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Permit CITY T I GA R D PLUMBING PERMIT PERMIT #: PLM2001 -00059 DEVELOPMENT H Hall Tigard, E ) 639 -4171 DATE ISSUED: 3/2/01 SITE ADDRESS: 12342 SW QUAIL CREEK LN PARCEL: 2S103CB -09500 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5 BLOCK: LOT: 053 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: 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: Back Flow Preventor FEES Owner: Type By Date Amount Receipt DON MORISSETTE HOMES INC PRMT CTR 3/2/01 $36.25 27200100000 4230 GALEWOOD ST #100 SPOT CTR 3/2/01 $2.90 27200100000 LAKE OSWEGO, OR 97035 Total $39.15 Phone 1: 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 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: 2 Permittee Signature: Call (503) 639 -4175 y 7:00 P.M. for an inspection needed the next business day op ' - ^_. Plumbing Permit Application Datereceived: Permit no.: p(4/ "L 00/ 4205 -. +� ., 1 � City of and Ti 1 , � g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard,RIRMAFD City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Expire date: • Fax: (503) 598 -1960 g 200 Date issued: • By: I Receipt no.: Land use approval: Case file no.: Payment type: 1 MMIIN lY FVF ' NT TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement XNew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: / 0 23 /7‘.,? -CIO at/CU-CZ- L ci -c LlaU1..2• Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: atr5 85- SFR (1) bath Lot: (Block: 'Subdivision: Ct (t, /-/-0/ /cscu SFR (2) bath Project name: 0,U a.t--Q . /d-crl /67-05 (JW 5 -- SFR (3) bath City/county: TR7 L&a- /W/)-g / ZIP: q7 -. Each additional bath/kitchen Description and 1 ation of work on remises: Site utilities: ,2 , k f /�) CL »V r c e . Catch basin/area drain Est. date of completion/inspection: 3 og o Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: pre 6 - 7pa s L 2I1aEc , T E o Manholes Address: o 2 -9,Eq - KIX) &'M G-A. RI) Rain drain connector • City: j,() f smmuti( e. I State:ok.IZIP77O Sanitary sewer (no. lin. ft.) Phone:(c, . - 607 jo I Fax: �$�;- 4 -mail: Storm sewer (no. lin. ft.) CCB no.: Co 13 -(, Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.:3 D__/ Fixture or item: Absorption valve Contractor's representative signatur Back flow preventer / 27, 55 ag. 5=' Print name: /en , 11rl - t ) Date: , o d Backwater valve CONTACT PERSON Basins/lavatory Name: Era i oa ` -y y _i Clothes washer _ Address: o 2q �{ %S � k (r1 oft 20 Dishwasher Drinking fountain(s) City: LU 1 I s{(r'1 U tLt -e.. State:0/21ZIP: C% 707 d Ejectors/sump Phone: . 8,Q -(O7, Fax: ( . - qn -mail: Expansion tank OWNER Fixture/sewer cap Floor drains/floor sinks/hub Name (print): ,1)-1 Y) m(JY) 2�r( t'- � Garbage disposal Mailing address: Q SC,L) L:x= 1.'�' .1-0CK;Ci{ 1-C C. '" Hose bibb City: / , C a I State©/Q I ZIP: `? 7039 Ice maker Phone a - Go Lt 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 Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: I Fax: I E -mail: Total • Minimum fee $ 34 .2.5" Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number. 1 / within 180 days after it has been State surcharge (8 %) .... $ 0. 90 Expires p Ex 31. /S Name of cardholder as shown on credit card accepted as complete. TOTAL $ $ Cardholder signature Amount 440 -4616 (6/OWCOM) PLUMBING PERMIT FEES: • ,; ° • , � _. - ` - . _PR ..TOTAL'' : N e w and 2-family dwellings, only: • ";t° ; '- FIXTURES (individual) QTY . (ea) AMOUNT' (includes all plumbing fixtures In, ` PRICE TOTAL' ; Sink 16.60 the dwelling and the first100 ft. .--' QTY ; (ea) AMOUNT 16.60 for each utility connection) - Lavatory 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 • - Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL - Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 ` Quantity by Work Performed - Gas piping requires a separate mechanical Fixture Type: , ' :New Moved Replaced Removed/ permit. . Capped 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 8 Acief7fru.) c a tale? . Commercial Back Flow Prevention Device 46.40 - Residential Backflow Prevention Device' / 27.55 027 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 Isometric or riser diagram is required if / n / �5 C� - 27 ' Quantity Total is > 9 *SUBTOTAL 3( ,a5 8% STATE SURCHARGE 0 2.9 0 • **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL • $3q. t.5- * Minimum permit fee is . 0 + 8% state surcharge, except R- ential Backflow Prevention Device, w ch is $36.25 + 8% state surchar' - ** AIl New Commercial ans wd Is or riser diagram and • plan review. is \dsts \forms\plm- fees.doc 10/10/00 . 707., CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 1 1 — I 7 AM PM BLD Location / Z 3 t( Sw Q k a ' ( GYM - Suite MEC Contact Person Ph Ggir, lio 7 G LM 21 / -trio oS l Contractor Ph 2C 2 /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 . �/� " - � n� Framing • /.. A 3A/6 6 Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service f c Sanitary Sewe Rah • ains ply 40 PART FAIL ANICAL 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 I / Approach /Sidewalk Ex Date / / v Inspector ` t Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION .0 24 -Hour Inspection trine: 639 -4175 Business Line: 63 -4171 d BUP /�! `' P Date Requested 27/ g AM /1 / PM BLD Location (7'2. (QU 41-(c_ a-ti Suite MEC Contact Person Ph 0 r''= 4 -� Contractor Ph SWR BUILDING Ten ant /Owner ELC Retaining Wall ELR - ' Footing . ' Access: Foundation FPS Ftg Drain SGN (s Crawl Drain Inspection Notes: • Slab - SIT }-1C,,Post & Beam Ext Sheath/Shear A Int Sheath/Shear / Y�'V Framing L' ! /0 01 000 l/V' c,..� 1/4..Z./N. ��� yl� Insulation 'V" pu I Q — e , • Drywall Nailing 4, 'K- r�f^� ..,—;1/4...S, 4.,J2 I G" Fire wall • V' ✓ 1 _ ! S c . _ (1 --�- Fire Sprinkler G` s-r�C. S Fire Alarm o Susp'd Ceiling . . G v e S Roof Misc: . Final et• S 1 GCS l/1/\ 4..tA a Cam e <$ S t 'c PAS _ PART FAIL / C lJ O Ke • UM= . Post & Beam - � // - Urr-Slab Jv v i 6-�/� , v--, --, (}4./Top Out r',4,.Water Service • I M S .�„.y c).k Sanitary Sewer _ Rain ains w a." T . • i _J �.A . 1/ EC HANIG� r V /Post & Beam - ( iKi Rough In DA Gas Line I. ...- . ... - c. -- ThtiC-- 1/ 1/s Cor-sr L i"-OLJ7 - li[attibi ti PART FAIL `wvS1- f^..M krQ ' ELECTRICAL yt(/ �J Service v Rough In UG /Slab .1/1A_, 4 t Low Voltage Fire Alarm - ASS P • • T FAI SITE e`r k S INC Backfill/Grading Sanitary Sewer O Storm Drain �T� I 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 _ , . roa ',walk of e i, 6_ D' e Inspector Ex i, - k PART FAIL DO NOT REMOVE this inspection record from the job site. • .