top Out Wa ervi Sanitary Sewer Rain Drains Final PASS PART IL MECHANICAL 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 ��� Otheoach /Sidewalk Date ✓� /� ��� In spector 1 � / C nW e- Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. r ' CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested D --� AM PM BLD Location q c / -� � S7 . Suite MEC Contact Person Ph q'80 PLM .0740/ GrD 6 Contractor Ph SWR BUILDING e n Owner P• tr ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: 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 / • P ASS PART FAIL PLUMBING Post & Beam Under Slab Top Out ervic Sanitary Sewer R.'. • -ins PART FAIL CHANICAL 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 Approach /Sidewalk / ' Other D /o / I Inspectori i �'W E x t Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.