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Permit CITY TIGARD PLUMBING PERMIT a44 I DEVELOPMENT SERVICES PERMIT #: PLM2001 -00306 i� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/18/01 SITE ADDRESS: 14435 SW 92ND AVE PARCEL: 2S111AB -04600 SUBDIVISION: PENMAR TERRACE ZONING: R -4.5 BLOCK: LOT: 013 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 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: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of back flow preventer device. FEES Owner: Type By Date Amount Receipt LIEUALLEN, NANCY S PRMT CTR 7/18/01 $36.25 27200100000 14435 SW 92ND AVE 5PCT CTR 7/18/01 $2.90 27200100000 TIGARD, OR 97224 Total $39.15 Phone 1: Contractor: OWNER REQUIRED INSPECTIONS Phone 1: RP /Backflow Preventer Reg #: Final Inspection 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. - /i /1� _ %A Permittee Signature: ,/ _ / /� i _ _ I' /j Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne business day Plumbing Permit Ap lication 6.--) Date receiv ed fi Permit t �A _�I • , ,, t , City of Tigard g Sewer perm n o.: Building permit no.: Address: 13125 SW Hall Blvd, Tigar , OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598-1960 Date issued: B f Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ,addition/alteration/replacement ❑ Food service ❑ Other: ig JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist) Job address: y 1e - / S' 9 f�( Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: 'Block: Subdivision: SFR (2) bath i s Project name: SFR (3) bath • City /county: I ZIP: Each additional bath/kitchen Description and location of work o .remises: Site utilities: ,% _,�,�,, ���' - I � Catch basin/area drain Est. date of completion/inspection: Dry wells /leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: d l4 ) i\j Manholes Address: /1 VA S .. ,) q xve , Rain drain connector City: State: ZIP: Sanitary sewer (no. lin. ft.) Phone: Fax: 1E-mail: Storm sewer (no. lin. ft.) CCB no.: Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: _ Contractor's representative signature: Absorption valve Back flow preventer Print name: Date: Backwater valve • CONTACT PERSON Basins/lavatory Name: Clothes washer Address: Dishwasher State: ZIP: Drinking fountain(s) City: I Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture /sewer cap Name (print): A69-41 k a ,9zz. -71)- Floor drains/floor sinks/hu Mailing address: / ,ItL �-' •'& 9 me, Hose bibb disposal Hose bibb City: 776-X-4„,/) ' State(7,e I ZIP: 9 7,7„„z 3 Ice maker Phone: b 39-O?/, 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 pro .: I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) - Owner's signature: „_,L , .. Alk ./ rate: • 40 Sump ENGINEER Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: ' ZIP: Other: - , Phone: Fax: E -mail: Total 55� Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ '7(O Notice: This permit application at % ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review ( %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ - Expires TOTAL $ c3 c/ . /6 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00 /COM) PLUMBING PERMIT FEES . ., ., . .• -. ' ':',-" . ,,, , 4,:;.' ,-,..,-,, ',,.,, , I.:-.-, c' , r,, , :-,--0 , PRICE '10TAU. ,'' 3 ,4,100:Aiid::- - 27 - fariilly,Oellifidi.,diilyT:'.. ., 2 ' ,-, -:- •.';',-,;' ,,,,:;,--1-. `-,,,.. FIXTURES (individual) , , ',,,,'": , `.:QT•r :• ',(ea) , - ; - AMOUNT,. , :(i01(14141:011iPlillyi01441ikes,in , -. ,PRICE Sink 16.60 thOW011ing'pncihe*St100ft. , ' QTY (ea) :' ''.,,, Lavato -for4Sch:titiliti„ , . , - . :,„-;: .' J::' ry 16.60 One (1) bath $249.20 Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE - •- .. .., Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL . . Garbage Disposal 16:60 TOTAL . . Laundry Tray 16.60 Washing Machine 16.60 . Floor Drain/Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 - ... ' . „Quantity by WOrk.Peirfdriiied .. Gas piping requires a separate mechanical *iictiire - . ' New : , Moved.:, Repladed 3 )3enloved/ , . , permit. ' Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory . ... Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher _ Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" Sewer - 1st 100 55.00 3" Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Other Fixtures Water Service - each additional 200' 46.40 (Specify) Storm &Rain Drain - 1st 100' 55.00 . Storm & Rain Drain - each additional 100' 46.40 _ Commercial Back Flow Prevention Device 46.40 - - Residential Backflow Prevention Device* 27.55 .. 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 16.60 ' QUANTITY TOTAL -,. =:' ' Isometric or riser diagram is required if Quantity Total is >9 *SUBTOTAL ' ''' 0 ' 8% STATE SURCHARGE **PLAN REVIEW 25% OF SUBTOTAL "' '' ' ,,,', Required only if fixture qty. total is >9 TOTAL . ..:, , . , $ * Minimum permit fee is $72. ° state surcharge, except Residential Backflow Prevention Device: whic s $36.25 + h state surcharge. ** All New Commercial But trigs require plans with isometric or riser diagram and plan review. imsts\forms\plm-fees.doc 10/10/00 - 'CITY OF TIGARD BUILDING INSPECTION DIVISION . MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested -' ? AM PM BLD Location ! C H 3 S ✓21 ce Suite MEC Contact Person Ph 6;39/ 6 3e, PLM O / OD 36 C Contractor Ph SWR Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN • Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service _ e Sanitary Sewer r Rain Drains PART FAIL 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 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date g/ Inspector Z " cjl / Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. - CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 7 - a- AM PM BLD '7 "� Location . 1 3 s �� A--/,&e, Suite MEC Contact Person Ph PLM (-tea/ - 030 69 Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR • Footing Access: Foundation d► w � FPS I n Ftg Drain d7��r�N /� e" — � - V,�e�J (v„i - 9'Z Crawl Drain spection Notes: SGN Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear ► � > Framing / j� V I. 7 , ,.. •'r .l c d,r� L '�r 1,l" Insulation Drywall Nailing • 07ir Q. // pr) q. 4 Lk. 7 v c i O iI Firewall Fire Sprinkler „�S � �* � '� ✓ ✓r `e Fire Alarm Susp'd Ceiling r Lil i • /•• H .•..� alec / °2er" Roof l ' a / � r 0 O'ce%/e. �,., avr b .' 1- Misc: - Final 0 PASS PART FAIL 3 ) Tr / e/ , 1"� �' u" e (� PLUMBING Q r-0 GAK41 i 04(/ ,�C�F Post & Beam Under Slab yi 741-6 / / / ¢? r ,, r j 2 u Top Out �( Water Service / re,.r Sanitary Sewer . Rain Drains B r- PASS PAR FAIL MECHANICAL & 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 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date - 2 c 7 - U / Inspector ' Z ? // // Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.