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Permit � f CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00446 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/3/2008 PARCEL: 1 S133DD -16300 SITE ADDRESS: 11957 SW 129TH PL ZONING: R-4.5 SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 5 LOT: 199 JURISDICTION: TIG PROJECT: CLANCY Project Description: Replacing dishwasher and kitchen sink for remodel. 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: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Owner: FEES MICHAEL & CLANCY 11957 SW 129TH PL Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 12/3/2008 $72.50 [TAX] 12% State Surch 12/3/2008 $8.70 Phone : Total $81.20 Contractor: BLACK CAT PLUMBING 4630 SE 26TH AVE PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 788 -0300 FAX 503- 788 -2180 Reg #: LIC 178183 PLM PB467 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. , C Issued By l� / _ Permittee Signature: " � '�/ _ // Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application �t Building Fixtures �',� ii "� lt,h r,l I It I i ,t. „\l., Received I'enttit Na / �' City of Tigard Q4 I_1 r Ltl i . . 2 C D ell 1 s �� • • 13125 SW Hall Blvd., Tigard, OR 972 P hone: 503.639.4171 Fax; 503.598.1 Plan Review e Date/By Other Permit No.' I i t A p I Inspection Linc: 503.( >39 0� i ' , S1oN Date Rea /Ay� runs B See Page 2 for Internet: www.tigard- or.gov 1 NntiftadJMedrod: , , Sop 'lemeutal Information TYPE OF WO41 FEES SCHEDULE ❑ New construction 1:1 Demolition rP ..�_ ,,mallon use checklist: _ Fors special In orlist: _ Description Qt Ea. Total Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 1001. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 El Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional buth/kitchen 45.00 ❑ M aster builder ❑ Other: Fire sprinkler (_ sq. tt) Page 2 JOB SITE INFORMA'T'ION AND LOCATION Site utilities Joh site address' , ` t _` I ZG i Catch basin or area drain 16.60 City /State/ZIP: �1 00 0 0 °I 1 a �3 Drywell, leach line, or trench drain 16.60 Suitt /bldg. /apt. no.: J Project name: � +-f Footing drain (no. linear tt,; _) Page 2 Manufhctured home utilities 110,00 Cross Street /directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no, linear ft.; _) Page 2 Subdivision: I Lot no.: Water service (nu. linear ft.: ) Page 2 - Fixture or Item Tax map /parcel no,: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventor Page 2 . j I r, 0 r ir i r r Me- r Backwater valve 16.60 Clothes washer 16.60 Dishwasher / 16.60 it-, , (90 Thinking fountain 16.60 - 7 / Ejectors /sump 16,60 Name: (__PROPERTY OWNER I ©TENANT 0-n0 1 19 % �'lAt�" V a-1 14.t.c4 Expansion tank . _ _ -Tmm 16.60 Address: Fixture/sewer cap 16.60 City/State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) ('rarbagc disposal 16.60 ~ ❑ APPLICANT I ❑ CONTACT PERSON Hose bib M 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 T City /State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) l Fax: : ( ) Sink/basin/lavatory T 16.60 A(, . (, c_) Cub /shower /shower pan 16.60 E -mail Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: P I t` /L- 0-at P1 () m b � n I y Water heater 16.60 Address: 4 ?)o �� o am. Other; City/State /ZIP: Pte.} -lt� rr� 611—/2o7- , - Subtotal ( Minimum permit fns; $72.511 Phone: (5'03) 7g 030-0 Fax: (%5 ) 7 TiS - 2-i Residential backflow minimum p ermit fee: $36 25 .� CCI3 Lie.: } 7 I 3 Plumbing Lie, no.: PP) (4--7 Plan review (25 %of'permit foe) Authorized signa. • : State surcharge (12% of permit fee) TO TOTAL PERMIT FEE Wt Print name: / A yid( i1 )-i i a Date: • 4, This permit application expires if a permit is not obtained within CJ ` 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. r:aruitdlna \Forms- \PLMP•PermitApp.doc 12/27/06 440-4616T(1WU2/COM/wtf1) Z002] XYd ZZ :CT 8002/C0/ZT CITY OF TIGARD / BUILDING DIVISION PERMIT #: PLM2008.004/1j • 13125 SW Hall Blvd., Tigard, OR 97223 U r DATE ISSUED: 17J3/200f3 Phone: (503) 639 -4171 hogia�11�i ° 1 Inspection Requests (24 Hrs.): (503) 639 -4175 ‘ 4.14- e`� __.. ( f If % INSPECTION WORKSHEET FOR DATE: 13/&2QO8 TIME: 7.00: PAGE: 12 SITE ADDRESS: 11957 SW 129TH PL CLASS OF WORK: SUBDIVISION: V ILIAOE AT SUMMER LAKE PARK 5 LOT #: 199 TYPE OF USE: PROJECT NAME: CLANCY DESCRIPTION: Replacing dishwasher and kitchen sink for remodel. OWNER: CLANCY, MICHAEL. & MARINA PHONE #: CONTRACTOR: BLACK CAT PLUMBING PHONE #: 503 768✓0300 . Inspection Request Scheduled For: Date: 12/5/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 078815 -01 50378B -0300 N Corrections/Comments/Instructions: PASS 1 1 PARTIAL APPROVAL ❑ CANCEL H NO ACCESS n FAIL 1 I CALL FOR INSPECTION 1 1 ADDITIONAL FEES SSESSED dtr b ej---1 ?'(A- • Inspector: Date: 1 d / ( 1 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION /�� PERMIT #: PL.M200f3 0416 13125 SW Hall Blvd., Tigard, OR 97223 i'�J DATE ISSUED: i ?lam " }f)f'rij Phone: (503) 639 -4171 ��HNN��gpiq�l)� I 6 Inspection Requests (24 Hrs.): (503) 639- 4175 Id ( INSPECTION WORKSHEET FOR DATE: 2/4!2009 TIME: 7 :00AM PAGE: •i5 SITE ADDRESS: 11957 SW 129TH PL CLASS OF WORK: SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 5 LOT #: 199 TYPE OF USE: PROJECT NAME: CLANCY DESCRIPTION: Replacing dishwasher and kitchen sink for remodel. OWNER: CLANCY, M CHAEL & MARINA PHONE #: CONTRACTOR: BLACK GAT PLUMBING PHONE #: 503 - 78130300 Inspection Request Scheduled For: Date: 7./4/2009 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 080267 -01 503. 788.0300 N • Corrections /Comments /Instructions: %_..- )(td 0 4(40.,"2),/../7A4ekbae_ / SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 714/ Inspector: Date: Phone #: (503) 718-