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Permit 4t CITY OF TIGARD PLUMBING PERMIT I DEVELOPMENT SERVICES PERMIT #: PL /25/20 -00016 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/25/2000 SITE ADDRESS: 07580 SW HUNZIKER 16 PARCEL: 2S101 DB -00200 SUBDIVISION: ZONING: C -P BLOCK: LOT: 1. � ` L ( pit- -' JURISDICTION: TIG 1 CLASS OF WORK: ALT GARBAGE DISPOSALS: f 7 MOBILE HOME SPACES: TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R1 FLOOR DRAINS; TRAPS: • STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: 1 SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replacing tub /shower. FEES Owner: Type By Date Amount Receipt PETRUSHKIN, SUSAN RO SE PRMT BON 01/25/200C $50.00 00- 321382 7315 SW 27TH AVE 5PCT BON 01/25/200C $4.00 00- 321382 PORTLAND, OR 97219 Total $54.00 Phone 1: Contractor: • NICHOLS PLUMBING PO BOX 68551 4375 SE MARK KELLY COURT REQUIRED INSPECTIONS MILWAUKIE, OR 97268 Phone 1: 653 -2069 Rough -in Insp Final Inspection Reg #: LIC 132527 PLM 03 -414PB ORIGINAL 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 cal;,•,! (503) 24. •87. • Issued By: Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business da • CITY OFTIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Rec'd By , � TIGARD, OR 97223 Date Rec'd I - ZC (503) 639 -4171 Date to P.E. Print or Type Date to DS Incomplete or illegible applications will not be accepted Permit# i-(M1u -i((, Related SWR # Called e elopme UProj ct XTUR dividual) � " ' I' RIC ; ;PE ` °' AMT ; Job 5 Sink 11.50 Address Street ACi�d ess Suite Lavatory 11.50 i 5T) r ' 5 3 Y\ZM 1 'Tub o Yub /Show�r Comb. 1 11.50 Bldg # Ci hate Shower Only ) 11.50 ` Water Closet 11.50 Name/' �t 11L lz\i �1� Ctl� l°J1 Lcx Urinal 11.50 Owner Mailing_ Address Suite Dishwasher 11.50 1 IS Z AR- - Garbage Disposal 11.50 City /State Zip Phone X ct7z-tet Laundry Tray 11.50 Name Washing Machine /Laundry Tray 11.50 Floor Drain /Floor Sink 2" 11.50 Occupant Mailing Address__________---- Suite 3^ 11.50 4" 11.50 City /S te Zip Phone Water Heater 0 conversion 0 like kind 11.50 Name Gas piping requires a separate mechanical permit. � *� `�,���tn MFG Home New Water Service 32.00 Contra Mailin ss ( \ \\ wte 1 � i U 1 0/� MFG Home New San /Storm Sewer 32.00 n Hose Bibs 11.50 Prior to permit 't /S \te- \ Z ��� 1 � () q hone ,..,r, , Roof Drains 11.50 issuance, a copy � t,U� L k ' (5 d`1/(0 Drinking Fountain 11.50 of all licenses are regon Const. Cont. Board Licit Exp. Date required if k)g,1 Other Fixtures (Specify) 15.00 expired in COT P umbi g Lic. # , 63 t © . database /v`), Name Architect Sewer- 1st 100' 38.00 Or • Mailing Address Suite Sewer - each additional 100' 32.00 Water Service - 1st 100' 38.00- _ Engineer City /State Zip Phone Water Service - each additional 200' 32.00 Describe work to be done: . Storm & Rain Drain - 1st 100' 38.00 New 0 Repair 0 Replace with like kind: Yes )' No 0 Storm & Rain Drain - each additional 100' 32.00 Residential O Commercial 0 Commercial Back Flow Prevention Device 32.00 Additiona description of work: rjl 1 � 1 % i - ' r• f , t,n� \),� `, Residential Backflow Prevention Device* 19.00 A V�X� � A b )L Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 3a' No 0 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 0. y g pP Isometric or riser diagram is required if Quantity Total is > 9 , a i; L T',; given is correct, that I am the owner or authorized agent of the owner, and that pl_ns sub itted a Oregon iance with egon State Law *SUBTOTAL '. 0 : ;, , Sig • •. • re f '. wrier g�t r QJ lz) 8% SURCHARGE \' s " "5'' 1 Co ' ct Person Name one * *PLAN REVIEW 25% OF SUBTOTAL witati €'s, BAT �� .. _ 9 � .,_ ,: Required only if fixture qty. total is 9 <s : < ;; � ;"ii.� . H HOUSE $17.8.00 "` S� / pL� BA - :HOUSE $25000 ;; . A BA HOUSE $ �� y z TOTAL < n; V ,,,�:t,'s,, a g�'� �� i 285. .:fib -C i., s g . � - - ��""� ('his aii°plum ing f r � a dwelliing an f m ' -Minimum �,� permit tee is $50 + 8% surcharge, except Residential Backflow Prevention *-0-4-4k.' 4sanita" sewer sto sewer and water, service) Device, which is $25 + 8% surcharge .aw,v� < .. a >_. "All New Commercial Buildings require plans with isometric or riser diagram and plan review. 11dsts \forms\plumapp.doc 11/18/99 PLEASE COMPLETE: Auctir =•,..711Voyed : 1 - 44Replasefl , ,Remyp t , „ Sink Lavatory Tub or Tub/Shower Combination Shower Only Water Closet Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Floor Sink 2" 3 " 4" Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: UO VON\E f\ VA\ `"\ Ckv\ c\ • • I: \dstsVorms\plumapp doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 1 BLD Location S % D � OA //�� 11 " `�..� _ /� q MEC - Contact Person bril0 Ph 6, S3 - / PLM 2 0) Contractor Ph SWR Bl11LDING a`n, Tenant/Owner ORCAl-4-/— 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 Susp'd Ceiling Roof Misc: Final • • P A FAIL L UM BING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Drains PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL 1 ELECTRICAL Service Rough In UG/Slab 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 Approach /Sidewalk Date 1 Inspector 972' Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.