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Permit CITY TIGARD PLUMBING PERMIT i DEVELOPMENT SERVICES PERMIT #: P 2/2006 -00272 `'` - �JI — 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2006 PARCEL: 2S 109 D D - 09700 SITE ADDRESS: 15617 SW RAPHAEL LN ZONING: R -7 SUBDIVISION: BELLA VISTA LOT: 027 JURISDICTION: TIG Project Description: Backflow preventer for irrigation. 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 RIVERSIDE HOMES INC 1925 NW AMBERGLEN PKWY #200 Description Date Amount BEAVERTON, OR 97006 [PLUMB] Permit Fee 6/2/2006 $36.25 [TAX] 8% State Surcha 6/2/2006 $2.90 Phone : 503- 645 -0986 Total $39.15 Contractor: STREAMLINE PLUMBING 2505 SW AUGUSTA DR. ALOHA, OR 97006 REQUIRED ITEMS AND REPORTS Contact # : FAX 503- 379 -9543 • PRI 503- 888 -6657 Reg #: LIC 142111 PLM 34 -370PB 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: ) 1I Permittee Signature: 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 Application t FOR OFFICE USE ONLY City of Tigard (� ECEIVED Date/By: : i - / J� st \ �� ii ��, 1 1 Permit N .:� 13125 SW Hall Blvd., Tigard, OR 972 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 �l 1 + Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 JUN 1 20O ` ;IL Date Ready /By: . El See Page 2 for ,internet: www.ci.tigard.or.us Notified/Method: I I Supplemental i nformation �dri,__,. _ ,,, .,. ,:*- ,r ,r x %a „,•. ,, , „„ ..:.. ,:_ ^ ,�,;: � 5v f. . ` �g � 1p�A . s�' €..,5'.� �> - 3. �z,�_ - : - ;:,,. °. o •�. �•�,._ �'. �, E.:�CHEDI3I:E >,.... ���_ _.... � � , _ ; -�z�•- -'. - >= fur ^'. -'< x New construction ❑ Demolition For special information use checklist. Description I Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ' -emu, r „u a ` .M. , :. � = ;;.r Ty -3, ,e. a n.. :. • , ., „ .'_,_ ' AC g .. CATEGOR \ OF C© fO N� A SFR (1) bath 249.20 _ : _ :� � ..- , ...r �,.�. _ _ ... d ,- ;a.,. sue, - M. - _ .. �� �. ,..in, „ ��.r, a a= - - .,_ .,,, ,ors a 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 Fire e ( sq. ft.) 2 Other: - :����° -. - ;��;�, _ �;W.:'- �� , .�= :- ��::r:_w F' sprinkler s ft. Page JOBI II 1NFiiiii A UI A iiiiiki TJON , ;„,b;,-4,21, ,. F , 5 . „ .1 ,. _,.,. ,�:. itt .. i. . v w S ut Job site address: +g t/ ? 514 egiv Lt4C Catch basin or area drain 16.60 City/State /ZIP: 7 Qa � ��++ J 0 e c, a a�4 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: J Project name: ,\\ �` Sk"cx, Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 ar t Subdivision: " V Lot no.: 2 Water service (no. linear ft.: ) Page 2 � Fixture or item Tax map /parcel no.: „' `_'`-;: ;1 . >..:,: x >, tea.. - ..; " . - t Absorption valve 16.60 1,4 '3.3%x' ;; DEg 614,=OF'A3'O t;: , Ii , : " i'r ; -.,... li , y ;, v'- ;; : T -,4;0- :• >, z. : ' -, ,, .. - ,, ,, i , , , Backflow preventer 3 ( 2 - Page 2 „ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ,,,, >.,, , „,„„„„,...,,,,,, ;., ,,,,» :,se; " io ;;, a 4 , ri 1':- Drinking fountain �E- :- =i�1[•'r: - a. 9!$- -,PY „: .;., n „ s i ,s;,1R�'•, - - -, ,,, _ . �, >, 3 ,,, a, rz.l. ,,,_, >'S`P�, >,. _ -fin, ._.F ..., ..<, � ,.,. . ,... ., Ejectors/sump 16.60 Name: Ei !V- FA (. t1l.JYI't.P-, , Ylef. . Expansion tank 16.60 Address: G G l f F ixture /sewer ca 16.60 L 1 2S vv raL e1. it, It o r ' > p City/State /ZIP: °%t v , . r),12 `44 -ieo (,f Floor drain/floor sink/hub 16.60 Phone: (5i) L Lis _ (.) Fax: (S �) j -,Z U. Z Garbage disposal 16.60 3 :,,,_ �. Hose i , g�a-:, �a•�- >,;:� ; t � � _ „� x-.= sar, - -� H bib 1660 APE I;IC tI! iT i F ,, `? x I ER�+ . ' ,' -._�� '�a� >a= . ;,.�rr�,�,;�n ;,:.,•�y,�.;.. =e��a -. �. ..:;�_,, ------------ :.fie � ..... _��- ',w, >...:....., - ._ �,�s +��+,'auf,•.. _ _ _ maker 16.60 �� �� �� °> -� - d �� �'� Ice Business name: � l v,� i ( H k' 5 i lc_, Interceptor /grease trap 16.60 Contact name: AL ( -; ✓ C Medical gas (value: $ ) Page 2 Address: j '1 7 S AtA/ ,n / Y k IT 7_00 Primer 16.60 City/State /ZIP: J Roof drain (commercial) 16.60 Phone: ( ) p ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 > ;H,;' :„ „'•:j; % . ;tr '..- y�rrx..; GO . . C f 1R I!IT.RA , �, .� - >�:: ` :. -:�, b ', 4;= � ��:" �yF "> Water close i F. _.. �; :: _� -.... _. -tea -• �>A1,� ., _,:...a =� = �. .... `" ".,; �� 16.60 Business name: ,7 *1- ( et*Wt I i• y) i'l VVIilof ✓IS Water heater 16.60 Address: S 05 . S • I.c.' - A u5 �4- _ b f • Other: City/State /ZIP: 4 u, 0t 1 700(0 $72.50 Minimum permit fee: : $72.5 0 Phone: (5 j ) e3ge - (, 6s 7 Fax: (563 ) j7 - 95 y j Residential backflow minimum permit fee: $36.25 ill 2 ( ( g 3 ti _ 37o . Plan review (25% of permit fee) CCB Lic.: Plumbin Lic. no.: i � � 3 , . State surcharge (8% of permit fee) 2 9,®. Authorized signatures G TOTAL PERMIT FEE 3 / .1 5 :, Print name: , in ! j f I -- ( Date: 2 - g t`j j This permit application expires if a permit is not obtained with ,, Q 180 days after it has been accepted as complete. *Fee methodology set by Tri - County Building Industry Service Board. i:\Building \Permits \PLM- PermitApp.doc 12/03 440-4616T(10/02/COM/WEB)