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Permit CITY F TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2004 -00193 II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/28/04 SITE ADDRESS: 13675 SW FEIRING LN PARCEL: 1S133CD -04800 SUBDIVISION: COTSWALD MEADOWS ZONING: R -25 BLOCK: LOT: 046 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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: 40 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replacing approx. 40ft. water service. FEES Owner: Description , Date Amount PETERSON, PAM 13675 SW FEIRING LN [PLUMB] Permit Fee 4/28/04 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 4/28/04 $5.80 Total $78.30 Phone : 503 - 524 - 6066 Contractor: METRO ROOTER + PLUMBING BARRICH INC 5008 SE WOODWARD ST #3 REQUIRED INSPECTIONS PORTLAND, OR 97206 Phone : 652 - 2626 Water Service Insp Final Inspection Reg #: MET 2150 LIC 106824 PLM 3 -265PB 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 Issued By: Permittee Signature: �D. �� !� Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Pltmting Permit Application - FOR O FFICE USE ONLY City of Tigard Received L.f Date/By: 1 6 b Permit No - , -00/ 13125 SW Hall Blvd., Tigard, OR 97223 �� 'hone: 503.639.4171 Fax: 503.598.1960 // Plan Review Il�p� �' Date/By: Perm y: Other Permit No.: I- Hour Inspection Line: 503.639.4175. I • Internet: www.ci.tigard.or.us ---.- Date Ready /By: H See Page 2 for Notified/Method: Supplemental Information � g _ 1:X. 3, • =•.t. i 43'a`..; "" Via. ...,. ._�..x, -.•�- .. -.�.c. _, . .Ir ✓.��.•`�� - � _�� -,�.u- .€- _....Y�a.E -zt; ..: rcr :.� _, _ '�'+`"� - = ".. ._- _ -..... �-a-;:,.:5' .�. , � rte... ❑ New construction ❑ Demolition For special information use checklist. Description Qty. I Ea. I Total ' % ddition/alteration/replacement ❑ Other: px :; *,��;«,.v�;�,�� >,;�R =�;,e��,� va;. <..=.u;:. „E,�.v� ,.;;�� , .,,;, •< ,,e New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) y m _ : , ,-. ,"I a f3 @ GtONS�.+1ttT t N , , , SF (1) bath 249.20 A . . and 2- family dwelling [1] Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 111 Master builder Each additional bath/kitchen 45.00 ❑ Ot her: -.. :, >r. .,:,3,, k ,•.:.r. Fire sprinkler ( s ft. Page 2 ITE` `URNI-i.TION rti: <LOCA'T' �, _- .a m:aw > =; .: �,.. .. .....� -,��r -: ,,� as p... -, _ -a< =�a::;<ed °aiv�; = ,x�, is .:g:::;.,t�,•,. ha a ., .,t`� Sit • ut Job site address: / ep / 5 k) % 4...../t/ Catch basin or area drain 16.60 City /State /ZIP: t - v` i C/L 97aa 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: U I Project name: �� Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: map /9Q /yp (7 5 S � Manufactured home utilities 110.00 map �`- Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.:} 710 Page 2 . go Tax map /parcel no.: Fixture or item ;'r.F ', :;`" ": °.;:. , y z=:<,a.,;,,.:... Absorption valve 16.60 �,.'. MCO r -4 1 - rillg t IBTIt1 O V :..```,. ,:f- & ; ,': 1 s ves < .= .,a> ::?4 -tA., ,r.. ;,,,;k: ,5� ' , A ,,. _:; I_ .. Amit ?�; ,.. , ,N;: fi Backflow preventer Page 2 I . ' .Ai -- . I ,44 _IA., t.,_; _! /[_ L / Backwater valve 16.60 f Clothes washer 16.60 Dishwasher 16.60 g• > �. :.•; . , >. r:< =a:;. r ; - , Drinking fountain 16.60 :' , *=-F o�.�- . � . , . .:i '.� -:�: 3,,�'::s�= .;�' " ',; 0. a..<.: E /sump 16.60 Name: > Parrn P Expansion tank 16.60 Address: / 36, 75 S it' ..4Cn_ L1 v Fixture /sewer cap 16.60 City /State /ZIP: r� Me 9 l aa 3 Floor drain/floor sink/hub 16.60 Phone: (5 8 4/4 © 3 cg - , � .. Fax: ( ) Garbage disposal 16.60 >y "';,.: a. 'L r : , >,',,, ; :- :.;r ego :. t;a Hose bib 16.60 ":AP ;; . - ;< ; ..1;'CO irw: °r.., ,m" ? eq , ; rye. _... ..TC NT'�;i li ~> ,; . •. >_ :. _;..... ° "ar. a: , ... ,:,:..::;a,< • b - . Ice maker 16.60 Business name: , , / - iL� u ., .�ii.G - Interceptor /grease trap 16.60 Contact name: _ Medical gas (value: $ ) Page 2 Address: / % x 3 3 5 ?- Primer 16.60 City /State /ZIP: V6ZKe I ()-'j7 . q 7a- 9 Roof drain (commercial) 16.60 Phone: ( ) („G-,. a(� - j Fax: : ( ) at,/ _ (e c Sink /basin lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 Via _-,. - ., ' ,a ,�„ m v= s- :�;. °::._�'t �.�..a��:�:- ,�,;,z -, ]:. '„ Water closet 16.60 Business name: �9 t � . j ( Water heater 16.60 Address: 4 nn ,,,,,, 3 5 0 1Y1 Other: J City /State /ZIP: n�kp�,,_ n 1 9 7a 9 a - 3 (' 5 Subtotal LAO b 1 9 Minimum permit fee: $72.50 °hone: ( ) 69 GA - Fax: ( ) Ll - c, C Cos Residential backflow minimum permit fee: $36.25 Z2 5 0 .B Lic.: ( Cg )14 Plumbing Lic. no.: 3 --' :IO P/_ Plan review (25% of permit fee) State surcharge (8% of permit fee) fr 2 Authorized signature: ( � f�/1 TOTAL PERMIT FEE �t 7 Print name: 5A - 6R iA A' (1.150 Af Date: Li g7 6 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. i:\Buil di ng\Permits\PLM- PermitApp doc 12/03 440461 6T( I 0 /02 /COM /WEB)