13700 SW CRESMER DRIVE 13700 SPIV CRESMER DRIVE
CITYOF TIGARD PLUMBING PERMIT
� oEvEi_ornnEn>iT sERvicEs
PERMIT#: PI_M2003-00337
1312.5 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: x/11/03
SITE ADDRESS: 13700 SW CRESMER DR PARCEL: 2S102CC-07300
SUBDIVISION: BEREA ZONING- R-4.5
BLOCK: _ LOT: 0'14 _ JURISDICTION_TIG _
CLALS OF WORK: OFR GARBAGE DISPOSALS: MOBILE HonE .ACES:
TYPE OF USE: SF WASHING MAL i;: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS.
STORIE=S: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIX rL)RES:
TUBISHOWERS: SEWER LINE: ft
W4 i ER CLOSETS: WATER LIW:: 30 ft
r,ISHWASHERS: RAIN DRAIN- ft
Remarks: Installation of 20'of water service.
---� —_
C wne►: [-Description
FEES
MASSOUD AZGHANDI _-- —_
-- —` Date Amount
—
7 MOUNTAIN VIEW LANE IPLUMBI Permit Fee 7/11/03 $72.50
LAKE OSWEGO, OR 97035 I VAX]89/o State T-A 7/11/03 $5.80
Total $78.30
Phone : _
Contractor:
ROOT EXCAVATION
106245 E OAK ST
MILWAUKIE, OR 97222
REQUIRED INSPECTIONS
Phone : 503-638-3447 Water Service Insp
Final Inspection
Reg#: LIC 134498
PLM 3-433PB
This permit is issocii subje(-t to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will he done in accordance with approved
plans. This permit will expire if work is n,)t started within 180 days of issuance, or if work is suspended
for more-than_ 180 days. ATTENT:0N. Oregon law requires YOU to follow rules adopted oy the Oregon
Iss ed By: �/ �� Permittee Signature: --
Call (503),09-4175 by 7:60 P.M. for an inspection needeEl the ni- usiness day
�Y
Building Fixtures
Plumbins Permit -Application� Received Plumbing
DsPl.te/B PermitNo.: 0�'GYJ: J
City of Tigard Date/Planny: vat Sewer
)G )/� DateJB ; Permit No.:
13125 SW Hall Blvd. 13& `% Plan Review Other
Tigard,Oregon 97223 Date/By:__ Permit No.
Post- se
Phone: 503-639-4171 Fax: 503-598-1960 Date/
ev'.�w land o.:
:..,.°f Dete/I3y: Case No.:
Internet: www.ci.tigard.or.us Conricl Jy , See Page 2 for
24-hour Inspection Request: 503-639-4175 Na nc/tvletCod: '�1t Su Icmental information.
_ TYPE OF WORK -V' FEE*SCHEDULE forspecial Information use checklist
1'8
❑ New construction Demolition DescrlNew Qiy� Fer(ra.) Taal
Addition/alteration/re lacement Other: des 1 i-&2-faintly Ility co gi
ne
�._�- (Includes IUO ft.for rach ut111 conncctlon
_ CATEGORY OF CON STR ON SFR I bath 249.20
T.711 &2-Famil dwelling Commercial/Industrial SFR 2 bath 350.00
OAccessory Building_ Multi-Family SFR 3 bath 399.00
Master Builder t Other: Each additional bath/kitchen 45.00
_ JOB SITE INF01tl41&TION and LOCATION Fire s rinklcr-sq. R.: Page 2
Job site address: ;':-7VO ��76I6 'Y41_'. Site Utilities
Suite#: r3ldg./A to Cp'•:n basin/area drain 16.60
I --- Dr ell/leach line/trench drain 16.60
Project Name- Footing drain no.linear fl. Pa ,e 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 10.60
Rain drain connector 16.60
Sanitary sewer no.linear ft. Pae 2
Subdivision: Lot#: Storm sewer no. linear fl. Pae 2
- ----- Water Service no linear f1.
Tax map/parcel #: Fixture or Iter
DESCRIPTION OF WORK, Absorption valve 16.60
----------_--_-_--__-_- -�.-.- Backflow preventer Page 2
- -- -- Bac'(watervalve 16.60 ---~
Cloth:3 washer 16.60
-- -- - - -- r.ic►.,asher 16.60
_ - Drinking fountain 16.60
pPIrRTY C1WPit tt -'iTENANT� E'ectors/sum 16.60
��------
Naive: M d`a .� A z txb/ Expansion tank 16.60
Address: -7 1�O- , J'rr t t� I �? /^�1 ►J� Fixture/sewer cap 16.60
Floor drain/floor sink/hub 16.60 J
Garbage disposal 16.60
Phone: _ Fax: __ Hose bib 16.60
CONI�ACTPERSON Ice maker I6.60
Name: lntcrceptor/gtease trap 16.60
Address: ^-'---- --__.�- -- -- Medical gas-value: $ Page 2
-- - --- Primer 1660
City/State/Zip: Roof drain commercial _ 16.60 _
Phone: Fax: -� Sink.'basin/lavatory _ 16.60
E-mail: --- - - Tub/showcr/shower pan _ 16.60 _f
CONTRACTOR Urinal 16.60
% --- --- '--" -- Water closet 16.60
Business Name: _ -_ r� - ��J� Water heater _ 16.60 _
_Address: _[ c �Z4Y(i�J TIS Other: -----
Cit /Stat@/Zl - ii'/) J>� Other: r
Phone: Fax: __ Plumbinng-Permit Fees* _
X30-12, _-- --- Subtotal S
CCB Lic. #: L Plumb. Lic.#: Minimum Permit Fce$72.50 $ � , c
Authorized Residential Backflow Minimum F'ee$36.25
/ J Signature: .r Uate: Plan Review 25%of P,:rmit Fee $
State Surcharge 8%of Pennit Fee $
(Please print name) TOTAL PERDdiT FEE $ , J�.
Notice: This permit application expires If a permit Is not obtained within All new commercial buildings require.1 torts of plans with Isometric or
180 days titer It has been accepted as complete. riser dlegram for plan review.
I�,�j •ter methodology set by Trt-County Building Industry Service Board.
i.\Ntq\Permit FormsYPlmPermitApp.doc 01/03 UI�I
PlumbinePermit Application -City of Tigard .
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ca) Total Square Foots e: Permit Fee: _
Footing drain,I"100` 55.01 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-I st 100' 55.00 7,201 and greater $309.00
Sewer-each additional 100' 46.40
Water Service- Isr 100' 55.00 Medical Gas S stCms:
Water Service-each additional 100' 4640 V aivation: Permit Fee:
Storm&Rain train-1st 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain[pain-each additional 100' 46.40 `n5,001.00 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 Itein Qty. Fee(es) 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 thercor,to
minimum permit fee$36.25 27.55 and including$25,000.00.
Rain Drain,single fancily dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the lirst$25,000,00 and$1.45 for
each additional$100.(x)or fraction thereof,to
Inspection of existing plumbing or and including$50,000.00.
specially requested inspectionsper 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,movir.g or replacing existing fixtures? If
"yes",please inn:to work performed by fixture. Failure to
accurate) re)ort fixtures could result in increased sewer fees*.
-- uantit by(Fixture)Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Eslsitn Capped
kiaptistry/Font _ _
Bath =fhb/Shower
-Jacuzzi/Whirl pool
Car Wash -Each Stall �.
-[rive Thru _
Cuspidor/Water Aspirator
Dishwasher -Commercial _- --_ �-
-Domestic
Drinking Fountain ----
E e Wash -- —
Floor D min/sink 2"
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 Mach./Refri .[rains _ plumbing permit can be Issued.
Oil Separator Gas Station
Rec.Vehicle Du Station _
Shower •(Jong,
-Stall
Sink -Bar/Lavatory
-Bradley
-Commercial
-Service
Swinuning Pool Filter _
Washer-Clothes _
Water Extractor
Water Closet-Toilet
Urinal _
Other Fixtures:
L
i\Dsts\Permit Fonns\PlmPermll.\ppPg2 doc 01413
07/11/2003 11:10 FAX 6035961960 CITV or' TT6ARD tgjuuz
Building Division RECEI U,
Applicant Request to Cancel Permit .,Uj. 11 2U 3
L001 aid_. — —------- ---- -- -- c�
jUILDING 01VISIM
TO: CITY OF TIGARD,BUILDING Or,FICIAL
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.639.4171 Fox: 503.598.1960
:FROM: ApplicautName: - 0 - -
2) . PLU M �oG
Mailing Address: -11174742
City/state/Zip: 1 I G A-E _O P--_q -
Phone No.: ��503) X20 - YU O O
Fax No.: _� -
PLEASE CANCEL PERMIT APPLICATION AND'REFUND PERMIT FEES, IF ANY
FOR THE FOLLOWING:
PErntit No.: pt-M q,U 0,5 a o J 3�5
Type of Permit: —ILL)
Site Address: it ZJ70 JIti)
Subdivision:
Lot No.: _. 034
.�---
EXTLAN'ATION: _ [__ o•I Q
T->I-v Ml �f N
Signature: '�K/� ('cmc! � .----.- Date:
Print Name:
Route to Admin.: I Date.
_ Date: 7 /s5 D 3 B
Parmit Canceled:- _ --1
Retlutd Processed: Date: !:E 0.;' __ BY. 914- _
4F 74—70
islItuilding�0ermlRegContelPrrmit,doc 04/01
S'1
CITYOF T'IGARD -__PLUMBINGPERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00335
13125 `';W hull Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/10/03
SITE ADDRESS: 13700 SW CRESMER DR PARCEL: 23102CC-07300
SUBDIVISION: BEREA ZONING: R-4.5
BLOCK: LOT: 034 JURISDICTION: TIG
GLASS OF WORK: OTR 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 VIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 98 f;
DISHWASHERS: RAIN DRAIN: ft
Remarks: 98' of new water service.
�---- --------- — FEES
Owner: —_- -
- Description Date Amount
MASSOUD AZGHANDI — - -- -
7 MOUNTAIN VIEW LgNE I I'LUMBi Permit I cc 7/10/03 $72.50
LAKE OSWEGO,OR 97035 I'-\Xi 8'r�'state"fax 7/10/03 $5.80
Total $78.30
Plane --
Contractor:
JOHN D PE.UMBING
7472 SW FIR STREET \
TIGARU, OR 97223 RE-bUIRED INSPECTIONS \
Phone : 503-620-7000 Water Service Insp —
Finaj Inkpection
Reg#: LIC 89537
PI.M 34••257PB
1 i
I
I
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, nr if work is suspended
for i-norp than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Iss140 By: �" t' LF - Permittee Signature:
Cell(503) 39-4175 by 7:00 P.M. for an inspection needed the next huslitest day
Building Fixture. 1
Plumbing Perniit.Ap hicagon 6
Date received: D Q3 Pcrmit no.:
city sof Tigard _
Sewer permitgo�: Building palmit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 11223 Pro eet/a l no.: Expirc date:
Ciro aJ Tigard phone: (503)639-4171 3 PP
Fax: (503) 598-1960 Date issued_
Cue file no.: j Payment type:
Land use approval: � ---
OF
l &2 family dwelling or accessory :3 Cotrlmerclal/inrinatrial UMulti-family ❑Tenant improvement
0 New construction ❑Addition/altcmtion/replacenrent IZI Food Service 0 Other:
iVV ME� Desc:riptiun W"(W. Total
Job address: V New 1-3-171.jamny dwelfts.only:
r
Bldg.no.! Suite no.: (tactodes 100 it.for each utiUty eottnection)
Tax map/tax lot/account no. _71 __ SFR(i)-bath
Lot: Block Subdivision FR(2) ash
Project name: FR(3) ath
City/county. G b W ZlP' aeh t�been
Description and location o work on premises! Siteutthties:
n,el J �� '�/c Catch basin/area drain
Orywell leac liao/trenc drain
Est.date ul'com lclion/Ins ection: hooting ran no,lin.
� Manu acturcd borne utilities
Business name: {A L(J H nholes _+
Address: ie Rain rain connector
City; Q State; ZIP: Z Z Sanitary sewer(no.lin.it.
Phone Fax all: corm sower(no,lin. .)
S Water sorvice, no.lin.it.
CCD no.�( Plumb.bus.reg,no: Fixtureoritem:
Ci /metro lic.no.: Absorption valve
Contractor's representative signature: r Back ow preventer
Print tiaa.C; ft INK" MA'MuJiM
asins/avatory _
Name: Clothes was t—T r
--- -- Dishwasher
Address: nu in ouniain s)
cctors/sum --
Phone: tax: E-mail: x a_nsionnta _
ixture/sewer cap
tloor drains/ oor tin s u _
Name(print): S`J nv���-�ZC- 1L I _ _ Gia e isposul V
Mailin address: V M"/WAJ '/ __W , Mose bibb
City: _G r7 State: '�, ZIP: C tee maker
Phone: Fax: I E-mail: Intercc for/grease trap
Owner installationiresidrntisl maintenance only. The actual installation Pritner(s) _
will be made by me or the muiatenance and repair made by my regular —Roof dra ncommerctal�)
employer on the property I own as per ORS Chapter 447. Sink(s),basin(s),lava(s) i
Owner's si nanire: — _ _ Datc: Sump _.
TSa/showerlower pan
r na
Name: Water clow
Address: Water eater
City_- _ �+ State; ZIP: Other:
��Fax: E-mail: ora
Phone: _ _
Minimum fee................
Not sit Juv"c tem wep aa�lit rank$pian call lttr.utictkm(of mote IntormaNun Notice, This pennit application —
p vin nmmC'
U ht +wi expires if■ permit is not obtained Plan review(atio) S
�—
Statc surcharge(81(,)
n 5
....
creed uuA number —4,— / within 180 days aRcr it has beenExpires 7
NMne o ea n tTlrrr a flmwn on er It n
accepted us complete. TOTAL........................ Sw
S
!-ZaedtwWe+��a - Mwunl ,t�U.ap;!(NUC/C011i
Td IME:6Z Me To .130 : *ON xed W0dJ