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14465 SW HAZELHILL DRIVE c. 2 N m v N 14465 SSV Hazelhill Drive \ CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT##: PLM2001-00147 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/11/01 PARCEL: 2S110BB 01600 SITE ADDRESS: 14465 SW HAZELH1,_L CSR SUBa IVISION: AMES ORCHARD ZONING: R 1 BLOCK: LOT: 009 _ v_ _ _ _JURISDICTION: TIG___ JvCLASS OF WORK: ALT GARBAGE DISPOSALS: IV,�OBILE HOME SPACES: TYPE OF USE: -:F WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: _ FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: 1 SEWER LINE: ft WATER CLOSET: 1 VVATER LINE: ft DISHWASHERS: RAIN GRAIN: tt Remarks: Repiace one sink, one tub/shower, one water closet FEES Owner: _ Tyaa By Date Amount_ Receipt ORNELAS, STEVE PRMT CTR 4/11/01 $72.50 27200100000 14465 SW HAZELIAILL DR 5PCT CTR 4/11/01 $5.80 2.7200100000 TIGARD, OR 97223 — Total $78.30 Phor? 1: (:ontractor: CROWN PLUMBING 5429 SE FRANCIS PORTLAND, OR 97206 REQUIRED INSPECTIONS Rough-in Insp Phone 1: Sr)3-771-9449 Top-out Insp Reg#: LIC 42671 Final Inspection PLM 34-70PB 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 189 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 qut•stions to OUNC by calling (503) 246-1987. Permittee Signatu Issued By: re: Call ( 03) 639-4171 by 7.00 P.M. for an inspection needed the ney'husiness day Plumbing Permit Application Date recciveri: —/-p Permit no"l ;749/-Ov City of Tigard Sewer permit no.: Building perndt no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 City of Tigard Phone: (503)639-4171 PmjecUappl.no.: Expire date: Fax: (503) 598-1960 Date issued: By Receiptno.: Land use approvtil: _ Case C1e no.: Payment type: s ' 14 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alterationlrepiacement U Foori service U Other: INI-70,RMATIONtinforniation use cheek Ist) Job address: S�'J / ' r, Description_ Qt)'. 1'ec-(ea.) I utal Aift Vj- New 1•and 2-family d"ellings only: Bldg.no.; Suf a no.: (includes 100 A.f wreacl►utllily connection) Tax map/tax loUaccount no.: SFR(1)bath Lot: Block: Subdivision: SFR(2)bath Project name: _ ^ _ SFR(3)bath y �` City/county'-fj^17C.11VI—M,0-4-, I'LIP: '7).7-c/ L:ach additional hatTkitchen rhac ►ion an ocu on of work r n remises:_ _ Site utilities: ,KP Vyt � I3 ��s Catch basin/area drain r st.date of completion/inspection: Drywells/lcach line/trench drain Footing drain(no.lin.ft.) Manufactured home utilities Business name: (d g-Frc.-^ P f3 A Cvz-A. /uv16,. Manholes Address: Lf 2` 5f- q. c-, S: ' Rain drain connector _City: r ori r r State:014, I ZIP: 97:10 ( Sanitary sewer(no.tin.ft.)Y Phone: 7 7/-5►4&1 y Fax: )/• FYs ti I E-mail: Storm sewer(no.lin.ft.) rCCB no.: y,Z / 1 Plumb,bus.reg.no: 3,9.70 AD Watet service(no.fin.ft.) City/metro tic.no.: / Fixture or Item: Absorption valve Contractor's representative signature: �'' Back flow prove„ter Print name: .t V.r (,bl r, ;;57 ! : : f3 itt" t -1 �" / Backwater valve Basins/lavatory _ Name: (� r Glottics washer Ashwasher Address: Drinkingfountain(s) City: _ State: ZIP: Ejectors/sum Phone: ----Fr,—ax E-mail' Expansion tank Fixturelsewer cap _ loor drains/floor sinks/hub (rrnt): ,riv z I oN Garbage disposal Mailing addre.9% /y At t, e/k t'I Hose bihb City: ) ' I ell C1 Mate:()r ZIP: 7» Y Ice maker Phone: } b�"s Fax: E-mail: Interceptor/grease tri Owner installation/residential maintenance only: The actual installation Primer(s) will he 7iade by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Smk(s),basin(s), ays(s) Owner's signature: _ Date: Sump Tu s/shower/shower an U ;1 Name: _ iter closet C Address: _ ater eater City: State: ZIP Other: Phone: _ Fax E-mail: Total Not att juriedictlons accept credit cards,please con juriattctlnn for moxa Infatrrution. Y Minitnum fee.............. . Notice:'Phis permit application Plan review(at __ %) $ U Visa U MasterCard expires if a penntt is not obtained U State sure harge(8%).... Credit card number — within 180 days after it has been — accepted as complete. TOTAL ......................$ S Name or cii-RWder u shnwn on credit cwt $ Cardholder il�nawie �matal 4404616(6MCOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: --- FIXTURES individuals _ (TY (ea AM011N_T (Includes all plumbing fixtures in PRICE TOTAL Sink ' 16 60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory r ;6.60 for each utility_connection Jne�ath 3249.24 Tub or Tub/Shower Comb. 18.80 Iwo 2 bath _ $350.00 Shower Only / 16.60 '14,40 Three 3)bath $399.00 Water Closet 16.80 SUBTOTAi Urinal _ _ 16.60 8'/e STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL_ Garbage DiLposal 16.60 TOTAL Laundry Tray i 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 1 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater O conversion O like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ per lit. _ _ Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/E hower Hose Sibs - 16.80 Combination Roof Drains le.60 Shower Only Drinking Fountain 16. 00 Water Closet Other Fixtures(Specify) 16.60 Urinal Dishwasher _ Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" Sewer•1st 100' 55.00 3" Sewer-each additional 100' 46.40 4" - Water Service• 1st 100' 5500 Water Heater Water Service-earh additional 200' 48.40 Other Fixtures Storm$Rain Drain-1st 100' 55.(J (Specify) -' Storm 6 Rain Drain-each additional 100' 46.40 Comm -tial Back Flow Prevention D;vice 46.40 Residential Backflow Prevention Devlt,e' 27.55 -- Catch Basin 16.60 --- - - Inspection of Existing Plumbing or Specially 72.50 _ Requested Inspections or/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 6525 Grease Traps 1660 QUANTITY TOTAL -- --- - ------ Isometric or riser diagram is required If ---- -- - --- Quantity Tntal is >9 'SUBTOTAL i - -- - 8%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL -- _ -�-`---- --- Required only if nxlure qty total is>P _�---- TOTAL - $ - `Minimum permit fee Is$72 50•8%state surchargP.,exrept Residential Backflow Prevention Device,which is$30 25•8%state surcharge I New Commercial Buildings require plans w,th isometric or rlser diagram and plan review i:%dsts\forms\plm-fPes.doc 10110/00 CITY Oh TIGARD BUILDING INSPECTION DIVISION 2441our Inspection Line: 639-4175 Business Line: 639-4171 p BUP Date Requested ell --AM PM BLD Location / Y `� 54' A --�X 1 f2k ' Suite MEC, Contact Person _ Ph Jb 3' 71,l—y—y y PLM' �"—" d� t V 7 Contractor _ Ph SVR - BUILDING Tenant/Owner _ ___ E`1_ - - Retainmg Wall ELR -- Footing Access:��jl/1/` "'1t S(�-O�A.rQ!' �/v�c.�r' c F'PS Foundation l u -- Fig Drain '" SGN -__-.----_.. Crawl Drain Inspection Notes: SIT -.- Bleb Post&Beam Ext Sheath/Shear - Int Sheath/Shear J f Framing -- — - Insulation Drywall Nailing - Firewall Fire Sprinkler Fire Alarm I Susp'd Ceiling t /� Roof D) IAJ - Misc: — -r---r—, Final _ PASS PART FAO. Post Beam Under Slab 3it _� Top Out ' A.M"j, Water Serv4 -- Sanitary Sewer PE ins PART FAIL _ — oseam Rough In Gas Line — Smoke Dampers — Final PASS PART_ FAIL ELECTRICAL Service - Rough In UG/Slab -- -- Low Voltage Fire Alarm �— Final PASS PART FA!1_ I - SITE Backfi!1/Grading Sanitary Sewer Storm Drain [ Reinspection fee of$ _ required bPfare next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Beisin [ ]Please call for reinspection RE: [ ]Unable to inspect-no access Fire Sit,:;oly LIn^ ADA , .. Appr�ach!:'.id3walk Date d �_. Inspector ti2''� V - v Ext 1 Othei - Sinal PASS PART FAIL DO N DT REMOVE this inspection record from the job site.