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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2004 -00450 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/27/2004 SITE ADDRESS: 14685 SW 91ST AVE PARCEL: 2S111AC -01000 SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5 BLOCK: LOT: 051 JURISDICTION: TIG CLASS 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 FIXTURES: TUB /SHOWERS: SEWER LINE: 60 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace sewer from house to street. FEES Owner: Description Date Amount S, GEORGE 14685 SW 91ST ST [PLUMB] Permit Fee 9/27/2004 $72.50 14685 TIGARD, OR 97223 [TAX] 8% State Surchan 9/27/2004 $5.80 Total $78.30 Phone : Contractor: 3 MOUNTAINS PLUMBING PO BOX 386 SHERWOOD, OR 97140 REQUIRED INSPECTIONS Phone : 503 Sewer Inspection Final Inspection Reg #: LIC 141187 PLM 34 -368PB 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. Issued By: Permittee Signature: _sue c? Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day 09/24/Z000 14:54 FAX 50359 CEIVEEJ OF TIGARD (001 • Building Fixtures Plumbing Permit Applic4tio P 2 4 2004 FOR OFrlCt. use ONL\' City of Tigard CITY OF TIG ° R Y '1� ?� eemsitNa. "(/ ,0 �,-a 13125 SW Hall Blvd., Tigard, OR 97223 BUILDING DI ' SI0 \I Ptanntvicw Phone: 503.639.4171 Fax: 503398.2960 � • Dud13y: Other Permit No.: • 24- }lour Inspection Line: • 503.639.4175 • . -`ii . 4/ Date Ready/Br 13 See tree Z tar mac: W W W .c tiga<a• is 1401ificd/Motbo4 Sapplen.ental lntonnaGoo ., = t :. + _ r� o' t. + f, �il�,, s i ! 'i 1� + ..F. .'••', .... .. � ... /_ I', . ,✓ _ I', _ t. .__ —.. ,..� �.,(,` �` .,: ?!1'F.2 k`�c? w'tt �. +.. ii , • � / `tu1:�JV . .� _._ w r :ti Jere A_.. ❑ New coastntction Q Demolition For mean/ information ass ch Description I Qty. ) Ea. I Total Addition/alteration/replacement 0 Other: New 1.2- family dwellings (includes 100 ft for each utility connection) -' ' I - ..? I .. 1 ; �, f s �?'� 1 a' r SFR (1) bath 249.20 _ 1- end 2- 6smily dwelling ❑ CommerciaVindustrial SFR. (2) bath 350.00 i Accessory building 0 Multi - family SFR (3) bath 399.00 ❑ Mason builder CI Other Eecb edeidanat bath/larchat 45.00 — - ,_- . ti Fire sprinkler (_____ sq. tt) • Page 2 -- ,__ - '' `' : t '. . ` 1 Site utilities Yob site address: \yam 1 6S S\ OA st ` IN y e. Catch basin or area drain I6.60 City/State/ZIP: - t% pt rd • O.. • O-'1 ZZ,L{ Drywell, teach line, or Rrnch drain 16.60 Suite/bldg./apt. no.: Project name: Cj fir iL Footing drain (no. linear ) Pam 2 Cross street/directions to job she: Manufactured home utilities t 10,00 Manholes 16.60 Rain drain connuoar 16.60 Sanitary sewer (no, linear ft.: tla 1 Page 2 % 5 is d Storm sewer (no. linear ft.: ) Page 2 _ Subdivision: ,Lot no.: Water service (no. linter R : ) Page 21 Talc xnap/parcel no.: a or R t e oritem r' 7 , "-.., _' :rfi, t •- ` s. " q'r}r F i Ire.':? Absorption valve .6� + ,� ,,X. "t P.. � ,) 4.. ...'r ''1 i ` 1...., ' .� .. P'• - 1 - _ � Backnow preventer . Page 2 _ e #C .. S.e V1/ f P�,Oty )4 ( Backwater valve 16.60 1t - A" ( # - Clothes washer . 16.60 Dishwasher • 16,60 , .t..2...... r '..41q Drinking fountain • 16.60 �Natne: , �Ocr\ Se_r \..h e- _. F ~ j pmaion t an • 16.60 Pspsnaion tank .26.b0 �, Address: 1 y lo,' 5 5\13 q; St , vv , Fixture/sewer cap • 16 /' City/State/ZIP: S \ c y,‘ 0 C%- 2:2-4 Floor draia/flou ink/hub 16.60 - - Phan= 6 03) L0301 - --A3L/1") . Pax: ( ) Garbage disposal 16.60 717 t' ,. t , , T -- -"'t ., . 1 71 p• Hose bib .16.60 • .. '. '_ f-_- ,� ? • . __ —.. '° - - - , ..._. - .,. ke maker 16.60 Baseness lnterceptor/grsase trap 16.60 Contact name: Medical gas (value $ ) Page 2 Address: Primer 16.60 City/Statc/ZIP: Roof dram (commercial) 16.60 ' Phone: ( ) l 'F : ( ) . Sink/basin/lavatory 16.60 Tub/shower/ahowerpan - 16,60 E -mail: T •y _ Urinal 16.60 t:. . .. Jj.J.r:e.',i. �y.t' +ice 3: t .. 4 11 . . i � . i 4. �yf�;L _..i�}r L. Water closet 16.611 Business name 3 �1C1 t R - 'tOet V-'t S c.\ Pi l� t tNeA Wares heater . 16.60 Addy ss: P. O - OX 3' Other: City /State/ZIP: S W ©o C� Qom- q,1� 0 Subtotal Minimum pens! fee; 572.50 Phone (543) cy2.5 - \3 y 2_ f ,.,<.vFax: (St>3) 0 1/..5 - 0 0 O y Residential backflow minimum permit fee: $3625 111,,,,r0 ., C(� Lie.: Plum �1 bing ' ao.• 2 t I --46g. permit renew (2596 of fee) ���,.�� /� State surcharge (8% of pt fcc) + 1ra r TOTAL PERMIT - - 1 - F Print name: 13 v.'^ 4 S �., ,. I - ! , may f — I - Date: : y .. 2 - 4 - ell J This permit application expires if a permit is not obtalpe within �...,, � _ _ 1 0 days after it has been accepted as complete. Se i ��7 erre �i � /J t ..e-- 3 —g1.-- 0 � *Fee methodology by Build ology set by Tri County Building g industry ustry ry Service Board. er a+o (I O.'oz/CQMM� ®) E'd 01 L2ei*D irD S2 daS CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (. •39 -4175 INSPECTION DIVISION Business Line: '� 4;0 ,-4171 ✓ ., 4 MST � Received Date Re nested lb ' PM elii.jji Location / L /6 W 7 /"Q /4 -- Suite MEC Contact Person /L--2 — Ph ( ) 5 7 9 a 5 e4aooy--06)95 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear �' ■ Int Sheath/Shear Ay N 6 Li t -a c ' 1 _ (' �f_ Framing Co l V o Insulation �'`Q ` „ n —— �� C��, Drywall Nailing / �`� /' : .�`�" Firewall � 7 (t3 (% 22 S 6 , Fire Sprinkler • Fire Alarm --,.-.. `• y c iev . Susp'd Ceiling ,Roof Other: Final PASS PART FAIL ( f2s (..... �� ` , + CT — i PLUMBING V`J Post & Beam Under Slab Rough -In Water S:6, ice I Rain Drains Catch Basin / Manhole 4. S tor m Drai Shower Pan i • Other: Fin. , <0 C . PART FAIL • O / . '' '''' MECHANICAL Post& Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE ❑ Please call for reinspection RE: El Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date 1 (:)*70 Inspector F.7ct Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL