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Permit CITY OF TIGARD PLUMBING PERMIT , ��yy PERMIT #: PLM2001 -00315 DEVELOPMENT SERVICES DATE ISSUED: 07/23/2001 �` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12177 SW QUAIL CREEK LN PARCEL: 2S103C6 -11000 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5 BLOCK: LOT: 068 JURISDICTION: TIG CLASS OF WORK: ALT 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 Remarks: Installation of back flow preventer device. FEES Owner: Type By Date Amount Receipt DON MORISSETTE HOMES PRMT CTR 07/23/2001 $36.25 27200100000 4230 GALEWOOD ST STE 100 SPOT CTR 07/23/2001 - $2.90 27200100000 LAKE OSWEGO, OR 97035 Total $39.15 Phone 1: 503 - 387 -7538 Contractor: PROGRASS LANDSCAPE SERVICES 29895 SW KINSMAN RD WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone 1: 682 -6076 RP /Backflow Preventer Reg #: LIC 6136 Final Inspection PLM 11558 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 calling (503) 246 -1987. Issued By: Permittee Signature: dam. Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day ' , T .... _ ... ) - Plumbing Permit App Datereceived '? / / P erm itno.: , rjl _G iS .h .r. City of Tigard • i `J' g R ECE���� • - Sewer permit no.: Building permit no.: � + • Address: 13125 SW Hall Blvd, Tigard, O 7223 City of Tigard Phone: (503) 639 -4171 .. Project/appl.no.: Expire date: Fax: (503) 598 -1960 JUL . �� 1 Date issued: By: bb I Receipt no.: Land use approval: COMMUNITY DEVELOPMENT Case file no.: Payment type: . • TYPE OF PERMIT 0 1 & 2 family dwelling or accessory ❑ Commercial/industrial - - ❑ Multi- family O Tenant improvement . ❑ New construction O Addition/alteration /replacement 0 Food service . ❑ Other: JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist) Job address: ,a / 77 Sw saI cu.L crr�-BL (Q.I'iQi Description Qty. Fee(ea.) Total Bldg. no.: I Suiteno.: ■ New 1 - 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath _ Lot: (i W. (Block: I Subdivision: irk UC) SFR (2) bath Project name: OWL-0— A/a/OZV (p g SFR (3) bath City /county: 77g6�C_ 1(. .4.14 ZIP: q 7.D,...3 Each additional bath/kitchen - • Description an ocati • 8 4C 1-f0-u.D 1)W i C Catch basin /area drain . Est. date of completion/inspection: / 6 Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities _ Business name: p &r&SS L41 4 'Citice, Zr) C ? Manholes ,__ Address: aq ) km WILLr\, RD Rain drain connector City: (,U i I S.i-y in I /C.) . I State:0/2I ZIP:97 a 7('' Sanitary sewer (no. lin. ft.) - Phone , - 1,07(o I Fax:6ga —1870 E -mail: Storm sewer (no: lin. ft.) • -• - - CCB no.: /3 (o I Plumb. bus. reg. no: Water service (no. lin. ft.) - . City/metro lic. no.: (j03_1 Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer / .27-55 az SS Print name: / /Gn , , i Oil , ' Date: 7 r 0 Backwater valve CONTACT PERSON _Basins/lavatory . Name: E-/ t �arr',(7 i Clothes washer . Q'QS' LW /CC/l - rivet Dishwasher Address: 9 (4 ZIP: 9'7670 Drinking fountain(s) • . • City: U jl ( i 1 1/e.) I State: I Ejectors/sump - Phone: a _ , qb • Fax: 6K2-9g7 E -mail: Expansion tank • OWNER Fixture/sewer cap Name (print):))Q7'1 , pr% S,S'•e7f f -� Floor drains /floor sinks/hub Garbage disposal Mailing address: t-M30 WJ e..t.c3 0OCk• Sr Hose bibb • City: Lake p O State:ORA Z1P9' 703 f Ice maker Phone: i ax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Urinal . • Name: Water closet Address: Water heater , City: I State: I ZIP: Other. Phone: I Fax: I E -mail: Total • Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ aS ❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: / / - within 180 days after it has been State surcharge (8 %) .... $ .3. 90 Expires TOTAL $ 3`1. /.S Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/00/COM) PLUMBING PERMIT FEES: g, : te ,, 2 ' ALA e M wl and 2- family dwelri li "s "on a: ter•, "' "` " t' " �Sv:�;:;:x� ;•zirf;� :�:^ ,•�, :3; .,w•`�:,q �,.d:.... .7 �P,RI .'TOT ..,. t� j '•�,9,�,;�r� =' ��.���'s�r: �t,,, °,.s� sfy�z: -Ly,y_n 'k"� k,' .r _ � z ` :3 4,,a- a , g p NT inuiies`all umtiing fixtures In 5 ' v` 4� Z ;PRICE; ..;ATOTAL 'F U(TURES�(i ndi viduaq „�= e�,.. ;�:�: ...:� xQTY:� ,��(ea . „AMOU s .( .,�� . ..� � :¢w _ ..�..e. 16.60M '; '' r ea :AMOUN •Sink °tile dwelling grid thefirst100 ft.•: ,; QTY ;�(' ) ;. �. _ ti : v� r tc : e . Wit• O'.S ' ` ! 1�r . , ` fi s ts:, ; f YF7 � for.each uiility ,connection) . +- rte: ;.. , ,. -c• ~;nr:,,: Lavatory 16.60 One (1) bath $249.20 • Tub or Tub /Shower Comb. 16.60 • . Two (2) bath $350.00 ' Shower Only 16.60 Three (3) bath $399.00 ' Water Closet 16.60 SUBTOTAL -.... . Urinal 16.60 8% STATE SURCHARGE - ,:; , ,:;i0 �.'•. •7: Dishwasher • 16.60 PLAN REVIEW 25% OF SUBTOTAL . • : 16.60 • TOTAL . - - . Garbage Disposal - Laundry Tray _ 16.60 • • Washing Machine • . 16.60 , Floor Drain/Floor Sink 2" 1. • 3" 166.660 0 PLEASE COMPLETE: . 4" - 16.60 ;;` -r. `:•,;::.. � 1 ` "-r' `Quantity. Work Performed {= >`:, Water Heater 0 conversion 0 like kind 16.60 ' : r ,9 }Fixture . Type 1• _ ;•c s• :Nair_ Moved c Replaced , ;Removed/ Gas requires a separate mechanical .- _ > '-k .,---.....r.: _.- :?i.^"}� $t * i :i : = •� £ -=- permit -'0, . : � z,: . " ! . ,, - t- a , - , , .41 , ,. C apped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory • - Tub or Tub /Shower Hose Bibs - 16.60' - _ Combination Roof Drains 16.60 . - Shower Only - • Drinking Fountain 16.60 - Water Closet Urinal • Other Fixtures (Specify) 16.60 _ Dishwasher ' • Garbage Disposal . • • • - Laundry Room Tray ' - Washing Machine • Floor Drain/Sink: 2" - • Sewer -1st 100' 55.00 3" Sewer - each additional 100' 46.40 4" - Water Service - 1st 100' - 55.00 • , Water Heater "Other Fixtures Water Service - each additional 200' 46.40 (Specify) . Storm & Rain Drain -1st 100' 55.00 - . Storm & Rain Drain -each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 . Residential Backflow Prevention Device' / 2 27_55 Catch Basin - . 16.60 • Inspection of Existing Plumbing or Specially 72.50 - • • Requested Inspections - per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 • QUANTITY TOTAL ' `' . -- "_ 'Ar,-..,';' `Y" - Isometric or riser diagram is required if 7 7 � -5S - - `" -•.CS Quantity Total is > 9 -• t. c'SIr ;., " ;, • *SUBTOTAL - '« ::;"-;'':'•-r: " "` a 5 8% STATE SURCHARGE +� �� 9D • **PLAN REVIEW 25% OF SUBTOTAL ' '.,-.- Required only If fixture qty. total is > 9 • , •s'' - TOTAL "° ' * Minimum permit fee is $7 % state surcharge, except Residential Backflow • Prevention Device, whit Is $36.25 + % state surcharge. ' New Commercial Buildings require plans with Isometric or riser diagram and plan review. • I:\dsts\forms\plm- fees.doc 10/10/00 ' ITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested - 7 -27 AM PM BLD Location 1 �- / 7 - l c .ee.� �OO ��, �ulte MEC Contact Person Ph 4,0 7, PLM o / — D 6 3/S Contractor Ph V a / 7 SWR BUILDING Tenant/Owner 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 c/Ifi) Misc: Final PASS PART FAIL PLUMBING Post & Beam Q Under Slab Top Out Water Service Sanitary Sewer Rain Drains I PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL 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 Other Date Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION t 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST UP Date Requested 7 Z 6 AM PM BLD Location ` v Z / 71 5 w `1/ t t . 4•e l Cj /C Suite MEC Contact Person Ph .S/ f -5` Z— ir 026/--e. 1),/,) Contractor Ph SWR BUILDING Tenant/Owner 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 PAS RT FAIL , ( L f�IN i Bea '- y Under Sla (, Top Out 4 Water Servi : Sanitary Sewe Rain Drains Fina ASS. PART FAIL "MEC11 NICAL - ' / Post & Beam // Rough In e / Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage . Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date - 7/ 2(2 /v I Inspector ' A (. BO ( / Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.