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1195x! SW HAZEL.WOOD LP
CITYOF T I G A R D _- PLUMBING PERMIT
DEVELOPMENT` SERVICES PERMIT#: PLM2004-00148
1312.5 SW Hall Blvd., Tigard, CR 97223 (503) 639-4171 DATE ISSUED: 43/04
SITE ADDRESS: 11950 SW HAZELWOOD LP
PARCEL:. 1 S134BD-03900
SUBDIVISION: ENGLEWOOD NO.2 ZONING: R-4.5
BLOCK: LOT: 127 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOI':LE HOME SPACES:
TYPE OF USE: SF WASHING MACK: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORES: WATER HEATERS: CATCH BASINS:
_ F1X_TURES LAUNDPY TRAYS: SF RAIN DRAINS:
SINKS: URINAI_S: GREASE TRAP S:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHV,,ASHERS: RAIN DRAIN: ft
Remarks: Backflow preventer residential. ll
_.--. �----- FEES
Owner: -- -- -- -
-� Description Date Amount
HOVEE, ELIZABETHAN NE — - — --
11950 SW HAZELWOOD LOOF I'I \lltl Permit Fee 4/7/04 $36.25
1'IGARD, OR 97223 I '�\JN ;Ul(e surcharl 4/7/04 $2.90
Total —�$39.15
Phone —
Contractor:
l_ANDSERVICES, INC.
30033 NW EVERGREEN RD.
HILLSBORO, OR 97124
REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : s03-644-8575 Final Inspection
Reg #- I'I.M 5108
I Ic' ALL PHASES& Hr+
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 adopt:d by the Oregum
Issue+ 3y:'k �,C Permittee Signature: L t ,1, C(,...0 ..1-4t tc
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
lWilding Fixtures
Plumbing Permit Application
City of Tigard Reecived
13125 SW Hall Blvd.,Tigard,OR 97223 Date/D _- Permit No.
Phone: 503.639.4171 Fax: 503.598.1960 Plan Revie
DataB Other Permit No.
24-Hour inspection Line: 503.639.4175 nate Ready By: mr ® See Paac 2 for
Internet: www.ci.tigard.orus Date Ready/By
d.
- % Supplemental Information -
TYPE OF WORK _ FEE* SCHEDULE
-®New construction ❑Demolition -� For special information use checklist.
- - -- - -
Description I Qty I Ea. 'fotal
❑Addiuort'alteration/replacement ❑Other: New I-2-family dr,ellings ina,udes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath -1- 1 249,20
❑ 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 350.00
❑Accessory building - ❑Multi-family - SFR(3)bath 39900 r
❑Master builderOther: - - Each additional bath/kitchen 45.00
--- - Fire sprinkler sq.ft.) Page 2
_ -- JOB sin INFORMATION AND LOCATION Site softiies
Job site address: I t q S 6 S w__I,C UL 'M ct). X sQ(1 Catch basin or area drain 1660
City/State/ZfP: o� a R 9 7 12.3 Drywcll,leach line,or trench drain 1660
Suite/bldg/apt.no.: Project name: Footing drain(no.linear ft.:!_) Page 2
Manufactured home utilities 1
Cross street/directions to job site:
-- 10,00
Manholes 16.60
_st�¢ ✓5�•�-� F��� . er 121 ..l.e 1 Rain drain connector 16.60
a.mjas }I a n�1 job _ Sanitary sewer(no.linear ft ) Page 2
Storm sewer(no,linear tt. ) Page 2
Subdivision: c ,I — Lot no — Water service(no.linear fl. —) Psge 2
Tax map/parcel no.: - - -- Fixture or Item
----- -- Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
.a,kr----
,�..�ink
Backwater valve 16.60
1 ( Clothes washer 1660
Dishwasher 16.60
'® PROPERTY OWNER TFNANT- _ -' Drinking fountain -- 16.60
— - -� —� ----- --- Ejectors/sump 16.60
Name. I { - ( Expansion tank 16.60
AddressEE�
I(A enJI�Li. 7�I n��o_l,,;rs oQ A; -- Fixture/sewer cap 16.60
City/State/ZIP: 3 Floor drain/floor sink/hub 16.60
Phone:(;os ) S 9 U I & 9 2 Fax:( ) - jarbage disposal - - 16.60
mi '°, --- -- Hose bib 16.60
I a` w_- - •�"r COtl1 A(T PERSON ' -----
_-__.____-
Business name: fee maker 1660
---- —_- -___ Interceptor/grease nap 16.60
Contact name: L`,�_�" ta.�z- Medical gas(value S ) Page 2
Address: Primer 16,60
City/State/ZIP: - _— W- - - Roofdrain(iommercial)i 16.60
-- --- ----"
Phone: Far: Sink/basin/lavatory 1660
_
( ) f ) _.
Tub/shower/shower pan 16.60
E-mail:
---' Urinal 16.60
t:ONTRACTOR - --a . r Water closet 16.60 -_
Business name: Water heater 1660
Address: Other.
City/State/ZIP . Rq 7 d _ Subtotal _
�- --- Minimum permit fee $7250
Phone:(509 ) /; 4 -8$ 7 Fax:(Sp4 ) 5.4 7-osv g Residential backflow minimum permit fee $36.25 ' �
CCB Lic.: 5 .� Plumbing Lic.no.: — Plan review (25%of permit fee)
Authorized signature — State surcharge(8914 of permit fee)
TOTAL PERMIT FEE
Print name: �_� i a e+L A. Nevee_ Date: 4 .7_ o� This permit application expires if a permit is not obtained within
190 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
1\9alldlna\Pern+iu'PLMFPemut.\pp doe 17'01 Ir0-a516T(INOYCUM/wEa)
Plumbing Pern)it Application - City of-Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total S uare,Foota e: Permit Fee:
I-ootn g drain- 1" 100'^ 55.00 0 to 2,000 $115 00
Footing drain-each additional 100' 46.40 2,001 to 3,600 $16000
3,601 to 7,200 $220.00
Sewer-I st 100' 55.00 7,201 and greater $309.00
Sewer-each additional 100' 4640 — -
WalerService- Iat100' 55.00 Medical Gas S stems:
Water Service-each additional 100' 46.40 -_- '—'--''-""-
Valuation: Permit Fee:
Storni&Rain Drain-1st 100' 5500 $1 (U to$5,0(0.60 Mmin.im fee$72.50
Storm&Rain I)iiun-each additional 100' 4640 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Fixture or Item Qty. Pee(ea) Total additional$100.00 or fraction thereof,to and
including$10,000.00._
Commercial[Jack Flow Prevention Deice 46.40 510,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1 54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof',to
minimum permit fee$'6,25 27 55 and including$25,000.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379 50 for the first$25,000 00 and$1 45 for
Inspection of existing plumbing or each additional$100.00 or fraction thereof,to
P g P EL and inchidit.$50,000.00. _
specially requested inspections-per ho.ir72.50 $50,001.00 and up $742.00 for the fust$50,000.00 and$1,20 for
- Subtotal_ each additional$100.00 or fraction thereof —
i
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"Yes",please indicate work performed by fixture. Failure to
accurately report tixtul es_could result in increased sewer fees*.
Nand b' Fixture Work Ptrformed
Fixture Type; Replace
A", , Moved Exlblina Capped Comments regarllRlr; 11\lttl't' 11pr1�;
VA'
Itunsu` Iuu
Bath Iub;5hower
-Jacuaai/Whirlpool_ _ ----------- _ -------�___ . -
('at Wash -Each Stall
-Drive Thru ---- - — ------ ---- ----
�_
Cuspid t/Wate.Aspirator - - - -----
Dishwasher -Commercial
-Domestic
Drinking"ourtain - —_La-W-23 IL_
Flour Drai.ikink 2" --
3" -
4"
Car Wash Drain _-_ — ---- -- - ---
(Jarbage ' nmestic
Disposal -Commercial — *Note: If the!::.ture wort:under this permit results in an
-Indu"al
Ice Mach./Refri .Drai,is increase of sewer hll!1s,a sewer permit will be issued and
Oil Separator(Gas swiion) fees assessed for the sewer increase must he paid before the
Rec.Vehicle Dump Staticin _ plumbing permit can be issued.
Shower -Gang
-Stall
Sink -Barilavatcry �tantity Total
81adley Isometric or riser diagram is required If fixture quantih
-Commercial _
total oal is?9.
Swittinling Pool Filter
Washer-Clothes
Water L•xtractor Plan Review
Water Closet-Toilet _ Plan review is required if fixture quantity total is>9,
Urinal
L Other Fixtures:
i i11vilding\Peimit0t.M.PermxApp doc 303
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-41 X15
MST
INSPECTION DI"ISiON Business Line: (503) 639-41.1
-- �------ _�.._—
BLIP - ---- —
Received �� Sro +Date ReGlIlested 2—:3 -6 AM PM - BUP
o
Location .�L. * _- Suite _- - _ - - -_- MEC
J
Contact F'orson --- --__- ) --._e-. ---- PLM </�:--C���-1;��.
Contractor ---- --- -- -- - - 11h (- - - ) - ---- - --.. SWR s-----
BUILDING TenanUOwi er ELC
Footing ELC --- .
Foundation —
Arress:
Ftg Drain ELF!
Crawl Drain
Slab Inspection Noes: - SIT
Post&Beam
Shear Anchors - - - --
Ext Sheath/Shear
IntSheath/Shear
Framing
Insulation
Dnrwall Nailing - ---- - - -
Firewall
Fire Sprinkler ----
Fire Alarm
Susp'd Ceiling - -
Roof
Other: - - -
Final -
NAS FRIL -
-PLUMBING
Under Slab --
Rough-In - --
Water Service - - _— -- --
Sanitary Sewer
Rain Drains - --
Catch Be-Jn/Manhole
Storm Drain - - _._-- - -- - — -- - --- —
Shower P n
aA
PART FAILNICAL
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 F] Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk pati �-
Other:
Final - DO NOT REMOVE this Inspection record from the Joh site.
PASS PART FAIL
04/27/2004 13:59 N5035001336 ERNSTERS PAGE 01
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LOCATION:
RRDUCErI PRUTIIRIS ASnjQ l.Y P.V.RA
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1'1m& uRM _.----�� INLET CHP.CX A"En
INITIAL ti:rtar vALVY K RI
TEST "'INYD AT ( full �+a,Ar. Pum t+,x
RfiliU1,TA .I!AXL'U❑ Pu" DATE
BU*'FPR _
A A- ami Pu ( CHS K #7
RF.IJEF VALVF 10"T DID NOT rA)LEU AYNTE
PASA 0 FAIL C3 KED(I ''R' OPEN ❑ ❑ Psi�T
�AIRI -
AMO�oe
PART{
P V.B.A 19 V.B.& AFrEn RFPA1RJf
Rs"O!!x (Ai 'i. ,r
Tial ---- CHECK Al„ - DATH
gr
AFTER oi[uMip I oPaeD AT PIMA Drar
R6PAIRf rlP�>t ,:.,. TIGHT two /
CH
—, TIGHT E3 ►uD '-gip PASSED ❑
y JR11 AMM Mt7 TEXT ei1QT.Tlt TRWIM
tJ A-UU MW Y PIAS REGI aRTtttp T TTY
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OAM`` CAiIHRATION nnTF _ILL5_LU4 DOCTOR HETFR READING;
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