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Permit . CITY OFTIGARD -,,„„.„,.. DEVELOPMENT SERVICES PLUMBING PERMIT i'llili0 ii ~�"��"��n�~�" ��"~~"� " ~�"�""�"**�~=° PERMIT # : PLM97-0205 = �� 13125 SW Hall BlVd.,Ti��OR�� /�. Tigard, ' ISSUED: 05/27/97 ~- PARCEL: 2S104DD-02600 SITE ADDRESS...: 12873 SW RIDGEFIELD LN ~ SUBDIVISION ^ MOUNTAIN HIGHLANDS #2 `Sip ING: R-4.5 PD BLOCK ^ LOT '023 JURISDICTION: _ _ CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0 TYPE OF USE....:SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1 OCCUPANCY GRP..:R3 FLOOR DRAINS ^ '0 TRAPS ^ 0 STORIES - 0 WATER HEATERS : 0 CATCH BASINS ^ 0 FIXTURES LAUNDRY TRAYS - 0 SF RAIN DRAINS - 0 SINKS - 0 URINALS ^ 0 GREASE TRAPS - 0 LAVATORIES • 0 OTHER FIXTURES : 0 TUB/SHOWERS...: 0 SEWER LINE (ft)...: 0 WATER CLOSETS.: 0 WATER LINE (ft)...: 0 DISHWASHERS ^ 0 RAIN DRAIN (ft)...: 0 Remarks: REDUCED PRESSURE BACKFLOW PREVENTION DEVICE LOCATED AT FOUNDATION NEAR FRONT OF HOUSE. Owner: FEES JEFF & CINDY RODGERS type amount by date recpt 10889 SW DOVER CT PRMT $ 15.00 JMH 05/22/97 97-294981 TIGARD OR 97223 5PCT $ 0.75 JMH 05/22/97 97-294981 Phone #: • Contractor OWNER • Phone #: 639-4171,370 $ 15.75 TOTAL Reg #..: 001312 REQUIRED INSPECTIONS — This permit is issued subject to the regulations contained in the RP/Backflow Prey Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection 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. - ________ • � y� � �. �� Permittee Signature: �.�� _°�u _ ' r � � Issued By: v ��/ ~ ____ ____ U Call for inspection -.639-4175 'i TTY OF TIGARD P lumbing Application Recd By 3125 SW HALL BLVD. Commercial and Residential Date Recd I -?)- ' iGARD, OR 97223 Date to P.E. '503) 639 -4171 ; `fD� -- 6� � Date to DST Permit ALM97 - 0 D-05 - Print or Type Related SWR it Incomplete or illegible applications will not be accepted caned Name of Devetopmen • . • _ . - Fp(PRES :Zii ra mss # s� , � Q ' .iP Cg` tAmT4 1 Job *AY `'. 1 1 w �. Sink 9.00 i Address Street Address S lavatory 9.00 B L, Er73 S � � : _ y _ t„ Tub or Tub/Shower Comb. 9.00 ldg = City/State i ZI Shower Only I c� v ii( L ZZ Water Closet 900 oset 9.00 Owner Address Suite Garbage Disposal 9.00 ,,( Dishwasher 9.00 wner r dd n + •` 13 cSo . uX. eJ4 Washing Machine 9.00 City /State Phone Floor Crain . • n �.r.d 7 7ZZ c s LY- 6/4151 3• 9.00 9.00 • S 6,, 14 -0, 4 9.0 Occupant Mailing Address Suite Water.Heater • - 9.00 City/State Zip Phone Laundry Room Tray - 9.00 Urinal 9.00 Name 2dt Other Fixtures (Specify) 9.00 r/- 9.00 •.aontractor Maiang Address Suite • 8.00 prior to Issuance City/State Zip Phone 9.00 applicant must 900 provide all Oregon Const Cont. Board Uc.e Exp. Date - contractors 9.00 informa license on Plumbing Lic. S - • Exp. Date Sewer - 1st 100' 9.00 30.00 for COT COT Business Tax or Metro s � - each additional 100 25.00 database). Exp. Date Water Service • 1st 100' 30.00 Name Water Service - each additional 200' 25.00 Architect Storm & Rain Drain - 1st 100' . 30.00 Or Marling Ad Suite Storm & Rain Drain - each additional 100' 25.00 Mobile Home Space 25.00 Engineer City /State Zip Phone Commercial Bad( Flow Prevention Device or Anti- 25.00 Pollution Device ‘xribe work New 0 Addition 0 Alteration 0 Repair 0 Residential Backfow Prevention Device' 15.00 /r�� `e My Residential 0 Non - residential 0 / l(d /_- - :itional desaiptinn of work Y Trap or Waste Not Connected to a Fixture 9.00 L G. 4 ,A.. 5 r ;Vi 1 /6.4 , --- : Catch Basin 9.00 [��` Q�z ' W I - t Insp. 6f Existing Plumbing 40.00 ,` / Gr1 / per/ hr s irg use of - � Specially Requested Inspections 40.00 =.:ing or property D Petmr may . Rain Drain, single family dwelling 30.00 - -:csed use of � Grease Traps •.. tiding -or property ( //J � 9.00 QUANTITY TOTAL . • :: you capping . moving or replacing any fixtures? Yes No isometric or riser d'egrarn is required R �• yes see back of form) ❑ ❑ total i 9 , .. ;� ; T : ':, *SUBTOTAL •°= • '_ ~� that by acknowledge at I have read this application, that the information - "`''- ' e :•ri is correct, that I -the- ne i aathorized agent of the owner, and 5% SURCHARGE - - Mans • ed are in compyance with _ regon State Laws. ;ia of 9 ` Date PLAN REVIEW 25% OF SUBTOTAL - - ` /_' s-/2z( 17 Required oNy A fixture qty. tail is > 9 - Tact P on Name' - / - Phone TOTAL 'Minimum permit fee is $25 4- 5% surcharge. except Residential Bad(flow -- Prevention Device. which is 315 + 5% surcharge • I: \plmapp.doc 12/96 (dst) 'LEASE COMPLETE AS APPROPRIATE TO PROJECT: Fixtures to be capped, moved or replaced -_ -..:. Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain 2" 3" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) ;OMMENTS REGARDING ABOVE: I: \plmapp.doc 1'2196 (dst) Permit #: � 917'-aroAmg7~ O 1�� F Addres f 17 )160 Atli r /oJ ti ° �° aEt s , VI tVerk l ' ' Issued by: ii D ate (�f s5e 1 •G Z2 � Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: r�X 1. I own, reside in, or will reside in the completed structure. V 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. n 3A. My general contractor is I (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certth the above i , ormation is correct and that I have read and do understand the Information Notice to roperty Owners a o out-€trns ruc ion Responsibilities on the reverse side of this form. s�2 z/? (8_ :rare t applicant) (Date) J!° (White copy to issuing agency permit file, pink copy to applicant) . ` � KD�� «n�S�� 0o� ��K��N�n�x -'--'-'__ ''__ -_ ' "-'-� ~_~...~..~ CoU0ztruetkon Reeporrus'Kn`KM /V6e: This Information Notice to Property Owners about Construction Responsibilities wmdevelupcc/by the Construction Contractors Board in accordance with ORS 701.055(5). construct rovement to an existing structure, you can prevent many problems 6vbeioguwuzauftbefoUnw/\ngo:opooxibUjdeauuduzcamufcuncoom. Rh ,OY 17,�RESPOKUBMITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement a residential structure, you will, in most instan.ces, be ruled to be an employer and the people you hire will be employees. As the employer. you must comply with the following: Orwgon'owIthleu2ding !o*R: As an employee, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue u1g45'8O9|. D]nempiloymxcnt inourazoulone As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For -note information, call the Oregon Employment Division at the Department of Human Resources at 378-3524. Weir-ken' co�pe:=9.", As an empIoye, you ar subject to the Oregon Workers' Compensation and must obtain workers' cornpensatien - Insurance for your empioyees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and w1 liable for ail claim costs i[ one of your employees im injured nntbe job. For more information, call the Workers' Comperrsaion Division at the Department of Consumer and Business Services at 945-7888. US. Interne Dcvcz've E.er As an eenployer, you irras withhold federal income tax from employees' wages. You will be liable fot the payment even [yre6;.dn'tuctudlywbbhm|dtberux. For more information, call the Internal Revenue Service atl'8O0'829-l04C. ��ESPONSCBtLrrli'ES AG\90 AREAS OF CNWHCERN: Code compliance: As the permiUloider for this project, project, you ae responsible for resolving any failure to meet code requirement that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify bui!ding officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box l4l40, Salem, (}]l9?309-5O52. 503/378-4621). The Board is located at 700 Summer St. NE Suite 300. in Salem. • pmp~n"oym* 6/9/00 Activities for Case #: PLM97 -00205 3:41:24 PM 464:44a$7" Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ® ®® PLMA007 Application received 5/22/97 JMH PASS J *H 5/27/97 PLMA011 Create Permit 5/22/97 JMH PASS J *H 5/27/97 PLMA799 Final Inspection 5/22/00 MRS FAIL AKJ 5/22/00 double check for irrigator not approved, req 2' of coverage • PLMA745 RP /Backflow Preventer 5/27/97 J *H 5/27/97 PLMA050 (F) Issue permit 5/27/97 JMH PASS J *H 5/27/97 PLMA845 Request inspection research 5/19/00 ST DONE No Hold ST 5/19/00 PLMA850 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00 Page 1 of 1