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13217 SW Falcon Rise Drive
_ PLUMBING PERMIT
CITY OF
TIGARD
DEVELOPMENT SERVICES PERMIT#: PL18/ 001 00206
13125 SW H:A Blvd.,Tigard, OR 97223 (503) 639-4171
DATE ISSUED: 0/18/01
PARCEL: ';S1;,3DC-01E00
SITE ADDRESS: 13217 SW FALCON RISE DR
SUBCIVISION: MORNING HILL NO.1 ZONIf:G: R 'r
BLOCK: LOT: 044 JURISUICTIION_TIC; —
CLA33 �F WORK: OTR GARBAGE DISPOSALS: MOBILE HOME ",FACES:
TYPE OF USE: SF WASHING MACH: BACKFLO'N PF:,.:`/ ;TRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
S'rORIES: 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 backflow prevention device for irrigation system---.—
FEES
ystem_ _FEES _
Owner: -- Type By — Date Amount Receipt
NAPIER, JON J + SHELLEY M PRMT GTR A5/18/01 $36.2.5 27200100000
13217 SW FALCON RISE DR 5FCT CTR 5/18/01 $2.90 27200100000
TIGARD, OR 97223 ---
Total $39.15
Phone 1:
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED INSPECTIONS
NP/Backflow Preventer
Phone 1: 691-6166 Final Inspection
Reg#: LIC 87906
PLM 3-1-250PB
This permit is issued subject to the regulations c,intained in the Tigard Municif:al 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 wo % is not started with n 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION Oregon law requh-�s yoti ,o follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in 0'\R 952-0001-0010 thro:igh OAR c.-J-?-0001-008J.
You may obtain copies of there rules or direct questions to OU.JC by callinq,(503) ��C-19$7. �
Issued By:
C ( r(T le Permittee Signature:
v -
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the no business day
Plumbing Permit Application
Date received: . ' /B d f Permit no.:
City of Tigard X21_.
Address: 13125 SW Hall Blvd,Tigard,OR 91223 Sewer permit no.: Building permit n%..
('in a/Tigard photic: (503) 639-4171 Project/appl.no.:_ Expire date:
Fax: (503) 598-1960 Dale issued: By: Receipt no.:
Payment type:
Case file no.: I
Land use approval: —_ _l.
1
U I 72faily dwelling or accessory U CommerciaUindustiial U Multi-f^roily U Tenant improvement
U Nenction U Addition/alteration/replacemen( U Food —vice U Other:
{ SITE INFORMATION1ULE(fqrspoclal Information
Job address: (Z S(,J ,F I C ��d ( Uescriplion Qty. Fee(ea.) 'Total
Bldg.no.: Suite no.: - New I-and 2-family divellings only:
Tax map/tax lot/account no.: — --- - (includes 1001t.for each utility.a;:ru::+;;;)
SFR(1)bath
Lot: $lock: Subdivision: S;R(2)bath
Project name: _ SFR(3)bath _
City/county: ZIP: Ea.,h additional badAitchen —
Description and location of work on premises: S�r� �cw. . Slteutilitles:
_ Catch basin/area drain
Est.date of completion/inspectiou: Drywells/leach line/trench drain
w 1 1nessissisill Footing drain(no. lin, ft.)
Business name: Manufactured home utilities
c eY h ►v Manholes
Address: tj JC) S _{�L� L _ Rain drain connector
City: State:0_tfzTi':y1�1 ,,[ Sanitary sewer(no.lin. ft.)
Phone: Fax E-mail: Storm sewer(no.lin. ft.)
CCB no.: Q"]qp(o Plumb.bas.reg. tic: Q
Water service(no.lin.ft.)
City/metro lic.no.: Fixture or Item:
Contractor's representative signa ,' Absorption valve —
Back(low pre-renter
Print name:
M6.11`14 [Dale..: Backwater valve _
1
Basins/lavatory
Name: Clothes washer
Address: V — Dishwasher _
— Drinking fountain(s)
City: St.::e: 'LIP: Ejectors/sump
Photic: Fax: E-mail: Expansion tank
Fixture/sewer cap
Name(print): t_e f- Floor drains/floor sinks/huh
Mailing address: r.��-1 �I , � Garbage disposal
Hose bibb
City: :11 1z ax aY State: ZIP:q � Ice maker
Phone: 'T gip' ( Fax: E-mail: Interceptor/grease trap _
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or tht. maintenance and repair made by my regular Roof drain(commercial) _
employee on the^roperty I own as ser ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner'_ i nature: Date .� Sump _
Tubs/shower/shower pan
Nance: Urinal
-_ -- Water closet
Address: Water heater
City: _ _ _ State: ZIP: Other:
Phone: Tax: E-mail: 'Total
Not all jurisdictions accept credit cards,please cell jut mliction ret more information Minimum fee................$
Notice:This permit epplicntion
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card number within ISO days alter
.—_. .�_. n has been
State surcharge(8%) ....$
>,phn
complete. TOTAL .......................$
accepted as com _
Nuri of crrdltoldet n shown on credit carol P P
_ S
Cardholder sipsature Amount
410-1616((vWICOM)
PLEA.'C COMPLETI=:
FIXTURES (individual) city Price Total ---Fixture type iluanttt b Work Performed
y -�---anti—
Sink 16.60 _ Naw Moved Replaced RamovadlCapped
6.60 Sink
1
Lavatory _ Lavatory ___
Tub or Tub/Shower Comb. 16.60 Tub or Tub/Stioeer Combination
16.6,1 Shower Only
Shower Only Water Closet
Water Closet 16 60
Urinal 16.60 Dishwasher
16.60 Garbage Disposal
Dishwasher — Laundry Room Tray
Garbage Disposal 16.60 Washin Machine
10.GU Floor Dratn/Floor Sink 2"
Laundry Tray 3'
Washing Machine 1660 4'
16 G0 Water Heater
Floor Drain/Floor Sink 2' Other Fixtures
3" 16.60
4• 16.60 - - --
Water Heater O conversion O like kind 16.60
Gas (ping requires a separate mechanical permit.
MFG Nome New Water Service 46.40
MFG Home New San/Storm Sewer 46.40 COMMENTS REGARDING ABOVE:
Hose Bibs 16.60
Roof Drains 16.60 ---
Drinking Fountain 16.60 — `—
Other Fixtures(Specify) 21.75 _- -- --
Sewer-1 st 100' 55.00
Sewer•each additional 100' 46.40
Waley Service-1st 100' 55.00
Water Service-each additional 200' 46.40
Storm 6 Rain Drain-1st 100' 55.00
Stone 6 Rain Drain-each additional t00' 46.40
Commercial Back Flow Prevention Device 46.40
Res:iential Backflow Prevention Device' 27.55
Catch Basin 16.60
Insp.of—Fist'-ng Plumbing or Spedally Requested 72.50
Inspections per/hr _
Rain Drain,single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL s' ,fir
Isometric or riser diagram Is required M Quantity Total is >9
-- "SUBTOTAL
,40,
8% St. RCHARGF I
••PLAN REVIEW 25%OF St18TOTALB� M
"'
Required only Ir nxture qty.total is>g ___ -`Mi;
TOTAL
'Minimum permit fee is$72 W 4 a%uxtharye,except Residential 3a,.i raw i bMili.•hn
Dev",which Is$3Y 25 8%surcharge.
"All New Commerclat Buildings require plans with isometric or dw diagram and plan review
DI-ry OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISI7N Business Line: (503) 639-4171
Bl''`
Received _ ___—,o,Dat Requested— __.�AM_.._______. FM — _____ BUP -
Location 13,42-/ 7 ?'' MEC
Contact Person _ Ph( ) PLM 206
1G,�
Contractor----,.--- SWR ----�
BUILDING Tenant/Owner _ _—_— ELG
Footing--- --- ELC
Foundation Access: ._' I .LR
Ftg Drain -----
Crawl Drain b:T
Slab Inspect' n Notes: -- -- —
Post& Beam ---... - --- - - —
Shear Anchors
Ext Sheath/Shear — - --
Int Sheath/Shear
Framing --
Insulation
Drywall Nailing -- T-- - -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ----� —
Roof
Other: - -
Final - -
P1s_`RJFAIL
LU--- G •
Post&Beam
----]
Under Slab —
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain - - —_ ----. -
Shower Pan
AOthe :-
PART FAIL
HANICAL _ —--- -- -- ----- ------ ----
Post&Beam
Rough-In —_---- --- -- -- -------- —
Gas Line
Smoke Dampers — ----_----- -- ._ _.
Final
PASS PART FAIL ! - - — -_ ---
ELECTRICAL
Service -- ---- —
Rough-In
UG/Slab
Low Voltage -- ---- — -- — -'
Fire Alarm
Final
lPART FAIL El Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hai'Blvd.
PASS
_ SITE Fj Please call for reinspection RE:.-- — Unable to inspect-no access
Fire Supply LinaL�
ADA fDate. Inspector � --- ---- Ext
Approach/Sidewalk
Other:
Final DO AOT REMOVE this Inspection record from the job site.
PASS PART FAIL