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Permit CITY T IGARD PLUMBING PERMIT P ERMIT #: PLM2003 -00434 ��� DEVELOPMENT SERVICES DATE ISSUED: 8/14/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11369 SW WINTERLAKE DR PARCEL: 1S133DB-04500 SUBDIVISION: BRITTANY SQUARE NO. 4 ZONING: R -12 BLOCK: LOT: 073 JURISDICTION: TIG CLASS OF WORK: ALT 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: ft WATER CLOSETS: WATER LINE: 70 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace 70ft. water line. FEES Owner: Description Date Amount GARBOT, DAVID R + JEAN E 11369 SW WINTER LAKE DR [PLUMB] Permit Fee 8/14/03 $72.50 TIGARD, OR 97223 [TAX] 8% State Tax 8/14/03 $5.80 Total $78.30 Phone : Contractor: ROTO ROOTER - WEST OFFICE 25599 SW 95TH B WILSONVILLE, OR 97223 REQUIRED INSPECTIONS Phone : 503 - 227 - 3330 Water Line lnsp Final Inspection Reg #: LIC 13989 PLM 37 -76PB 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: e��GG2�(d Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next buss day Building Fixtures Plumbing P b tin HoR OFFICE USE ONLY Received g Plumbing 0 Date/By: / P erm t No. City of Tigard Planning . pp /0 al Sewer Plan Re Permit No.: 13125 SW Hall Blvd. AUG 1 4 2003 : Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 F®II 5111a Post- Review Land Use //✓n��.di�. ti Date/By: Case No.: Internet: www.ci.tigard.B DING DIVISION - a �,I I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 ---a Name/Method: 77c-7 Supplemental Information. TYPE OF WORK FEE* SCHEDULE (for special information use checklist) [0.15x-construction ❑ Demolition Description I Qty. I Fee(ea.) I Total D'Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) SFR (1) bath 249.20 [I1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 ❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: 1 /3 ( S 4J, LJ i n/l'eir ! ctke M • fr-bArievul Site Utilities Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 1„ Drywell/leach line/trench drain 16.60 Project Name: i0�u'e.T� Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 'Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) f Page 2 Fixture or Item DESCRIPTION OF WORK r Absorption valve 16.60 t opct. /`' t,)a sei-v i C ,Z' n '.€- (9-e Backflow preventer Page 2 d' / 'l Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ❑ PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: Dew, C a,i., b o r - Expansion tank 16.60 Address: / /3 6 9 - $W , u,) , i, , r v` Lake. At • Fixture/sewer cap 16.60 City /State /Zip: / Oor' Q ,,,.� ©,e. Q 7 a z a Floor drain /floor sink/hub 16.60 j Garbage disposal 16.60 Phone: Fax Hose bib 16.60 El APPLICANT [C ONTACT PERSON Ice maker 16.60 Name: ,L°p 4 --e O D lc v. Do_q. 54. e.Adiooe / Interceptor /grease trap 16.60 Address: ;2. 9? s. t� . 95 4- $$ . -,B Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: F,0 /' ` .57N ), /i. o , P, ?7070 Roof drain (commercial) 16.60 Phone: 6 9'77 4 Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 CONTRACTOA Urinal 16.60 Business Name: ,d2 y -,tvf Water closet 16.60 Water heater 16.60 Address: ,26 F9 Sc,v, �iS- Other: • City /State /Zip: (.J: /504/ I , //.e. I pie.. 7707o Other: Plumbing Permit Fees* Phone :0d3 - G 8a- 977 Fax: Subtotal $ CCB Lic. #: /,3 q r? Plumb. Lic. #: i3 r 76 R Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 /02. 6.6 Signature: �� Date:SA /a? Plan Review (25% of Permit Fee) $ /2 a 0,,, n e s State Surcharge (8% of Permit Fee) $ S. 4Se) (Please print name) TOTAL PERMIT FEE $ 7 g. Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after It has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri- County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - l 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55 7,201 and greater $309 00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55 Medical Gas Systems: Water Service - each additional 100' / 46.40 Valuation: Permit Fee: Storm & Rain Dram - 1st 100' ( 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000 00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72 50 $50,001.00 and up $742 00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. Quantity by (Fixture) Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial • - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" - 3" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice MachiRefrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 Case Activity Listing 11/16/2004 2:26:09PM 9PM TIDEMARK Case #: PLM2003 -00434 COMPUTER SYSTEMS. INC. !It s , �-„.� �,, , � �. SSI e = 1p)ti ; , ._�S,�w ter,. `��-� � �„ a ctivl r . , . escriptloi,�,�. ate �k .x. ate�2 „ .r � oh �,.�., ISp'. - - o ��,-;, � � �. ; _~ ;N o t es ..,, � . : :4', v., PLMA003 Application received 8/14/2003 None DONE BB 8/14/2003 BLD PLMA005 Create Permit 8/14/2003 None DONE BB 8/14/2003 BLD PLMA710 Water Line Insp 8/18/2003 None PASS RB 8/18/2003 RB PLMA799 Final Inspection 8/18/2003 None PASS RB 8/18/2003 RB PLMA050 (F) Issue permit 8/14/2003 None DONE BB 8/14/2003 BLD PLMA800 Case Finaled 8/18/2003 None DONE RB 8/18/2003 RB Page 1 of 1 CaseActivity..rpt CITY OF TIGARD 24 -Hour 4 ; BUILDING- •- Inspection Line: (503 .x9 -4175 MST INSPECTION DIVISION Business Line: (r ( 171 BUP Received Date Requested Fie AM v PM BUP Location / / Suite MEC Contact Person Ph ( ) PLM 3 "X 4 /3 Contractor Ph ( ) SWR BUILDING Tenant/Owner t 3 S - y/ 7 S ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Ext Shear Sheath/Shear Anchors 44� �'� Ext eah/ ���'�'� • Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough-In am ary Sewer t Rain Drains Catch Basin / Manhole (sk/ Storm Drain Shower Pan // Other: �� Fin PART FAIL ,�/ 7 NICAL .� 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 62 Inspector \T Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL