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Permit t\ A CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00136 erlli DATE ISSUED: 4/8/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2 S 104 B C -01700 SITE ADDRESS: 14160 SW FERN ST ZONING: R - SUBDIVISION: HANDY ACRES LOT: 020 JURISDICTION: TIG Project Description: Replace water service. 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: ft WATER CLOSETS: WATER LINE: 60 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES HOHNBAUM, MICHAEL LEE + KARI ROC 14160 SW FERN ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 4/8/2005 $72.50 [TAX] 8% State Surcha 4/8/2005 $5.80 Phone : Total $78.30 Contractor: KENNEDY PLUMBING 13985 SW FARMINGTON RD BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS Phone : 643 -5535 Reg #: LIC 10967 PLM 34 -42PB 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 or 1- 800 - 332 -2344 Issued By: �� Permittee Signature: \ i I / i - 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. _ _ ` Plu ....",_..._ ,,,,,, mbing Permit 1 • , FOR OFFICE USE ONLY . - Received _ City of Tigard 2 005 13125 SW Hall Blvd., Tigard, OR 9722 R ®8 Date /By ©� ' ?A .��� 13O / {� Phone. 503.639 4171 Fax 503 598 196 ua.1 '` ( Plan Review Permi No. Date /By• Other Permit No . 24- Flour Inspection Line. 503.639 4175 .�. p • ? .674 I ® Internet www.ci tigard.or.us o A ►-� Date Ready /By Jun See Page 2 for 'ITV lJ �(� TT Notified/Method r I J Supplemental Information ' ' .. " 4 '. 1.- : ''',./4 4 q , ' .' , FEE * , SCHEDULE.' .: . t s m .-. � " s �'.� • >- e ❑ New construction ❑ Demolition For special information use checklist Description I Qty I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) „ - 4, °i . _ B ' . CATEGORY, OF `CONSTRUCTION`~ T_74,. _ ° . -.° _ SFR (1) bath 24920 1- and 2- family dwelling ['Commercial/industrial SFR (2) bath 350 00 ID Accessory building El Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: ti _ q _ _ � - ; a Fire sprinkler ( sq. ft) Page 2 -' ' ,,' ` ' . ' s « , J OB SI PE IIVFORMATI , AN_ , LO « ° ` ' , . _ " ' . �, s' _.,- TM 1 �� ��/' =e _ , _ :.. �.•� �� - _. � S utilities Job site address: 1 L- 16 5 (A D 1`,, tf(' 64—k) Catch basin or area drain 16 60 City /State /ZIP: 1 �Q 1G.( or O 1 D,-.3 Drywell, leach line, or trench drain 16.60 Suite/bldg /apt. no : I Project name: Footing dram (no. linear ft : ) Page 2 Manufactured home utilities 110 00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16 60 Sanitary sewer (no. linear ft.• ) Page 2 Storm sewer (no. linear ft. ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft. (9 2) Page 2 Sjr Tax map /parcel no.: Fixture or item �kc.: _ 3 _ _.•a , rs : k gy ,; _ e , Absorption valve 16.60 , l ;: , £ , c; DESCRIPTI N ,0 F W R ,' _ , .ti O O O K "'A" ' '. , " , °r , preventer y r" - �. - �, r, Yt <I >� a � - � - . r� - , �.� _=�� � �� ° ���,. - ������,.�,�,. Backflow pr Page 2 Backwater valve 16 60 Clothes washer 16 60 Dishwasher 16 60 t. - Drinkin fountain 16.60 - ' ®PROPERTl- 'OVVNERw b -- =< A , . ' , = o ® TENAN T» -,' - , " _�:,a,�x_r -..mot .. ,.. .,_• _� -tea_+ � �, :�- 'r l'"''-' �= .a,�sas:m=- -? - Ejectors /sump 16.60 Name: 1 14► k ohn b on Expansion tank 16 60 Address: (fit 5 - e(iel r Fil City /State /ZIP. \ j �, rd O f (1-1 a • • Phone: ( 03 n c). f b a7 Fax: ( ) Garbage disposal 1• • 1 : - 'e ❑;A 17 , . ' g ,4 F n CO NTACT PERSUI�t : • .1 /' • .1 Business name: [02 (1 l , P 61,_,i f 114 I-t-M 1 „ Interceptor/grease trap 16 60 Contact name: --- �� Page 2 Address: ( 9 F5 514) rG cm i r fovi ff 1 City /State /ZIP: �,1/ of C' D Roof drain (commercial) 16 60 Phone: (503) el-a, 55 3 5 Fax: : ( ) Sink/basin/lavatory 16 60 Tub /shower /shower pan 16 60 E -mail: Urinal 16.60 . . . ,, ` ' A ; C ONTRACTOR, ,5 .. #-'. -, - . -,_ � ,'t° �. . e . 1 ,.# t# , _- _.�_" •�: „1,� =� Water closet 16.60 Business name: Water heater 16 60 Address: Other. V Subtotal 5 .S City /State /ZIP: Minimum permit fee. $72 50 2 2 , $ 0 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee $36 25 CCB Lie.: 3 1 3 Plumbing Lic. no.: B y ,-9 L Plan review (25% of permit fee) f P State surcharge (8% of permit fee) ,5 , p� Authorized signature: `J (4e-k6 TOTAL PERMIT FEE 1 gi L 312 Print name: he v'(" EJ e &s Date: 3 , a-6 ,0 5 This permit application expires if a permit is not obtained within J 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board +\Buddmg\Permits\PLM- PermitApp doe 12/03 4404616T(10/02/C OM/WEB) CITY OF TIGARD BUILDING DIVISION ` / - PERMIT #: PLM2005.00136 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/8/2005 Phone: (503) 639 -4171 "III Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 512/2005 TIME: 7:10AM PAGE: 45 SITE ADDRESS: 14160 SW FERN ST CLASS OF WORK: SUBDIVISION: HANDY ACRES LOT #: 020 TYPE OF USE: PROJECT NAME: HOHNBAUM DESCRIPTION: Replace water service. OWNER: HOHNBAUM, MICHAEL LEE + KARI ROC, PHONE #: CONTRACTOR: KENNEDY PLUMBING PHONE #: 643 -5535 Inspection Request Scheduled For: Date: 5/212005 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 005730-01 5Q3- 643 -5535 N Corrections/Comments/Instructions: 0.."(fA \ 7 9 in 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL l NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / 5/ Inspector: Date: Phone #: (503) 718-