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12590 SW GLACIER LILY CIR
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CITY OF TIGARD ___ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00540
DATE ISSUED: 10/15/03
13125 SW Hall Blvd., Tigard, OR 977.2:3 (50',) 639-4171
PARCEL: 1 S'133DA-04600
SITE ADDRESS: 12510 SW GLALICR 1_II_Y CIR
SUBDIVISION: AMAR1 SUMMERLAKE ZONING: R-7
BLOCK: LOT: 068 _ JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPC,SALS: MOBILE HOME SPACES:
TYPE OF USE: .5F WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY i RAYS: 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: Install backflow preventer
FEES _
Owner' — Description Date Amount
HOUSTON HICKENBOTTOM PLUMB 1'ermit Fee 10/15/03 $36.25
12590 SW GLACIER LILY CRL TAXA 9%State Tar 10/15/03 $2.90
TIGARD, OR 97223
Tota;r $39.15
Phone : 503-524-012h
Contractor:
SUNRISE LANDSCAPE PROFESSIONALS LLC
PO BOX 665
BORING, OR 97009 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : 503-659-1829
Reg#: LIC 140714
PLM 7417LCB
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 adopts=:, by the Ore-on
Issued By: _�_ �; <_ —�� Permittee Signature: i _
Call (9b3) 639-4175 by 7:00 P.M. for an ins,)ection needec' the next b�isines,; day
Building Fixtures
FOR OFFICE iTSE (IINLY
Plumbing Permit Application ReceivedPlumbing
Date/B : 17,_
_, 11 I lJ Permit No. Lf S
Plannine,Approval Sewer
City of Tigard Date/By: Permit No.
13125 3W Hall Blvd. Plan Review Other t
Tigard,Oregon 97213 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960Post-Rev;ew Land Use
h DateJBv: —Case No.;
Internet: www.ci.tigard.or.us �. Contact Juris.: See Page t for
24-hour Inspection Request: 503-639-4175 Name/Method: _— Sup Ip emental Information.
TYPE OF WORK FEE*SCHEDULE(for spe•fal information use checklist
New construction — Demolition Description �Qt,. F'celca.) Total
Addition alteration/re laceme�tf Other: New 1-&2-fa,idly dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft.for es ch Will conoectbn
SFR(I)bath _ 249.=0 _
[� 1 & 2-Family dwelling Commercial/Industrial SFR(2)bath 350.00
Accessory Building L] Multi-Family SFR (3)bath ] 5.00
99.00 _
LJ Master Builder Other: Each additional bath/kitchen 4 —_—j
JOB SITE INFORMATION and LOCATION Fire sprinkler- . ft.: a c2 J
Job site address: 5 1C, y t ;-? r t, "• Site Utilities
Suite#: Bld ./A t.#: Catch basin!area drain 16.60
Dr ell/leach line/trench drain IG.60
Project Name: Footing drain nolinear ft.) Pae 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector _ 16.40
Sanitary sewer(no. linear ft.) Pae 2 _
Subdivision: Lot'': Storm sewer no. linear ft.) Pae 2
------ — Water service no. linear ft.) Page 2
Tax map/parcel #: Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
_ Backflow preventer Pae 2
Backwater valve 16.60
-- Clothes washer 16.60
-- -- Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER =TENANT Ejectors/sump 16.60
Name: HLLA i /, •, c ke A,6,: `—i Expansion tank _16.60
Address:/,. ,5 J ' r" (f-71, Fixture/sewer cap 16.60
Cit /State/Zip / r_ Floor ge disposal
sink/hub 16.60
Garbage dis osal 16..,0
Phone: 4 Fax: Hose bib _ 1 16.60
ADPL►CANT CONTACT PERSONIce maker — 16.40
Name: Interceptor,grease trap 16.60
Address: Medical gas •value: S Pae 2 —
Zi Primer 16.60
Cit /State/
Ri of drain(commercial) 16.60
Phone: Fax: Sink-hasin/lavatory16.60
E-mail: Tub!showerrshower pan 16.60
CONTRACTOR _ Urinal - 16.60
Business Name:
c / Water closet 16.60
S�,
--- =�--- Water heater _ 16.60 _
Address: / L L t- S Other:
Cit /State/ZIp: O G Other:
Plumbin Permit Fees*
Phone: to -y �' 1 / - C Fax: -- P
Subtotal S
CCB Lic. Z JWumb. LIc.#: l Minimum Permit Fee 572.50 S
Authorized p I„y t" Residential Backflow Minimum Fee$36 25
Signature � Datee'_' Plan Review(25""of Permit Fee) S
L . N�yf l r , State Surcharge 1 S of Permit Fee) S
iPlease print name) _ TOTAL PERMIT FEE S
Notice: This permit application expires Its permit Is not obtained within All new commercial buildings require 2 sets of plans with isometric or
IRO da%s after it las been aerepled as complete. ris:r diagram for pian ic%ko.
*Vee melho&-logy set b% 7 ri-County liaiiding Industry Sersice Board.
i Dsts'Perrnit Forms PlrnPermitApp doc 01'03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppcession Systems:
Site Utilities Qty. Fee(ea) Total_ Square Footage: Permit Fee:
Footing drain-I* IW' 55.00 r 0 to 2,000 $115.00
Fooling drain-each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer- I st 100' 55.00 7,101 and greater $309.00
Sewer-each additional 100' 46.40
Water Service- Ist 100' 55.00 Medi:al Gas S stems:
Water Service-each additknal 100' 46.40 _ Valuation: Permit Fee:
Storm&Rain Drain-Ist 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Stone&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(ea) Total including$10,000.00.
Commercial Hack Fluty Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1 54 rot
Residential 3ackflow Prevention Device each additional$100.00 or fraction thereof,to
(minimum termit tee$36.25) 27 55 and including$25,000.00.
Rain Thain,single family dwelling 65_'S $25,001.00 to$50,000.00 $379.50 for the first$25,0(10.00 and$1.45 for
-- each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or and including$50,000.00.
specially request ciins ections r hour 72 S11 S50,A 100 and up $742.00 for the first$50,000.00 and$1.20 1'or
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please Indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
uantl b Fixture Work Performed Continents regarding fixture work:
Fixture Typc. Replace
New Moved Fainting Capped_
Baptistry Font — — --
Huth -Tub/Shower —
Jacuzzi/whirlpool
(,'at Wash -Each Stall -- ----
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher -Commercial ------
-Domestic
Drinking Fountain
Eye Wash —
Flour Drain sink -21, — --,_
Car Wash Drair - *Note: If the fixture�:o k under this permit results in an
Garbage -Domestic increase of sewer EDT's.a sewer permit will be issued and
Disposal -Commercial
-Industrial fees assessed for the sewer increase must be paid before the
Ice Mach Reltut.Drains plumbing permit can be issued.
Oil Separator Gas Station)
Ree Vehicle Dump Station
Shower -Gang
-Stall
Sink -Har'Lavatory _
-Bradley
-Com.-xrcial _
-Servo a
S%immin Pool Filter T
Washer-Clothes
Water Extractor
Water Closet-Toilet
L'nnal
Other Fixtures. E-11
i:',Dsts\Permit Forms\PlmPermitAppPg2.doc 0103
CITY OF T'IGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MS
INSPECTION DIVISION Business Line: (503) 639-4171 BUP
Re.:eived _ Date Requested �0._-��' - AM - -- - __ PM_... BLIP�l
Location _ i o elL `..' �---Suite _ -- MEC - ---
Contact Person o mss __ _.--_._.__ Ph(._. _-) —(p/�8 (p-CM-) 1 - 005-140
Contractor Ph(__ ) -- _ - __ SWR -
BUILDING 7enanl)Ownei ELC _- ---- --
Footing ELC
Foundation /access: —�
Ftg Drain ELR -- ------ - -
Crawl DrainA -
Slab Inspection Notes: SIT
Post&Beam -----_-- -- -
Shear Anchors
Ext Sheath/Shear L
Int Sheath/Shear
Framing - -- -- - -- -
Insulation
Drywall Nailing - -
Firewall
Fire Sprinkler _
Fire Alarm
Susp'dCeiling ---
Root _
Other: -
Final - --------�- _ __
PART FAIL
LUMBIN j
Po eam
Under Slab - — — --
Rough-In
Water Service -
Sanitary Sewer
Rain Drains -
Catch Basin!Manhole
Storm Drain - - - - ---- - - - -
Shower Pan
C ger:ZPAS� 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 Reinspection fee of$— required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ PleajecII for rein pection RE:— [� Unable to inspect-no access
Fire Supply Line
ADA / /' _
Approach/Sidewall; Date —� Irws,pactar Ext
—
OthLI.
Final 00 NOT REMOVE this inspection record from the !*b site.
PASS PAR f FAIL