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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00323 11 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/22/2005 PARCEL: 1S133DC-11900 SITE ADDRESS: 13478 SW LAURMONT CT ZONING: R -12 SUBDIVISION: ARI GREEN LOT: 010 JURISDICTION: TIG Project Description: Blackflow preventer. 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 WEIDENBACH, PAULA 4- GLADYS A Description Date Amount 13478 SW LAURMONT CT TIGARD, OR 97223 [PLUMB] Permit Fee 7/22/2005 $36.25 [TAX] 8% State Surchan 7/22/2005 $2.90 Phone : 503 - 524 - 9923 Total $39.15 Contractor: DRAKES 7 DEES 16519 SE STARK ST REQUIRED ITEMS AND REPORTS PORTLAND, OR 97233 Phone : 503- 256 -2223 Reg #: PLM 5259 SUP ALL PHASE & BA( 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: ,_/�Gti- iLti 4-i-L4L Permittee Signature: j 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. . . : . , Plumbing Permit ApplicatiECEI TM , +Y''' �' H ' "_ ; "� � g w. gS ,lc . /IFOR OFFICE USE. ONC t � ,, - :: ,„ City of Tigard ReceZC JUL 2 2 " 005 Dat apt- of / 13 Perm N. gefQ/ 0( ' 13125 SW Hall Blvd., Tigard, OR 97223 C/" Phone: 503.639 4171 Fax: 503.598.1960 /� /n+ k{ Plan Other Permit No.: 24 Hour Inspection Line: 503.639.4175 ' �7 1 4L! Date Read /B tip CITY OF � � _ Y ,, �' . . Ready /By: RI See Page :for Internet: www.ci.tigard.or.us BUILD ∎r N ' ; rr a ... Supplemental Information = ^' .. ._ .. a.... .:r.. " 1XPE.:OF WORK FEE* - . -�.._, -. .. .. SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. addition/alteration/replacement El Other: Description Qty Ea. Total �y . ,, w ;,x -{ New 1- 2- family dwellings (includes 100 d. for each utility connection) rr K . -.. SF „.,.,40;„,,..;:. 4 QR 1 r R ;' ` ', t, .±', - s, .: ,? -: R I bath .,. '.• "� -. ,..; :_t... -x. ....: . O 249.20 Jf 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 Accessory building El SFR (3) bath 399.00 ❑ Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: . . :., . s ... n . , Fire sprinkler (_ sq. ft.) Page 2 _ ` ; F%� c >- 70) SIZ .< I? .. , FD .OGA ` � U F y ' " ` - - ` � " � • Site utilities Job site address: i13 / 7 f S'� > L ac ., r 11. ► O r e ° J Catch basin or area drain 16.60 1 City/ State/ZIP: , i �re • Z Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: J q Project name: - e f___ 6 _____ k e irN att., Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: Manufactured home utilities 1 10 00 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.. ) Page 2 Tax map /parcel no.: Fixture or item Absorption valve 16.60 - _FSCRIP_ . TQl!GrOF, Rroi2IC -- - -.. = < :.. j ,� l :- - .:a�::.:._ : .;_, : ` ._ . ... . :..,. :;- �,... a- , . ,... -. ,: "° - ..:, ;' -.:: Backflow preventer ( Page 2 . 3(0 • 2 j C O � ✓ E 'er , G e - .(- � . r v": GA.( .D • -1 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ,y� -,....,...=;,,,,,,,,,,,,,,,,,,,.,:. _ PE a :;O ER. '� - � - `y : : ' 1 ' '...- �.- �y ♦��. �;; x ■ ,.:.. Drinking fountain 16.60 .': �i;i a] . ` ., r . .., 1: : -,.,.' 1 +s+...M4 ±.:. q : . -`. '%:.:" "'' - W _ :y..- ._.:....:... a, -:.' `- z< >; Ejectors/sump 16.60 Name: ow � _ .- . p ( , /C t 4�'� Expansion tank 16.60 Address: 13 / 1 J (U) Lay r T 0v Cl Fixture sewer cap 16.60 ■ City/ State/ZIP: � .4414 r 0 re 4 9 7 2 2 3 Floor drain/floor sink/hub 16.60 Phone: (S^'1i)) j rr�� F ax: ( ) Garbage disposal 16.60 ?, a „ 1 ACT s • Hose bib 16.60 r 4 v .:.. -. . ... .. ., _='+.--'.:. . ••i al.. .:* x::. C ®i ACT'.P,EASQIY .. .. ; Ice maker 16.60 Business name: b r ``k .. -es 7 D es f'r c_ ;� Interceptor /grease trap 16.60 Contact name: Pa , L (� / Y ^ 1G d. k K I ( Medical gas (value: 5 ) I Page 2 Address: , S) S . s'h r k S • Primer I 16.60 City/State/ZIP: "O ,,- 4-/ " 1 O r e, q, 2 3 j Roof drain (commercial) . 16.60 eN t Sink/basin /lavato - 16.60 Phone: ( ) J) 2.1 ci 0 ,/ g3 Fax:: (Sb .1 )2 .i . , - ©p6 S' - Sink/basin/lavatory E -mail: Tub /shower /shower pan 16.60 Urinal 16.60 z : ::•; ' , : !3. �.4,,f :COPJTRA :' - Y,:: "s` :' ,.._; • ,...:::...: Water closet 16 60 Business name: b r 6.k -e S `7 00-es l v\ c_ Water heater 16.60 Address: 1 S ) l'( .J . L" S - ( k , .t- Other: i • City/State/ZIP: P .4.. d 6 n t 7 r . . _I 7 233 Subtotal Minimum permit fee: 572.50 Phone: (S2aj) 2 ft, - 2. . y Fax: (S "0,))2S (, - ('_Sr6pS� Residential backflow minimum permit fee: 536.25 3, 5 CCB Lie.: S S' - Plumbing Lic. no.: - (. Z / ) 7 ( -- Plan review (25% of permit fee) State surcharge of permit fee) z 0 Authorized signature: poj _. rge (8% perm 3 , q ` r TOTAL PERMIT FEE Print name: {4� y G fJ 1 �� Date: '470 )a S .-. This permit application expires if a permit is not obtained within 1 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Pamits\PLM- PermitApp.doe 12/03 440 46 i6r(10 /02/COM/WEB) CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00323 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/22/2005 Phone: (503) 639 -4171 8 pu il 'it Inspection Requests (24 Hrs.): (503) 639- 4175�I s 'I � .. INSPECTION WORKSHEET FOR DATE: 8110/2005 TIME: 7 :05AM PAGE: 59 SITE ADDRESS: 13478 SW LAURMONT CT CLASS OF WORK: . SUBDIVISION: ARI GREEN LOT #: 010 TYPE OF USE: PROJECT NAME: WEIDENBACH .DESCRIPTION: Blackflow preventer. OWNER: WEIDENBACH, PAUL A + GLADYS A, PHONE #: 503-524-9923 CONTRACTOR: DRAKES 7 DEES PHONE #: 503 - 256 -2223 Inspection Request Scheduled For: Date: 8/10/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 325 RP /Iaaclsflovd preventer 013237 -01 971 - 219.0483 N.„ Corrections /Comments /Instructions: �GL✓ i VF✓ --Dl ( 94 , - ) • • PASS El PARTIAL-APPROVAL El CANCEL O - NO- ACCESS- _ ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: d'b iS - Date: 71 / o J Phone #: (503) 718-