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Permit � , CITY OF TIGARD PLUMBING PERMIT � DEVELOPMENT SERVICES PERMIT #: PLM2001 -00010 " r � II I 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/18/01 SITE ADDRESS: 12466 SW QUAIL CREEK LN PARCEL: 2S103CB -09000 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5 BLOCK: LOT: 048 JURISDICTION: TIG 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 Remarks: Installation of residential backflow prevention device. FEES Owner: Type By Date Amount Receipt DON MORISSETTE CUSTOM HOMES PRMT CTR 1/18/01 $36.25 27200100000 4230 SW GALEWOOD SPOT CTR 1/18/01 $2.90 27200100000 LAKE OSWEGO, OR 97034 Total $39.15 Phone 1: 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 m y-ots al ies of these rules or direct questions to OUNC by calling (503) 24. -1987. Issu d By: A ; : //4 Permittee Signature: ��� _ .; , �L �d7/J Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bu iness day Plumbing Permit Application Date received: /17-0/ Permit no.:P/�J JO J City of Tigard � ' Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, Q_Ru,223 City of Tigard Phone: (503) 639 -4171 � . Project/appl.no.: Expire date: Fax: (503) 598 -1960 \•%‘‘' OQ Date issued: By: I Receipt no.: Land use approval: 4 V�L Case file no.: Payment type: u\''s TYPE OF PERMIT 0 1 & 2 family dwelling or accessory 0 Commercialindustrial 0 Multi- family 0 Tenant improvement • a 1 ew construction 0 Addition/alteration/replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special iuforn ation use checklist) Job address: /c21-/ C c et c) aik ext. , (1" Gt✓rt. L C C, 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.: (o 55 13 S SFR (1) bath Lot: 1-4 F( (Block: I Subdivision: ( .iZ (40 ant) cf ? SFR (2) bath Project name: Q,t.l_&. a _ Rol ((rU t) t_f SFR (3) bath City /county: ricia I W lttS I ZIP: qr9-a-3 Each additional bath/kitchen Description andlocation of work on premises: Site utilities: (3 - 1 - 1(su) G1GV lC - • Catch basin/area drain Est. date of completion/inspection: i — I 61-0 I Drywells/leach line/trench drain Footing drain (no. lin. ft.) PLUMBING CONTRACTOR Manufactured home utilities Business name: Pro& S (_t,nei Sate t, Manholes Address: o27 'jS ,S.--LO kin $NYUCU'1 Q Rain drain connector City: (,t) / /S-yl U t Iles I State: ORLZIP:9707() Sanitary sewer (no. lin. ft.) Phone: 10 -(,O7t I Fax ,& . - c E -mail: Storm sewer (no. lin. ft.) CCB no.: (p 13 , I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: 00 3 a-( Fixture or item: Contractor's representative signature Absorption valve Back flow preventer / x'7.55 ..7. Print name: Ellett jp ate: /- /S- cif - Backwater valve CONTACT PERSON Basins/lavatory Name: E// S c) Clothes washer Address: ,?.._q - 9S Ktn 21 , 1 - 1 . kb Dishwasher I State: Q tQ Iizi 9 70'70 Drinking fountain(s) City: W t j S tm v i ((L Ejectors/sump Phone: &,E -�.- 44'7!0 ut' -. Fax: , -q _ -mail: Expansion tank OWNER Fixture/sewer cap Name (print))( -1. /Y) err SG 'Y11� Floor drains/floor sinks/hub Mailing address:�a 30 S-tc3 CvCtL_Lu) c x/ Hose bibb disposal Hose bibb City: La kZ, I State0i2 I ZIP9 703 y Ice maker Phone: ' oq - C tts ax:i® ii'? - Cal, -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. Minimum fee $ 34 ' PS Notice: This permit application Plan review (at _ %) $ 0 Visa O MasterCard expires if a permit is not obtained Credit card number: / / State surcharge (8 %) .... $ • ` t U Expires within 180 days after it has been TOTAL $ 39.. /5 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 4404616. (6/00/COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) ry 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" 166.660 0 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 • Other Fixtures (Specify) 16.60 Urinal 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 Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 &/C Plink Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' / 27.55 a.7. SS 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 Quantity Total is > 9 *SUBTOTAL 36 aS 8% STATE SURCHARGE a gU *`PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $--3. /5 * Minimum permit fee is $72.50 + 8 %_state_surcharge, except Residential Backflow - Prevention Device, • s $36.25 + 8% state surcharge. ** AII New Commerc a = i i - ' ' • - ' mac '- . - ric or riser diagram and plan review. - is \dsts \forms\plm - fees.doc 10/10/00 CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -417 T -- B UP Date Requested / Z) AM PM BLD Location / Z V f ' a( 17 (' Suite MEC Contact Person Ph 5D > 68�--6007,a2i, o / -CrV. /U Contractor Ph 2 / 7 X 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 ? , \J\_ '../V\ Insulation Drywall Nailing Fire wall '�� � Fire Sprinkler V Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL - (PLUMBING T -mil& Beam _ Under Slab -- de Top Out � Water Service Sanitary Sewer Rain i rains a, PART FAIL HANICAL 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 c j Other Date / Inspector Ext _ 1 Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY,OF TIGARD BUILDING INSPECTION DIVISION — (/ 9 24 -Hour Inspection Line: 639 -4175 Business Line: 639-41 1 ' . B UP Date Requested / Z. AM PM . BLD Location / L V „ s w Qu a I/ 0224A Suite MEC Contact Person Ph ?. 'f e-l r 4 1 , z p 200I— QQOl Contractor Ph SWR B a c k - glad : UILDIN 4 . Tenant/Owner " ELC / sC.V ;C t./ Retain Wall ELR Footin . Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: • • Slab SIT Post & Beam Ext Sheath/Shear Int Sheath/Shear t � Framing qiWi ILILA. II 1 . • 1 - Insulation 1 1 /\ 1 _ll • , . _ 0 • Drywall Nailing - - �/`�r ` ` Firewall Fire Sprinkler Fire Alarm , r � M M I a C1 L L V Susp d Ceiling - _ Roof ' ` • • M i s anal S PART 40 # _ LUMBII�� ► / :4.( 0.12f - P17/1./IA r ' L)--e-./.6 ost & Beim 1 Under Slab t )J J - l .12--r . Top Out Water Service Sanitary Sewer - l I , „ Rain flr inc ♦ 1P — •A 4 _ 1' ■ ' _ �O[r • CIA J IC &w V1/\ (1 r d. s RT FAIL i \L A. PA.. C/\� a S Post & Beam - Rough In drikgrAikallilliegs1111111111h Gas Line - ...Ice Dampers WILIMM-1WIIIL; Wirgip PART FAIL ELECTRICAL i % — Service I � Rough In UG /Slab. • . Low Voltage Fire Alarm . Final - PASS PART FAIL S I ackfill/Grading ib1 Sanitary Sewer Storm Drain \11/ �` [ ] 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 Q • . • roach/Si al Other V45pr (.k". Date 7iZ Inspector C / Inspecto C ) Ext / 1 Fin, PART FAIL DO NOT REMOVE this inspection record from the job site.