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11347 SW Ironwood Loop
CITY OF "TIGARD _ _ PLUMBING PERMIT
DEVELOPMENT
11 SERVICES PERMIT#: PLM2002-00221
13125 SW Hall Blvd., Tigard, CR 97223 (503) 639-4171 DATE ISSUED: 6/11102
SITE ADDRESS: 11347 SW IRONWOOD LP P/RCEL: 1S134AA-01400
SUBDIVISION- ENGLEWOOD ZONING: R-4.5
BLOCK: LOT: 067 JURISDICTION: TIG
CLASS OF WGRK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES.
TYPE OF USE: SF- WASHING MACK. BACKFLOW PREVNTRS:
OCCUPANCY GIRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVArORIES: OTHER FIXTURES: 1
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of presve reduc;ng requlalor
_ FEES
Owner: — Type By Date Amount Receipt
LIVINGSTON, ROBERT F PRMT CTR 6/17102 $72.50 27200200000
11347 SW IRON',r1;00D LOOP 5PC1 CTR 6/17/02 $5.80 27200200000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
PLUMBING CONCEPTS INC
PO BOX 1068
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone 1: 658-5232 Misc. Inspection
Reg #• LIC 97587 Final Inspection
PLM 3-293PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Odes 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.
\ 7:�_
Issued By' 1ti t- lac .L_� .ct;ti Permittee Signature:,.-'
Call (503) 639-4175 by 7:00 P.M. for ar inspection needed the next business day
Plumbing;Permit Application _
�
Uatereceived:G - �-O Y ��
Permit � ' �
City of Tigarel
Address: 13125 SW Hall Blvd,TSewer permit no.: Building permit no.:igard,OR 97223 -
r Phone: (503) 639-4171 Projecl/appl.no Expire date:
Fax: (503) 59H-1960 Date issued: —.Iiyf,l . Receipt no.:
Land use approval. — Case file no.: Payment type:
_J 1 &2 family dwelling or accessory U CommerctaYindustrial U Multi-family U Tenant improvement
U New con.slnit:lion U MWilierfi;tlleraliun/n'placumen! U ht,t►d server Ij(W14.1
V50111 SUI L IN FORMATION ITE SCIIEDIT%�q
Job address: G ' fe�_,Q,tJ L - Description ()ts. Fee(ea. 7olal
Bldg.no.: Suite no.: New 1-and 2-faniHy dvrellings oniv:
- (includes 100 n,roreach utility cons caion),
Tax map/tax Iollaccount no.: _ SFR;1)bath
Lot: (,,,2 Block: Subdivision %jd..tt,Dt-f_vitrot) SFlt(2) _-
Project name: _ SFR(3)hath --- — --
City/crdntyq? a;xL _ Eac•haddiunnalbath/kitcben
Description and location of work on prernises:L"N L -�St sheutllities:
-TO Catch basin/area drain
Csl.date of completiunlinspccti m -" - _ - Drywells/leach line/trench drain _
Footing drain(no.lin. ft.)
Manufactured home utilities
Business name: I I r r-t:." Jr �� '-( -1 ," Manholes
Address: - J Rain drain connector
City: ,aG �- — I State: ZIP: q ' Sanitary sewer(no.tin.ft.)
Phone: Fax: E-mail: Storm sewer(no.lin.ft.)
CCB no.: 9 Plumb.bus.reg.no:
Water service(no.lin.ft.)
City/metro lie.no.: Fixture or item:
--� Absorption valve
Contractor's representative signaturm-- C^�-- Back now preventer ^
Print name: ate: Backwater valve _
MOO Is" Basins/lavatory _
Name: Cloths washer
Ar•
Dishwasher
ddrrs
City: _ State: 'LFP: Drinking fountains)
'ectors/
Phone: Fax: Email: EExpansion tank
Fixture/sewer cap
Name.(print): ( -Z! J r . Floor drains/floor sinksrhub
Mailing address: - - - -- - Garbage disposal -
Hose bibb
City: - - State: LIP: _! Ice maker -
Phone: F'ax: 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 pmpcoy I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature: _ Date: Sump
aft 11113 0 a 1, Tubs/shower/shower p,tn
Urinal
Name: —^_—�— -- - -- Water closet
_Address: Water heater
City: State: ZIP: - Other:-
T"i
C-Phone: Fax: E-mail: Total t.
Na as Jurisdictions arcepr credit card+,please call Jurisdiction for more InrorouUonNotice:This permit application Minimum fee................1;
U Vtaa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card number within ISO days after it has been State surcharge(S%)....$ _
—_ _of exP Irea accepted as complete. TOTAL .......................$
Name cardholder as shown on credit card J
— —i� Cardholder siguture s Amours Y �X 440-4516 MgWOMI
PLUMBING PERMIT FEES:
-- PRICE TOTAL New 1-and 2-family dwellings only:
FIXTURES individual QTY ea .MOUNT (includes all plumbing fixtures In PRICE TOTAL
--5--- ---- (ea - the dwelling and the first100 ft. OTY (ea) AMOUNT
Sink
for each utility connection _
Lavatory 16.60 One(1)bath $249.20
Tub or Tub/Shower Comb _ 16.60 Two(2)bath $35000
-" 18.80 Three(3)bath $399.00
Shower Only ---- - -
Water Closet 16.60 _ SUBTOTAL
Urinal 16.60 Be/s STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
- TOTAL
Garbage Disposal 16.60 ---------- -- --- ___ --. --
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor S, 4. 2" 16.80
s° 16.Ko PLEASE COMPLETE:
- 18.60
O_uanti_t�r by Work Performed
Water Heater O conversion O like kind 16.60 Ffxtur»Type: New Moved Rr placed Removedl
Gas piping requires a separate mechanical Capped
e
rmlt. - -
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Tuvato _
_ Tub or TuL•'Sho-.er
Hose Bibs 16.60 _ Combinatirn _
Roof Drains 16.60 Shower Onl
Drinking Fountain 16.60 Water Closet
Urinal --
Other Fixtures(Specify) 16.60 Dishwasher-
Ito
ishwasher ---
4f 1 Garbage DispoI
Laundry Room
WashingMach -
Floor Drain/SinSewer-1 at 100' 55.00 3 _-
Sewer-each additional 100' _ 4640 4-
Water Service-1 a 100' 5500 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 - ---
Commercial Back Flow Pr ivontlon Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60 _
Inspection of Existing Plumbing or Specially 62.50
Re nested Ins actions Ler/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
8%STT\TE SURCHARGE -
"PLAN REVIEW L;%OF SUBTOTAL
Required only if fixture g!y.total is>9
TOTAL S
"Minimum permit fje iq$72 50•8%state surcharge,except Residential 88ck8ow
Preventinn Device,which i•$39 25.8%state surcharge
"All New Commercial Buildings require 2 tete of plane with Isometric or riser
diagram for plan review.
is\dsts\forms\plm-fees.doc 12/26101
CITY OF TIGARDi 24-Hour
bJILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
'-22 �� BUP -
Received _ �� y )
_ Dat@ R U@[!"^ AMPM
- BUP
Location _-- �� —-
Suit@— MEC
Contact Person Ph( ) PLM
Contractor _ Ph( ) SWR
BUILDING 0nant/Owner ELC
Footing
Foundation Ac,r ess- — ELC
Ftg Drain - -
Crawl Drain _ ELR
Slab Inspection Notes: SIT
Post& Beam
Sheaf Anchors �J
r%!Sheath/Shear �P` GL,'� C,.ctc't.; (�
Int Shba!hlShear
Framing --
Insulation — - - - -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -
Roof
Other: -
Final —�----- -
PASS PART FAIL.
PL_UMBINO _
Post&Beam - -
Under Slab
Rough-In - --
Water Sorvice
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain --_
Shower Pan
O r:
ins — '—
S PART FAIL
F_ NICAL `
Post&Beam _ --
Rough-In -
Gac Line -
Smoke Dampers
I-inal —
PASS PART _FAIL
ELECTRICAL
Rough-In
UG/Slab
Low Voltage
Fire Alarm --- --- ---- --- --- _--
Final Rt,ns
PASS PART FAIL pection lei of$_ `required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Ej Please ca!!!or reinspection RE: _ _ Unable to inspect-no access
Fire Supply Line
ADA ^ �
Approach/Sidewalk date d V Inspector
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL