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Permit CITY TIGARD PLUMBING PERMIT Itt DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00121 DATE ISSUED: 4/7/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S133DA -04300 SITE ADDRESS: 12560 SW GLACIER LILY CIR ZONING: R - 7 SUBDIVISION: AMART SUMMERLAKE LOT: 065 JURISDICTION: TIG Project Description: Residential backflow prevention device for irrigation. CLASS OF WORK: OTR 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 Owner: FEES RANDY COOPER 12560 SW GLACIER LILY CIRCLE Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fcc 4/7/2006 $36.25 [TAX] 8% State Surcha • 4/7/2006 $2.90 Phone : 503- 998 -8999 Total $39.15 Contractor: MECHANICAL SERVICES INT. LLC 21185 NW EVERGREEN PKWY STE. 106 REQUIRED ITEMS AND REPORTS HILLSBORO, OR 970124 Contact # : PRI 503- 439 -9999 FAX 503- 439 -1999 Reg #: LIC 126015 PLM 37-421PB 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 rul-- • • questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. • Is ed By: i I /! Permittee gnature: /, ` J ,01140 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. `e=.4 ; � ro i 2z.76 wo.1SoI4 Plumbing Permit ApPl CatiOnn fl V E D .. , FOR OFFICE USE ONLY , u t� A.o -- City of Tigard y 5 d Date/By 7d N ,* /....... i ��Z CY,� — (�ld y P No 13125 SW Hall Blvd , Tigard, OR 97223 APR 5 00 4 1 6 Plan Review Phone 503 639 4171 Fax 503 598.1960 APR I Other Permit No A D ate / By 24- Flour Inspection Line 503.639 4175 - eL Date Ready /By �m 8 See Page 2 for Internet www ci ttgard or us CITY OF TIGARD Notified /Method �/ ({fj Supplemental Information TY FEE* SCHEDULE ❑ New construction 0 Demolition For special information use checklist Description I Qty I Ea I Total Addition /alteration /replacement ❑ Other: New 1-2-family dwellings (includes 100 0. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249 20 X I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399 00 Each additional bath/kitchen 45 00 ❑ Master builder ❑ Other: Fire sprinkler ( sq ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: / 256.0 5 f t) h I A_C i 4e L ',L1-.. G 4rt l Catch basin or area drain 16 60 • City /State /ZIP. T ti j. ca_le% ea © P • Drywell, leach line, or trench drain 16 60 Suite /bldg. /apt. no.: Project namr Footing drain (no linear ft ) Page 2 �00��1'? Manufactured home utilities 11000 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- ) Pane 2 Subdivision: Lot no.: Water service (no linear ft • ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16 60 DESCRIPTION OF WORK . . Bac,kflow preventer Page 2 34 25' I 1l�}!,, r(y.ki` 04-- 3 j 4 m I (>l du}j 1 (L.e.c.lc I rr Backwater valve 16.60 O w yU a tr' iViel 1 a. A:r 1 0-",3 S 3 Q S rte, r Clothes washer 16 60 V Dishwasher 16 60 Drinking fountain 16 60 PROPERTY OWNER ❑ TENANT A Ejectors /sump 16 60 Name: ¶�L JL,t9Optr Expansion tank 1660 Address: 54,,, _ Q S Al be 1./ 4.... Fixture /sewer cap 16 60 City /State /ZIP: Floor drain /floor sink/hub 16 60 Phone: (503) qq cs - 5;99 1 Fax: ( ) Garbage disposal 16 60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16 60 Business name. Interceptor /grease trap 16 60 Contact name: Medical gas (value $ ) Page 2 Address: Primer 16 60 City /State /ZIP. Roof drain (commercial) 16 60 Sink/basin /lavatory 16.60 Phone: ( ) I Fax::( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16 60 CONTRACTOR Water closet 16 60 Business name: i// £ eka..- CL_( St v'v t`G e S ;.)T L L C. Water heater 16 60 — Address• l ' 1 gS yv w tfe. � "L � f �w1 _g 4 Other yy��ee�� Subtotal City /State /ZIP: wlt 1/5,4 Q e rC, '774,y `- Minimum permit fee $72 50 r 2,s-- Phone. (. &? )q3 el, `l `1 `t Fax: (So 3 1 (37 . /999 Residential backflow minimum permit fee $36 25 CCB Lie.: ` 2 4 e/6- Plumbing Lie no37. L/2 i pe Plan review (25% of permit fee) Authorized signature: 1 ' 1 -� State surcharge (8% of permit fee) A r of b A �� .Ik TOTAL PERMIT FEE "j Id S Print name: 1 gy 1,,,2 b D- 1 `e ` 1 Date.3 /3 / hg' 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 \Budding \ Permits \PLM- PermnApp doc 06/05 440-4616T( 10/02/CUM/WEB) CITY OF TIGARD BUILDING DIVISION PERMIT #: p42-0-134, -Do /Z1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 = •'L. INSPECTION WORKSHEET FOR DATE: TIME: A-1Vl ) PAGE: SITE ADDRESS: ) .).,5 O Gae l eA✓ L t y C) ` CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #p i^3 jar 9 � CONTRACTOR: fail PHONE #: Inspection Request Scheduled For: Date: + /0 0 Pour Time: Code # Inspection Description Confirm # Contact # Message 36) 7 ; a_ Corrections /Comments /Instructions: "A o plorwor- • S I I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: / r 1 \f Date: Phone #: (503) 718- � I