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12310 SW Hollow lane
CITYOF T I G A R D _. PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: /29/0 oz 00107
3
DATE ISSUED: 3/`19/0
13125 SW Hail Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S 103CB-07500
SITE ADDRESS: 12310 SVV HOLLOW LN
SUBDIVISION: QUAIL HOLLOW- EAST ZONING: 4 5
BLOCK: LO'T': 024JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HCME SPACES:
TYPE OF USE: SF WASHING MACH: BACI;FLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAIN:. TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 01 HER FIXTURES:
TUB/SHOJVERS: SEWER LINE: ft
WATER CL OSE'rS: WATER. LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of back flow preventer. _ — —
_ FEES
Owner. _ Type By Jate Amount -Receipt
DON MORISSETTE HOMES PRM I CTR 3/29/02 $36.25 27200200000
4230 GALEWOOD ST#100 Fr CT CTR 3/29/02 $2.90 27200200000
LAIC.= OSWEGG, OR 97035 = ;Vital $39.15
Phone 1: 503-387-7538
Contractor:
PROGRAS5 LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone 1: 682-6076 Fit,.I Inspection
Reg ft: LIC 6136
lit 11558
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. AT*TCNTION: Oreynn law requires you to "ollow rules adopted by the Oregon Utility
Notification !;enter. 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.
Permittee Signature:
Issued By:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
.Plun-allingPermitApplication
Date received: Permit no.: ILil
City Of Tigard Sewerennit no.: J Building U
Address: 13:25 SW Hall Blvd,Tigard qR yS! p B permit no.: `
City of 1 igard phone: (503) 639-4171 w � ,"'� Project/appl.no.: Expire date:
too
Fax: (503)598-1960 Date issued: By,�,V, Receipt no.:
Land use approval: Case file no.: Payment type:
T
&2 family dwelling or accessory t pr�litfc t ustrial 0 Multi-family ❑Tenant mprovement
ew construction a Addition alteration/replacement ❑Food service O Other: _
JOB SITEINFORMATION FEE SCHEDULE(For special Information
Job address:;r�A 3 �� ) k 1 f Lt7Ci L�� Description ifity. Iee(ea.) Total
Bldg.no.: Suite no.: New 1-and 2-fandly dwellings only:
Tax ma /tax lot/account no.: (includes 100 ft.foreach utility connection)
p SFR(1)bath
Lot: 113lock: St:bdivision(�,t ta-XA- / //Crit.) SFR(2)bath �—
Projectname: , t t c t< 1 /4 C //r"it t jJ r/ SFR(3)bath
City/county: /C&'1 - .�� Each additionalbath/kitchen
Descrgtionadfocation Qf worlcon premises: Slteutilities:
Of t.�.�ICe_., _ Catch basin/area drain
Est,date of comp*,;rio,Jinspection: D e s/leac line/trench drain _
Footing drain(no.lin.ft.)
Manufactured home utilities
Business name: e) h "ASS [.LY"ndccAiac, Y,.r►G. Manholes
Address:a9?q,C 4W Rain drain connector _
l> Ci'Y l.I 1 i1 SthYlUi��G _ Stateb - Zll': 9-707 0 Sanitary sewer(no.lin.ft.)
Phone:tb&A-loo7Wall Fax: 1{ - qQ'J E-mail: Storm sewer(no.lin.ft.)
' Plumb. service no.lin.ft.)
s CCB no.: (a/a(,o 1 lumb.bus.reg.no:
City/metro lic.no.: p 03xAbsorption Fixture or valve
Absorption valve
Contractor's representative signature: 1 Back flow reventer
m
Print nae: S Rf'Y z`til Dater �jlc [�,)_ Br.,;kH iter valve
E asins/la.-itory
Name: JCt7r'1'Ct1_7 Clothes her
/1
Address:fit". g4 S Srw n K a,y� washer
rinkin fountain(s)City: 91Mt l C, State:R, ZIP: O DriEjectars/sump
Phone:(pgd-h,c"?{7 Fax:(nSd—q E-mail: Ex ansion tank _
11101 Fixturelsewer ca
Floor drains/floor sinks/hub
Name(print): 3 (yl(IY'�SSt 1� /f dYYt< '. +gage .'sposal
Mailing address: 14 azo i lekU d0d Sr Hose btbb
City: LAze- n State:()R, ZIP:g7lee rr er
Phol:e: Tax: E-mail: _ _1nte:ceptor/grease trap _
Owner installation/residential maintenance only: The actual installation Prinlcr(s)
will be made oy me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Si (s),basin(s),ievs(s)
Ownees si ature: Date: Sum
Tub shower/shower pan _
Urinal
Name: Water closet
Address: _ Water heater
City: State: ZIP: Other:
Phone: Fax: E-mail: _ Total I _
Not ell uctadlcdou accept credit card,,please call Juriadicdon fM morc Information. Minimum f-,:................$ r �5
1 Notice:This permit application
❑Visa ❑MasterCard expires if a permit is not obtained Plan review surcharge
(at r_ °b i $ D
Credit card number — —� within 180 days after it has been State surcharge(8%) ....$
x fres /
Name of cardholder u rhnwn on reAit cud S
accepted as complete. TOTAL .......................$
Cardholder signature Amount 4104616(6MCOM)
PLUMBING PERMIT FEES: y�
P ► E TO
,�A :.f`. .E�'r3 xadS^ w`e �fgS OnIY r �J c:`va
T' ytl 1 iricltfde5 al p161nE3 zture dna;, 1 P I E� ;;
FIXTt) ,� }�-( fr is ea "1�+�1 ,• s r+riytart
Sink liCf 16.60 a dwel g,an heft 0 {
16. $249.20
Lavatory 60_ One 1 bath -
Tub or Tub/Shower Comb. 16.60 Two 2 bath 5350.00
Shower Only
16.60 Three 3 bath 5399.00
Water Closet 16.60 SUBTOTAL ':''�• y, ',,'•.;)
Urinal 16.60 a%.STATE SURCHARGE r `'
Dishwasher 16.60 PLAN REVIEW::Y.OF SUBTOTAL
TOTAL
Garbage Disposal
16.60
LaundryTrey 16.60
Washing Machine 16.60
Floor Drain/Floor Slnk 2" 16.6
3"
16.60 PLEASE COMPLETE:
4" 16.60 _
Qan i
Water Heater O conversion O like kind 18.60 R �'
Gas piping requires a separate mechanical I ureie ���gacw� r ped! .
permit. 46.40 Sink ----
MFG Home New Water Service Lavatory -
MFG Home New San/Storm Sewer 46.40 ---'
- Tub or'Tub/Shower
Hose Bibs 16.60 Combination -
Roof Drains 16.60 Shower Only -
18.60 Water Closet
Drinking Fountain _ Urinal
Other Fixtures(Specify) 16.60 Dlshw cher
Garbage Disposal
Lound Room Tra
-
Washing Machine
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3'
Sewer-each additional 100' 46.40 4" ----
Water Service-lel 100' 55.00 Water Heater
48.40 Other Fixtures
Water Service-each additional 200' S eci -
Storm&Rain Drain-1 st 100' 55.00
Storm&Rain Drain-each additional 100' 48.40
Commercial Back Flow Prevention Device 46.40
Residential rlackfiow Prevention Device` 27.55
Catch Spain 16.60 _
Inspection of Existing Plumbing or Specially 72.50
Re u9 ested Inspections _ per/hr COMMENTS REGARDING ABOVE: --
Raln Drain,single family dwelling 85.25 _
Grease Iraps 18.60
QUANTITY TOTAL
Isometric or riser diagram Is required if _--
Quant Total -
"SUBTOTAL (0 is. C` _
8%STATE SURCHARGE y0
"PLAN REVIEW 25%OF SUBTOTAL
Required on( If fixture t .total la>g
TOTAL S3rjr�S
Minimum permit fee Is$72.50+s%state surcharge,except Residential Backflow
Prevention Device,which Is$38 25+a%stale surcharge.
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan review
lAdsts\forms`,plm-fees.doc 10110/00
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST _ -
BLIP _ -
Received _ —Date Requested_ _ AM PM Blip
Location _ �- 1 C j(-�-�� �i.�� )— Suite_ MEC _
Contact Person -� Ph ( ) PLM 7 -01C 000,
Contractor- — — - Ph ( ) SWR _
BUILDING Tenent/Owner ____ _ ELC
Footing
Ft
Foundation
Access: ELC
g aELR
ICrawl Drain -�--1--
Slah Inspection Nates: SIT
Post&Beam
Shear Anchors
Ext Sh,iath/Shear
Int Sheath/Shear - r
Framing
Insulation -
Drywall Nailing
Firewall L
Fire Sprinkler
Fire Alarm
Susp'd Ceiling —
Roof
Other: --- — -- — — — _
Final
PASS PART FAIL - -- ----
Post&Beam -' - --- ------ --
Under Slab _
Rough-in � --
Water Service
Sanitary Sewer —
Rain Drains —
Catch Basin/Manhol-
Storm Drain
Shower Fan
Other.
MSC'PART FAIL - --- - -
CHANICAL�
Post&Beam
Rough-In
Gas Line
Fmoke Dampers
Final
PASS PARTFAIL -- -- -
ELECTRICAL
Service - — --
Rough-In
UG/Slab --
Low Voltage _
Fire Alarm --4—�----� --�" "— -- -
Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PAIS r FAIL
SITE —_ Please call for reinspection RE:— Unable to inspect-no access
Fire Supply Line
ADA
l
Approach/Sidewalk Do" Inspector -�. -- -- Ut
Other.
Final - " DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OFTIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received ____.._ Date Requested—AM_— PM BUP -- _
Location 4 Suite _ -- MEC
Contact Persc,n _-� ph( ) G y y Y3-7 PLM --.—
Contractor _ Ph( ) SWR _
BUILDING _ Tenant/Owner — —_ ELC _
Fooling --`—-----
Foundaticn Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam `-
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear -- - --- - -----
Framing _-- ----- - - ---- — ------
Insulation _-------_�-___---
Drywall Nailing -------_------- --- _.- - --------.-_----_Firewall
Fire Sprinkler
Fire Alarm -
Susp'd Ceiling ------
Roof -------------- --- ----
Other.-- -�.`------- ----- — ---k-PART
P _FAIL ------- -- - . -- ---- -
N_G —
Post&Beam -- - -- --
Under Slab
Rough-In -----
Water Seri/ice
Sanitary Sewer
Rain Drains - - -- --- ------ - - -- —
Catch Basin/Manhole -
Storm Drain ----- - --- - -
Shower Porn
Other.- --- - --- -- - ---- _ ------..--- -- --
Final
PASS PARTFAIL ------- ---- ---
MECHANICAL
-MECHANICAL
Post& Beam
Rough-In -----__- - --- -__ -_-.-----
Gns Line
Smoke Dampers -------- - - - --- - ---
Final
PASS —PART,__FAIL -------- --- ---- —__— —
ELECTRICAL
Service __— -- ----------
Rough-In
UG/Slab - -- _—__ -- --__--
Low Voltage
Fire Alarm - - —�-
Final Reinspection fee of$—__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS—PART FAIL
SITE — - [� Please call for reinspection RE:— Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dane-Y � _— Inspector_ —_ T—_ Ililxt —
Other:
Final — DO NOT REMOVE this Inspection r000rd ho►n the job She.
PASS PART FAIL
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST —
INSPECTION DIVISION Business Line: (503)639-4171 BLIP -
Received Date Requested_+-. Z T_o AM—. PM_ -.- BLIP ---
Location 2 Q 10 LGW 4 AJ - -- _Suite_- -.-- MEC _ —
Contact Person Ph PLM -
Contractor Ph( ) SWR --
ILDIN Tenant/Owner --__- __ ELC
Footing ELC
Foundation Amoss: ELR -----
Ftg Drain
Crawl Drain SIT _ -.—
Slab Inspection Notes:
Post&Beam ----- -- -- - - ---
Shear Anchors
Ext Sheath/Shear -
Int Sheath/Shear1711
5 ,A?&
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm12ter6
Susp'd Ceiling
Roof —
Other:-.
IRMA
ASS PA FAIL
PLUMBING --- -- --- —
Post&Beam
Under Slab -
Rough-In
Water Service -
Sanitary Sewer _ —
Rain Drains - --
Catch Basin/Manhole -
Storm Drain -
Shower Pan
Other: _-_—
Final
PASS—.PART FAIL -
MECHANICA - -- —
Post& eam -
Rough-In -
Gas Line - --.
SECT
DampersPART FAIL
RICAL - ---__-_- -- - --- ------ -
Service ----�-----
Rough-In ----- -- --
UG/Slab _
Low Voltage - --- -- --
Fire Alarm
Final El Reinspection fee o'.$ req.jired before next Inspection. Pay at City Hall, 13125�W Hall Blvd.
PASS PART FAIL
81TE r-1 Please call for reinspection RE:-_____-- _- n Unable to inspect-no across
Fire Supply Line
ADA Dab -----
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the fob site.
PASS PART FAIL
CITY OF TIC--/ .RD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171 ��–
BUP
Received ---Date Requeste1.— _—AM _ PM.--_____ BUP —
Location —^_ �1LU —_ AJ Suite —__ MFC
?
Contact Person _— - — Ph -7 PLM
Contractor __-_,______ Ph( ) SWR _—
Pt IILDING Tenant/Owner ELC _
Footing ELC _.
Foundation Access:
Ftg Drain ELR
Crawl Drain —
Slab Inspection Notes: SIT
Post&Beam ------...---- -- -- ---
Shear Anchors
Ext Sheath/Shear
Int SheathJShear
Framing / `,�
Insulation rj j 1)0 (A A_1A tJI u
Drywall Nailing —�1—
Firewall
Fire Sprinkler — �—
Fire Alarm _
Susp'd Ceiling ——
Roof
Other:
Final
PASSPART FAIL
UM
PLB_INGPost& Bea
Under Slabm A��J[�� A�
RoughService
e
Water Se
rvice [�
Sanitary Sewer Lp
Rain Drains
Catch Basin/Manhole
Storm Drain _--- — —
Shower Pan
Other:
Final - ---_-----
PASS _PART FAIL
MECHANICAL
Post& sem
Rough-In
Gas Lino
Smoke Dampers ---- — --- -
Final
PASS PART FAIL --------- --- - _—_ �—
ELECTRICAL— _ --- ----- -- --. �-
Service
Rough-In Crl L —_�—
UG/Slab
Low Voltage — — _-
Fire Alarm
Zt�bPART FAIL Reinspection fee of$ _ required before next inspection. Pay at City Hall, 131;i SW Hall Blvd.
SITE _ [] Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA gyrate �� ` Q __ _ Inapeattt --Ext—
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from •job site.
PASS PART FAIL