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Permit .r, CITY TIGARD PLUMBING PERMIT „' DEVELOPMENT SERVICES PERMIT #: PLM2000 -00106 61. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/5/00 SITE ADDRESS: 14975 SW 103RD AVE PARCEL: 2S111 CB 01100 SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5 BLOCK: • LOT: 010 JURISDICTION: TIG 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: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of new sewer service. Does not require reversed plumbing, less than 100 feet of line. FEES Owner: Type By Date Amount Receipt HUMMEL, DENNIS AND JUDY A PRMT DEB 4/5/00 $50.00 0001159 14975 SW 103RD AVE SPOT DEB 4/5/00 $4.00 0001159 TIGARD, OR 97223 Total $54.00 Phone 1: Contractor: CANTRELL & SONS CONTRACTING 6860 SW NORSE HALL RD TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone 1: 503 - 638 -0800 Sewer Inspection Reg #: LIC 97005 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. Issue By: K o p t �{o g_ Permittee Signature: „Le (ceArZjr Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF.TIGARD Plumbing Permit Application Plan e7Th e_ 13125 SW HALL BLVD. Commercial and Residential Recd TIGARD, OR 97223 Date Recd S-a� (503) 639 -4171 Date to P.E. Print or Type Date to DT —' Incomplete or illegible applications will not be accepted Permit #;�GHr /(��o Related SWR #d Called Name of Development/Project ''FIXTURES (iriilividival)E - " ° -'' w ' f " "'t QTYs;<' P -RICER AMT ' P . Job Sink 11.50 Address Street Address Suite Lavatory 11.50 /yq�, - & rah Tub or Tub /Shower Comb. 11.50 Bldg # City[ State Zip , Shower Only © ('' I7� Wri Water Closenal (Specify) 11.50 � e 11.50 (! �(p!,uvl A ,I_((, 4 4,j7 Dishwasher 11.50 Owner Mailing Address Suite Urinal 11.50 /Vq ) /6 J Garbage Disposal 11.50 Cit /State Z Phone lJ� j������� Laundry Tray 11.50 Washing Machine /Laundry Tray (Specify) 11.50 Floor Drain /Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11.50 4" 11.50 City /State Zip Phone Water Heater O conversion O like kind 11.50 � Gas piping requires a separate mechanical permit. ��'�� MFG Home New Water Service 28.0 i :,Cd/Kyr Contractor Mailing Address Suite MFG Home New San/Storm Sewer 28.00 0 - , !P Hose Bibs 11.50 a Prior to permit City /St� at� Zip Phone n Roof Drains 11.50 / issuance, a copy r A Pfl , h �� ' 42 fig - "a � Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp D. to required if 9✓f�� Other Fixtures (Specify) 15.00 expired in COT Plumbing Llc. # Exp. 'ate database Name Architect Sewer - 1st 100' / 38.00 mi l , C/C or Mailing Address Suite Sewer - each additional 100' 1 32.00 b Water Service - 1st 100' 38.00 Engineer City /State Zip Phone g Water Service - each additional 200 32:00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New O Repair O Replace with like kind: Yes O No O Storm & Rain Drain- each additional 100' 32.00 Residential .O -- CommerciaLO_ - - - -- - - -_ -_ -_ -- -z - - -- - - Additional description of work: Commi �cial Back Flow Prevention Device - - 32.00 - - - - Residential Backflow Prevention Device* 19.00 Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes O No O Inspections per /hr If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL I hereby acknowledge that I have read this application, that the information given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is >9 11l , • ^ r 2W that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL S' ' tur7 e of ner /Ag D75* 8% SURCHARGE 66666 C t Person me Pe ? D�Ud "'PLAN REVIEW 25% OF SUBTOTAL G , �� Q Required only'rf fixture qty. total is > 9 1 BATH HOUSE X178:00 °" � '`� � � � j �. �- 2 BATH HORSE Sz5o�0oa_:= � E� � , �4 _ pro {Thtsfee mNudes ait ptumbinguresnthe ma dwellg ndthe first m •Minimum ermlt except is $50 + 8% surcharge, ex t Residential Backflow Prevention 100 feet of sanrta� sewer. storm sewer and sennce) > = 'Y Device, which is $25 + 8 °h surcharge •"All New Commercial Buildings require plans with isometric or riser diagram and plan review. l: \dsts\forms\plumapp.doc 10/1/99 -- - PLEASE COMPLETE: Sink Lavatory Tub or Tub/Shower Combination Shower Only Water Closet Dishwasher Urinal Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Floor Sink 2" 3 „ 4" Water Heater . Other Fixtures (Specify) • COMMENTS REGARDING ABOVE: • Mists \forms \plumapp.doc 10/1/99 - .. JOB INVOICE ORVALL T. CADE • ' a 3. :.,, -� BYER'S SEPTIC TANK SERVICE - •- ''P.O.,BOX 549 n r'.7.',. A OREGON CITY, 77 OREGON 0 CUSTOMERS ORDER NO :'' DATE ORDERED (503) 656 -3326 654 -9785 - :4- 8 -00,: 655 -6412 ' ` ORDER TAKEN BY . DATE PROMISED ID .A M: . . Grace 4 -10 .0 P BILL TO , PHONE ' 'Gene Cantreal. . . -638 -0800 ADDRESS - MECHANIC .. 611,60 S.W. Norse Hall Rd c Y : :. Tual. 97062 JOB NAME AND. LOCATION " - ❑ DAY WORK k 1497.5 S 1Q3=rd. z ❑ CONTRACT DESCRIPTION OF WORK .'%?r. . ❑ EMRA e. QUANT. DESCRIPTION OF MATERIAL USED', - . PRICE, . AMOUNT . • . C.: _ 1 Tank- Pumping-,-- : -_" 'gip Z. y _ • • • . .1 , s .. . HOURS LABOR - AMOUNT TOTAL Q ' MECHANICS @ ;MATERIALS • HELPERS ,," TOTAL LABOR I hereby acknowledge the satisfactory TOTAL LABOR TAX - completion of the above described work. _ • SIGNATURE DATE COMPLETED TOTAL _---- 4 '4 , ) aled ' ey//Lea C, o /y26 �� /6 6 im ii Pte, # oo -- o27 �� CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 �Y� BUP Date Requested 1 AM PM BLD Location 1 ci 7 S 103 Suite MEC Contact Person J Ph 6 38 -0g00 PLM 2 - CO/0(0 Contractor Ph SWR BUILDING 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 J Susp'd Ceiling yI J Roof Misc: Final PASS ART FAIL //I -._ ✓/- `� P B .640 9 / // // Post & Beam �� Under Slab �`` Top Out Water Service nitary Selocslo Rain Drains -- PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In ( 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 ( I 16-4Approach /Sidewalk Date other l Inspector di' Ext � Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •