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Permit • C ITY OF TIGARD PLUMBING PERMIT IA DEVELOPMENT SERVICES PERMIT #: PLM2000- 00162 �II� DATE ISSUED: 05/19/2000 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -417 . SITE ADDRESS: 11250 SW 82ND AVE PARCEL: 1S136CB -02100 SUBDIVISION: RANCH VALLEY • ZONING: R -4.5 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACK FLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: ' SF RAIN DRAINS: SINKS: URINALS: G REASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: • SEWER LINE: ft WATER CLOSETS: . WATER LINE: 100 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install a hose bib and water line. FEES Owner: Type By Date Amount Receipt RORMAN, JAMES M + SUSAN M PRMT GEO 05/19/200C $50.00 0002317 11250 SW 82ND AVE 5PCT GEO 05/19/200C $4.00 0002317 TIGARD, OR 97223 Total $54.00 • Phone 1: Contractor: MP PLUMBING CO . • • MILWAUKIE PLUMBING CO PO BOX 393 REQUIRED INSPECTIONS CLACKAMAS, OR 97015 Phone 1: 655 -9161 Water Line Insp • Final Inspection Reg #: LIC 000050 PLM 3 -17PB • . ORIGINAL - • _ 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 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. Issued By: �� �7 Permittee Signature: Call (503) 639 45 by 7:00 P.M. for an inspection needed the next business day ge;IT'r4F TIGARD. Plumbing Permit Application Plan Check# 13125'SW HALL BLVD. Commercial and Residential RECEIVE ® Rec'd By i TIGARD, OR 97223 Date Rec'd (503) 639 -4171 WAY 1 9 20 Date to P.E. Print or Type __ Date to DST .. Permit Permit # 1pG�?Roe0 - tro142 Incomplete or Illegible applications will rf8Higi ' 7 Related swR Called y pf Develop . nt/PP:Oct ti, ES'Aindivi¢ual f � _ ; 4,n i �.`�#'= 'QT , 4PRICE AMT v Job ' reY ISink 11.50 Address. • -: ' - ` Qr� / Suite �.evatory, 11.50 �� � r . . G i � �� Tub or Tub/Shower Comb. 11.50 . .81dg #,.. -, , /Stet = . Zi . Shower Only 11.50 � � . / Water Closet/Urinal (Specify) 11.50 Dishwasher 11.50 Owner Mailing Address Suite Garbage Disposal 11.50 CRylState .. Phone . .. , _ Washing Machinellaundry Tray ` (Specify)' 11.50 - . - • Floor Drain/Floor Sink Y _ - 11.50 - - Name 3' 11.50 . _ .. 4. 11.50 Occupant • Mapmo Address Suite Water - Heater 0 conversion 0 like kind 11.50 ' Gas piping requires a separate mechanical permit. • City/State Zip Phone MFG Home New Water Service 28.00 Nam y e ��/ 1/1 MFG Home New San/Storm Sewer 28.00 !�7 ii �� A- :i - Hose Bibs - / 11.50 #. Contractor , o . fling / : ddress t3 hill1111 Rain Drains 11.50 • - ..t ii I A . Drinking Fountain 11.50 Prior to ; !State Zip ho I P P Other Fixtures ( Specify) 15.00 issuance, s pyeL._i . u . ©- 1A of all licenses are Oregon Cont. Board Lic.# .. P - - required if ..�,:-- • I/ expired in COT ' Plumbin a Lic. # VAR1111 database /7/ Name Sewer - 1st 100' 38.00 Architect - Sewer - each additional 100' 32.00 • or Mailing Address Suite Water Service -1st 100' .. / 38.007 Engineer City/State Zip Phone Water Service - each additional 200' 32.00 • Storm & Rain Drain - 1st 100' 38.00 Describe work to be done: Storm & Rain Drain - each additional 100' 32.00 New 0 Repair . 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00 Residential O Commercial 0 Residential Back Prevention Device* 19.00 Additional description of work: Catch Basin 11.50 Insp. of Existing Plumbing 50.00 Are you capping, moving or replacing any fixtures? per/hr Yes 0 No 0 Specially Requested Inspections 50.00 If yes, see back of form to indicate work performed by . per/hr fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00 WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps . . 11.50 I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL 0 1 , • given Is correct, that t am the owner or authorized agent of the owner, and Isometric or riser diagram Is required if Quantity Total Is > 9 that , • ; submitted are in corn • iance with 0 - y on State Laws. *SUBTOTAL Sig , 1 • OwnedAgent �� /� ' 7 /L_ � `. ,4; 7% SURCHARGE ,L k `*PLAN REVIEW 25% OF SUBTOTAL `�} r � it T"-7 ; - I , i i,3 _ r" ':. 7•"7 a*.• � -`r Required only If fixture qty. total is > 9 '1 < t,r ,, 1i . . TOTAL g/CU , ,6 i , : r „ r,;(0 :iri' IC' 1r4 ' ,? r: :( ;Mir!) ii Ifinl it n; - . .. .- :. , - - . ..i'.' :-)) 'Minimumpermit fee Is $50 + 7% surcharge. except Residential Baddlow Prevention it o , r I. , n i` 11 flay.:; r _■[-i . Device, whldr M ti25 + 796 surcharge . "AII New Commerclal•Ouildings require plans weh isometric or riser diagram and rem. ridsaigennstplusisppdo4 ` ■ PLEASE COMPLETE: i sut0 Type t: y F M µa f ty b , rk PPtiormed ' 1,` : ', t : 1 ' Ne ; ' , Mov ty p l a c e d} . Remo ; -Sink- : ... , i ... ;. Lavatory , Tub'. or Tub /Shower Combination . • 7 - Shower, Only .... ., _ Water Closet ' ' Dishwasher . . • . Garbage Disposal .`..... . ... - Washing Machine... Floo' Drain /Floor Sink 2 ":. . -3" 4" • Water' Heater - Laundry Room Tray. . . - Urinal ' - • - . , - - • Other Fixtures (Specify - . - • COMMENTS REGARDING.ABOVE: - I: ldstsl{o app.doc815f88 1. : CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 . Business • -4171 BUP Date Requested 5/ WOO A ■ BLD Location 11 9. S O `) 7i• -� Suite MEC Contact Person 0P Ph CD S S' T f 62 / PLM 0) •-OO/ (0 Z - Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation I 2- — gij t FPS Ca l Dr J on Notes: SGN Slab I Drain Inspecti /4/2/9... SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing • Insulation • Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL P LUMBING ) Post & Beam Under Slab Water Service anitary sewer Rai. ains •', PART FAIL ANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspect'. RE: [ ] Unable to inspect - no access ADA Date Inspector I Cf 1 Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.