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InitiallyGood CO Cn ou 1 (D O i Q 13 9440 SW Bentwood Place CITY OF TICARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection line: 639-4175 Business Line: 639-4171 _— Date Requested n —3 AM)7 :3� PM BLD — Location `1 L '`" -- e7'�„'g' '� Suite _ MEC - — Contact Person -_ _ Ph PLM C / - G C, Contractor -� Ph _ SWR _ BUILDING Tenant/ � 'L`1-c� r I Lk-,4- - ELC — - Retaining Wall 1. Z2__ ELR Footing - - Foundation Accessi: •�- �'�,,-t �D �'j Ct FPS Ftg Drain Crawl Drain Inspection Notes: / SGN _ Slab � f �_ �, __ _- SIT Post 8 Beam Ext Sheath/Sheary'� '. Ini Sheath/Shear Framing ��L u ` , lS/>S Insulation ---- Drywall Nailing Firewall - Fire Sprinkler Fire Alarm Susp'd Ceiling ____�� YY_�►-��( ,Q-, �,l/f�`��c..y 1 r, V rL� Roof Misc. -- ---- - 'Coe-, ---- Final PASS PART FAIL ' "`—'� Q'1•� "� _ _�_ �f �_ w PLUMBINGC,t --moi �� _fQ '�,�,f Post& Beam Under Slab Top Out Water Servic Sanitary Sewer "�- --- Rain Drains rn PART FAIL MECHANICAL Post& Bearn --r ---------..__--.----__-- - ----__ ___ --- Rough In -- Gas Line — Smoke Dampers Final --- __ ---- -- -- - -- -- PASS PART FAIL ELECTRICAL _._-- Service Rough In -_ _---- _- - - --- --------- I Ir lslah -L- Low Voltage - -- T- ------__®._J 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 ( 1 Please call for reinspection RE - _ - _ ( ( linable to inspect- no access ADA Approach/Sidewalk — U 1 �- ---- Z Other Date Inspector. ��_+ �- text J Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. n CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00323 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/27/01 SITE ADDRESS: 09440 SW BRENTWOOD PL PARCEL: 2S111DC-06900 SUBDIVISION: SUMMERFIELD NO.9 ZONING: R-7 BLCCK__ LOT: 495 JURISDICTION: TIG CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SFA WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Rernarks: Water heater replacement. owner: WELCH, KATHRYN Y TR _ lype By Date FEES Amount Receipt 14705 HARBOR VIEW DR PRMT CTR 7/27/01 $72.50 27200100000 ROCKAWAY, OR 97136 5PCT CTR 7/27/01 $5.80 27200100000 'Total $78.30 Phone 1: Contractor: STAN THE HOT WATER MAN PO BOX 33157 PORTLAND, OR 97292 REQUIRED INSPECTIONS Phone 1: 503-760-2992 Final Inspection Reg #: LIC 130755 PLM 26-632PB 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 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 By: :; �L, .r L c Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business,Ei y Plumbing Permit�k ion �� "Dateeived: j t Permitno.: City of Tigard �� Sewer permit ao.: Building permit i).:Address: 13125 SW Hall Blvd,Ti d OR 3 --- Cit i Y n f Tigard '- Phone: (503) 639.4171 ProjecUappl.no.: Expire date: Fax: (501) 598-1960 Date issued: By 0, R,:::eiptno.: Land use approval: _—_ Case file no.: Payment type: 7UNelv family dwelling or accessory U Commercial/industrial XMulti-family U Tenant improvement onstruction U Addition/alteration/replacement U Fuod ScrvuA• lU Other: Il Job address: q'/cI C'��— REN ��` Descri tion Qty. Fee(en) Total Bldg.no.: Suite no.: New 1-and 2-family dwellings only: (includes l()c.fl.for each utility connection) Tax map/tax lot/account no" SFR(])bath Lot: _ I Block: Subdivision: SFR(2)bath -- -- _ Project name: SFR(3)bath -City/county: 7.1 P: y 7 Z Z Each additional badi/kitchcn Description and location of work on premises:_ Site utilities: 0-!qC L W / Catch basin/arca drain Est.date ol"completion/inspection: rJ Z 7 -C) i Drywells/leach cine/trench drain — -- Farting drain(no, in. ft.) Manufactured home utilities Business name: j j LJ 7N4�_&1 W14-TeC� Manholes Address: C Q 3 3 1 S� �— Rain drain convector Slate: ZIP: Z Q Z Sanitary sewer(uo.lin. ft.)� Phone: Storm sewer(no.lin.ft. SO 'j �,. Fax_ E-mail: _ _ ) CCB no.: 13 L-`�5 S Plumb. bus.reg. no: 2 B Water service(no.lin.fl.) City/metro tic.no.: �--��3 p fixture or Item: Absorption valve Contractor's repri,wntative signature: (41 O � —•-- — Print narnc 7, � Back flow preventcr -- �(' D t : 7-Z 1`�/ Backwater valveMilo Kill.111112111M _ Basins/lavatory Name: V QNN E (AJ r-C C_H Clothes washer S Address: C�(� w Dishwasher City: 1 � State: Q/f' Zip: rj 7 Z 3 Drinking fountain(t;)� Ejectors/sump Phone:SLI; 1?2 - 7 Fax: E-mail: Expansion tank Fixture/sewercal. Name(print): VOriw� W IF-L CH Floor drains/floor sinks/hub _ Mailing address: 9,l y p $t,c1 (,�r�N1w Hdisposal L Hoose se bibh City: Q — Ice maker Phone:SU 312 -190 1 Fax: E-mail: Interceptor/grease trap _ owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _ — employee on the property I own as per ORS Chapter 44'1 Sink(s),basin(s),lays(s) _ Owner's si nature: Gate: —. Sump Tubs/shower/shower pan Name: Urinal _ _ -- - --- -- — Water closet Address: Water heater _— City:— _ State: �ZIP: Other: Phone: `! —Eax: E-mail: Total Na all jurisdictions accept credit cards.please call jurisdiction for nwre information. Notice:This permit application Minimum fee................$ rld S Visa U MasterCard Plan review(at �) $ expires it a permit is no `_t obtained � Cmlit card nurrtberg�O41 2 113 YY t / /QJ within 1 g0 days after it has been State surcharge(8%) ....$ rlaAFc- SO,CL-R fixtures TOTAL $ Nsm ,......•.• ••••••e of cardholder as shown on credit card accepted as complete. _ S - cardholder slit uttac Anwmt - 4dl}J6I6 Ifs+OaK'OMl PLUMBING PERMIT FEES: PRISE TOTAL New 1 and 2-family dwellings only: FIXTURES (individual) QTY ea AMOUNT I, eludes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ff. QTY (ea) AMOUNT Lavatory — 16;p 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 i $399.00 i Water Closet 16.60 — SUBTOTAL _ Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 - ___+__Y__ TOTAL�T LaundryTray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Healer O conversion O like kind 1660 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 o MFG Home New Sin/Storm Sewer 46Lavat 40 — . -� Tub or Tub/Shower Hose Bibs 1660 Ccmbination Roof brains 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" v — Sewer-each additional 100' 46,40 4" _ - Water Service-1st 100' 55.00 Water Heater Water Service-each additional 200' 4640 Other Fixtures Storm&Rain Drain- 1st 100' 55.00 _ ;toren&Rain Drain-each additional 100' 46.40 "ommerctal Back Flow Prevention Device 46.40 - - - -- ----- Residential Backflow F.evention Device' 2755 —� 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 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 1 1 1 —_ TOTAL 1 $ *Minimum permit 116941 $7251188%st a surcharge.except Residential Back Bow Prevention Device.w %state surcharge. **Ali New Commercial Buildings require plans with Isometric or riser diagram and plan review I-WstsUorms\plm-fees.doc 10/10100