Case File 1
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i
12005 SW Ann Street
CITY CSF TIGARD 24-Hour
BUILDING Inspection Line: (503)635-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
-- --
_ Requested �l BLIP
q
.1 BLIP
Received Date Re AM�-._ ---_ PM __. __ -
�-oa
Location ---Suite -
_-----. - MEC
Co , pct Person -.— _-- _—_ Ph PL.M = .�
Contractor -.---- -_-____ Ph(,--) --___—_- SWR
Footing Tenant/Owner „— ------- ELC
Fooing ng _
Foundation Access: / L EL_C
Fig a
�
Crawl Drain ELH_ _ / ' � -" - - - -_-
Slab Inspection !Votes: 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:. ----- --- ------a-----
Final -
PASS PART FAIL _ - ---- - - - - --
PLUAAgINQ
Post Beam
lJ
nderSlab
Rough_Iq, — -
Sanitary Sewer -- -
Rain Drains
Catch Basin/Manhole
Stoi m Drain ..�
Shower Pan - - -
Other: -- '�S_---
f=i�al ---- --
%PA S PART FAIL - --- - -- --
CHANICAL ,r
Past& Beam -
Rough-In ---
Gas Line f - --Smoke Dampers
Dampers
Final f --
PASS PAST FAIL - - ---- _
_ELECTRICAL
Service --
Rough-In
UG/Slab -----� -
Low Voltage -
Fire Alarm --_--- _.-_-----. - —
Final Reinspection fee of
PASS PART F�AII. $__ - -required before next inspection. Pay at C ty Hail, 13125 SW Hall Blvd.
_
Please call for reinspection RE F-1 Unable to inspect-no access
Fire Supply line
ADA
Approach/Sidewalk Inepecftos
Other
Ir -_ - _ _ - Ext
_
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITYOF TIGARD __ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00317
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE iSSUED: 8/9/02
SITE ADDRESS: 1200.5 SW ANN ST PAPCEL: 2S103BA-00111
SU2DIVISION: LERON HEIGHTS ZONING: R-4.5
- BLOCK: LOT: 011 _ JURISDICTION: TIG
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:
FIXTURESLAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHE'-R FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 60 ft
DISHWASHER: RAIN DRAIN: ft
Remarks: Repair of 60'of line work.
Owner: � � —`_� � FEES
PUGH, THOMAS R AND BARBARA J I_Type By �- Date —Amount Rereipt
12005 SW ANN STREET PRMT CTR 8/9/02 $72.50 27200200000
TIGARD, OR 97223 5PCT CTR 8/9/02 $5.80 27200200000
Total $78.30
Phone 1:
Contractor:
BUDGET PLUMBING LLC
8619 SE PATTERSON PL
VANCOUVER, "'A 98664
REQUIRED INSPECTIONS
Phone 1: 503-421-4347 Water Service Insp
Reg #: LIC 134355 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specially 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
Notification-Canter. Those rules are set forth in OAR 952.-0001-0010 through OAR 952-0001-0080.
Yovfliay obtain co-pies of these rules or direct questions to ( UNC by calling (503) 246-1987.
Is ued By: �� 1� G� ��{/ Persnittee Signature:
Call (503) 639-4175 by 7:00 P 161. for ars inspection needed the next I�usinessAAy
lumbin� Permit Application Received Plundn
Datc/B : T 7,ew Pcrtnit No.:
Cit of Tigard Planning Approval Sewer
Y g Test F o r m Date/BX: 'ormiI No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.: _
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review [.anti Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us Contact Juns.: sec Page 2 for
2a-hour Inspection Request: 503-639-4115 Name/Method: I Supplemental Information.
TYPE OF WORKT FEE*SCHEDULE(forspecial informatior use checklist)
New construction 10 0 Demolition Descrt;tion Qty. I I�ec(ea.) Totul
Addition/a lteration/replacenient Other: NL,-1-&2-family dweliir;s
__ CATEGORY OF CONSTRUCTION (includes 16'R.for each utilit connection
- ------r-- -
1 &2-Famuy dwelling ��CommSFR(1)bath 249.20ercial/Industrial SFR 2 bath _ 350.00
Accessory Building ❑ Multi-Family _ SFR 3 bath _ 399.00
Master B-ilder Other: Each additional bath/kitchen 45.00
_ JOB, ' 31NFORMATION and LOCATION Fire s rinkler__sq. R.: Page 2
Job site address !fes- /�; v , Site Utilities
Suite#: � Bld r./A t.#: Catch basin/area drain I16.60S
Suite Name: ��/>7 D cll/leach linc/trench dr.,in 16.60
Pr9jFooting drain no. linear ft. Pa gc 2
Cross street/Directions to,job site: 1574/ l��= Manufactured ha_me utilities 110.00
Manholes 16.60 _
Rain drain connector 16.60
Sanitary sewer(no. linear fl.) Page 2
Subdivision: _ Lot#: Storm sewer no. linear ft.) Pae 2
Tax map/parcel#: Water service no.linear ft.) Pae 2
D CRIPTION O• WORK Fixture or Item
-- ----- Absorption valve 16.60
I'l/' ��/✓/Gr✓ __.-___ BacKflow prcN,cnter Pae 2
Backwater valve _ 16.60
Clothes washer _ 16.60
��-- -� - --� - Dishwasher 16.60
Drinking fountain 16.60
P[t01'IERTI'OWiVER TENANTEjectors/sump 16.60 _
Name: Expansi(in tank - - 16.60
Address: r Fixture, -r cap I6.60
City/State/Zip: g 713 3l it? Floor drain/fleor sink/hub 16.60
!- Garbage die sal 16.60
Phone. Fax Ilose bib _ _ 16.60
,� PL•ICANT _ I Ll CONTACT PERSON Ice maker 16.60 _
Name: _ e Interco tor/ rease trap16.60
Address rah Medical gos-value: $ Pae 2
y J
City/State/Zip_ �� Primer 16.60
Roofdtain(commercial) 16.60
Phone: yG,�-.��� 7 ax: Sink/basin/lovatory - 16.60
E-mail: Tub/shower/shower pan 16.60 J�
_CONT CTOR -� Urinal _ 16.60
Business Name: Water closet 16.60
` Water heatet 16.60
Address: i Other: _
Cit /$tate/ i p .�� Other:
Phone: '' Fax: Plumbing Permit Fees"
CCB Lic. #: _ Plumb. Lic.#: �_� Pe subtotal $
_ �'Z Minimum Permit Fee$72.50 $ n
Authorized �'� i r -15 Residential Backflow Minimum Fee 536.25 `�'
Signature: ( '�jv' Plan Review 25%of Permit Fee $
�` - - --- -- State Surcharge(g%of Permit FeeNo) $ r
TOTAL PERMIT FEE I $
_(Please print name Notice: This permit application expires irs permit is not Obtained within
All new Commercial building require 2 sets of plan with Isometric or 180 days after It has been accepted as complete.
riser diagram for plait review. Fee methodology set by Tri-County Building Industry Srrrice Board.
Plumbing Permit Applicaltian - City of Tigard
Page 2 - Supplemen.al Information
Fee Schedule: Residential Fire Su ression Systems:
Flee-
Site Utilities Qty. Fcc(ea) Total Square ootage: Permit
0 to 2,000 $1 15.00 _
Footing drain-I° 100'
55(X) 2,001 to 3,600. $160.00
Footing drain-each additional 100' 46.40 3 601 to 7 200 $220,00 —
S,wer-1st 100' SS.OU 7 201 and greater $309,Gt; _
Sewer-each additional 100' 46.40
Water Service-Ist IOU' 55.00 Medical Gas S stems: —_
Water Service-each additional 100' X(ea)
Valuation: Permit Fee:
Storm lir Rain Drain-1st 100' — $1.00 to SS 000.00 , Minimum fee$72.50 _
,to & Rain Drain each additional 100' $5,001,00 to$10,00o.W $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. Total includin $10 000.00.
CommercialBackFlowIhcvrntion Device $10,001.00 to$25,000.00 5148.50 for the first$IU,000.00 and 51.54 for
each additional$100.00 or fraction thereof,to
Residential Backflow Prevention Device and including$25 000.00.
minimum rmit fee$36.25) _ 27.55
Rain Drain,single family dwelling 65.25 _ $25,001.00 to 550,000.00 $379.50 for the first$25,000.00 and$1.45 for
each additional$100.00 or fraction thereof,to
Inspertion of existing pljmbing of and including 550,000.00.
s ecially requei_ s lied inspections-prr hour 7-50 _. $50,001.00 and up 5742.00 for 1. 1 610 00fr fraction
and thereof.far
Subtotal: each edditionnl$I W UO or fraction thereof.
Fixture Work:
Are you capping,mo�,illg or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accuratctort fixtures could result in increased sewer fees*. (ytmment5 regarding fixture.cork:
_Quandt by1_Flxturc Wurk Performed
FixtureType:
New Nluved Existing_ C&) ed
Na list !Foul --
Rath -Tub/Shower
-Jacerzi/Whirl uol _
Car Wash -Each Stall �—--�-
-Drive Thm — --- -- ----- - _._._
Cuspidor/Water Aspiratoi
Dishwasher -Commercial — -- — —�-
-Domestic _ -- --------- —
DrinkinFg ountain -
G calash —'�
Floor Drain/sink 2 -- _----- —_.Y
q" --
Car Wash Drain _ *Note: If the fixture%,rk under this permit results in .ill
Garbage -Domestic — increase of sewer EDUs,a sewer permit will be issued and
Disposal -Commercial fees asstssed for the sewer Increase must he paid before the
-Industrial _
plumbing permit can he issued.
Ice Mach./Rcfri .Drains
rJil Se nretor Gas Station
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/lavatory _
-Bradley _
-Commercial
-Service
swimming Pool Filter
Washer Clothes _
Water'wxtraclor —
War,r Closet-Toilet
llrina—I
Other Fixtures: