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Permit CI TY OF TIGARD PLUMBING PERMIT COMMUN)TY DEVELOPMENT PERMIT #: PLM2007 - 00119 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/26/2007 PARCEL: 25111 BD -01513 SITE ADDRESS: 14980 SW 100TH AVE ZONING: R -3.5 SUBDIVISION: ALDERBROOK FARM LOT: 006 JURISDICTION: TIG PROJECT: KNEZ Project Description: Connect existing house to sewer. Septic tank to be pumped, filled and inspected. Reimbursement District #27 fee paid this date. 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: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 60 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES JOHN KNEZ 14980 SW 100TH AVE Description Date Amount TIGARD, OR 97224 [PLUMB] Permit Fee 3/26/2007 $72.50 [TAX] 8% State Surcha 3/26/2007 $5.80 Phone : Total $78.30 Contractor: CENTREX CONSTRUCTION INC 8250 SW HUNZIKER RD TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS Contact # : PRI 684 -0443 Reg #: LIC 56358 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 NotificationCenter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of thes rules or direct question • • UNC by calling 503.246.6699 or 1.800.332.2344. ` \ Is ued By: 1 / /if. //, // ,', Permittee Signature: A 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. i Plumbing Permit Application I OR 01. l 11 1 l •1 ()NI ) 1111111 City of Tigard y go, /97 Permit No.: "I„, , ,, - a dj / 13125 SW Hall Blvd., Tigard, OR 97223 plan Review • P hone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No• (� 7 �� Inspection Line: 503.639.4175 Date Read /B 0 See Pa 2 for l I c I Internet: www.ti d ov o: gar g Notified/Method: �� SupplcmenMllntormation TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For speaal information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑� Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: c(L-91 % .. W ( Odact N.Q Catch basin or area drain 16.60 City/State/ZIP: 'T\ c v '' ? ` Drywell, leach line, or trench drain 16.60 Suite /bldgJapt. no.: Project name: 'k y,c � Footing drain (no. linear IL: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 tQ P'"' % � -., Rain drain connector 16.60 Sanitary sewer (no. linear ft.: C') Page 2 .UC Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 P Drinking fountain 16.60 ROPERTY OWNER I 0 - Ejectors/sump 16.60 Name: ©Avi 4f. %,) Expansion tank 16.60 Address: V--Zs0 ". \,) \C)t ' (\ Fixture/sewer cap 16.60 City/State/ZIP: 7 , © �'"?' fi t . Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) \ Garbage disposal 16.60 Hose bib 16.60 IR APPLICANT ❑ CONTACT PERSON Ice maker 16.60 Business name: E � F� ,1∎) l l �.•k Q5D a (Kv, Q.- I.) 9- Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: 4F3," S O S U) kAl.)., Z\ r..._,A .. Primer 16.60 City /State/ZIP: `-A t C � Av- p 9')----k. Roof drain (commercial) 16.60 �� Sink/basin/lavatory I 16.60 Phone: �-�°V �l ( T � 1 , O I Fax: : G `-. V O oQ. Tub/shower /shower pan 16.60 E -mail: � - ZEY\j n r\ c •H C l .) Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: A Q fN, f p Li Q" IV �- _ Water heater 16.60 Address: Other: I City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential back minimum permit fee: $36.25 ��'� CCB Lic.: C ,', i t k lumb 0 : Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) , ' .e0 Authorized signature: TOTAL PERMIT FEE 7g. 50 Print name: ` L., 0 C� �- Date; This permit application expires if a permit is not obtained within " 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. t:\ Building \Pecmits\PLM- PennitApp.doc 06 /26/06 440- 4616T(I0/02/COM/WEB) CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007 -00119 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/26/2007 Phone: (503) 639- 4171"''a'N yioglplrjll'I� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/512007 TIME: 7.03AM PAGE: 51 SITE ADDRESS: 14980 SW 100TH AVE CLASS OF WORK: SUBDIVISION: ALDERBROOK FARM LOT #: 006 TYPE OF USE: PROJECT NAME: KNEZ DESCRIPTION: Connect existing house to sewer. Septic tank to be pumped, filled and inspected. Reimbursement District #27 fee paid this date. OWNER: KNEZ, JOHN PHONE #: CONTRACTOR: CENTREX CONSTRUCTION INC PHONE #: 684 -0443 Inspection Request Scheduled For: Date: 4/512007 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 046005 -01 503-684-0443 N Corrections/Comments/Instructions: Lj " 7d3L! P I4-4 T.,(41. d-- Fr 1 1 Cat ( ✓ ek. t Se ❑ PASS KPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: dZ Date: iff { 3/ a -'7 Phone #: (503) 718- • CITY OF TIGARD _ BUILDING DIVISION ' PERMIT #: PLM2007 -00119 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/26/2007 Phone: (503) 639 4171 / 411„ 1411iiylpl�11�� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/19/2007 TIME: 7:01AM PAGE: 61 SITE ADDRESS: 14980 SW 100TH AVE_ CLASS OF WORK: SUBDIVISION: ALDERBROOK FARM LOT #: 006 TYPE OF USE: PROJECT NAME: KNEZ DESCRIPTION: Connect existing house to sewer. Septic tank to be pumped, filled and inspected. Reimbursement District #27 fee paid this date. OWNER: KNE7., JOHN PHONE #: CONTRACTOR: CENTREX CONSTRUCTION INC PHONE #: 684 -0443 Inspection Request Scheduled For: Date: 4/19/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 350 Septic tank 046732-01 503-793-6116 N Corrections/Comments/Instructions: Pl1- L c3 S ep. A- .-) �.- p �, (Ze-v t Cir,ri/aL. g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: L Date: �'I j I ■ I 07 Phone #: (503) 718- facan On Qi Jeremiah, Inc. 1 ( WW�iJJ lE( S 810 E. Main ��11 �UVV 't " l�� Molalla, OR 97038 aJ " / '� x r (503) 829 -7600 / 0 1) I Dave's cell: (503) 209 -7641 S „ • •� Newberg (503) 538 -8808 eht1 Pumping &Reran Silverton (503) 873 -7622 CCB# 158543 DEQ# 38346 ✓ Complete System Installation 1 -866- 939 -7600 i Z _erirtr,e. i x ii0 51 /60,/ 4ve 7 ,::,\,,, y - ,. 0 A 4 531,_ pee6 Terms: Net 10 days. A service charge of 1 -1/2% (18% per annum), $2.00 minimum will be applied to past due accounts. DATE CHARGES AND CREDITS BALANCE BALANCE FORWARD I 4 1, lir i rt 1 0 . 1 A k A , e 9,,„1 ' A ...." /7 it e)'/),,,v OW i r d 84 °I. / e PUMP IN APPROX. 1 2 3 4 5 6 7 8 yrs. 74•144 l,_