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Permit C ITY OF TIGARD PLUMBING PERMIT a ; � l �� DEVELOPMENT SERVICES PERMIT #: PLM2001 -00247 I� 13125 S Hall Blvd., Tigard, OR 97223 (503)639 -4171 DATE ISSUED: SITE ADDRESS: 15111 SW 83RD AVE PARCEL: 2S112CB -17100 SUBDIVISION: HAMPTON COURT ZONING: R -7 :BLOCK: LOT: 020 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OT HER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of back flow preventer device. FEES Owner: Type _ By Date Amount Receipt MARK DOBSON PRMT CTR 6/13/01 $36.25 27200100000 151 SW 83RD 5PCT CTR 6/13/01 $2.90 27200100000, TIGARD, OR 97223 Total $39.15 Phone 1: 503- 968 -9041 . Contractor: TRYON CREEK LANDSCAPE INC 11400 SW NORTH DAKOTA ST TIGARD, OR 97223 REQUIRED INSPECTIONS Phone 1: 624 -2174 RP /Backflow Preventer Reg #: LIC 11525 Final Inspection PLM 6296 • • 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 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: J r r� r . Permittee Sig Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day Aite CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2001 -00247 ', 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: PARCEL: 2S 11X8 -17100 SITE ADDRESS: 15111 SW 83RD AVE SUBDIVISION: HAMPTON COURT ZONING: R -7 BLOCK: LOT: 020. JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: 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 back flow preventer device. FEES Owner: Type By Date Amount Receipt MARK DOBSON PRMT CTR 6/13/01 $36.25 27200100000 15111 SW 83RD 5PCT CTR 6/13/01 $2.90 27200100000 TIGARD, OR 97223 Total $39.15 Phone 1: 503 - 968 -9041 Contractor: - TRYON CREEK LANDSCAPE INC 11400 SW NORTH DAKOTA ST TIGARD, OR 97223 REQUIRED INSPECTIONS RP /Backflow Preventer Phone 1: 624 -2174 Final Inspection Reg #: LIC 11525 PLM 6296 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: 01 Permittee Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day a` CITY TIGARD PLUMBING PERMIT �. � i;� DEVELOPMENT SERVICES PERMIT #: PLM2001 -00247 ` '� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: SITE ADDRESS: 15111 SW 83RD AVE PARCEL: 2S112CB -17100 SUBDIVISION: HAMPTON COURT • ZONING: R -7 BLOCK: LOT: 020 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: 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 back flow preventer device. - FEES Owner: Type By Date Amount Receipt MARK DOBSON PRMT CTR 6/13/01 $36.25 27200100000 15111 SW 83RD TIGARD, OR 97223 5PCT CTR 6/13/01 $2.90 27200100000 Total $39.15 Phone 1: 503 - 968 -9041 Contractor: TRYON CREEK LANDSCAPE INC 11400 SW NORTH DAKOTA ST TIGARD, OR 97223 REQUIRED INSPECTIONS Phone 1: 624 -2174 RP /Backflow Preventer • Reg #: LIC 11525 Final Inspection PLM 6296 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. _ _ ( T Issued By: Ai _ /, rr� Permittee Sig Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application Datereceived: Vol Permit no.? x / -01) 7 y " 11 T City of Tigard I ` 6 Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: BySei Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT 0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration /replacement U Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special iuforn ation use checklist) o Job address: j � (1 1 S n 3 f r> A -e- Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: (Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: i 4., r i I ZIP: ' 22 Each additional bath/kitchen scription and location of work on premises: Site utilities: _ u � ► WS A- ( V'I' - { Catch basin/area drain Est. date of completion/inspection: Drywells / leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name :�� C_p��t ( J f � k Qe Manholes Address: (1' -100 -. JoC -F'L ) t4 St Rain drain connector City Al•r7 r7 I State0(Z ZIP: 1 122 `2, Sanitary sewer (no. lin. ft.) 9 ° O E-mail: Storm sewer (no. lin. ft.) Phone :So`�} 102( -AI. •�oz` `�o I E CCB no.: /5? $ /�,l /pa.I.Plumb. bus. reg. no: Water service (no. lin. ft.) lr Ci /metro lic. no.: Fixture or item: G ' Contractor's representative signature w Absorption valve Back flow preventer Print name: - € 0; u (LQse , Date: , -13 - Backwater valve CONTACT PERSON Basins/lavatory ,_ Name: 44 J w T>.c q./2sc �- Clothes washer Address: 1(1 o f St.J far r-t- ,- t t 4k� -kw 5* Diinkinshwngfo Drinking fountain(s) City: brs:12.0 I State:02_ I ZIP: a * Z -Z- Ejectors/sump Phone: (pct '-41 1 (o Fax: fo2`('1' SF? 0 -mail: Expansion tank OWNER Fixture/sewer cap �q Floor drains/floor sinks/hub Name (print): 1M l 6 `TDo b •e-P.vr∎I Garbage disposal Mailing address: 1St 11 St.�) a 3 ( kJ sz_ Hose bibb City: 4 - 4-p,/-) I State: 0 p I ZIP: ' z- 1.5 Ice maker Phone: 9 I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made 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. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information Minimum fee $ N otice: This permit application Plan review (at _ %) $ U Visa 0 MasterCard expires if a permit is not obtained Credit card number / / State surcharge (8 %) .... $ t; . Expires / within 180 days after it has been p TOTAL $ 39 _ I Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/00/COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 . for each utility connection) One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 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' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backf low Prevention Device* 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL 8% STATE SURCHARGE ''*PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. is \dsts\forms\plm - fees.doc 10/10/00 IT Y OF TIGARD BUILDING INSPECTION DIVISION -_ � 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested AM PM BLD Location /571/ 5 (4) e 3vitifidP Suite MEC Contact Person Ph 2 0 • Contractor Ph // SWR BUILDING Tenant/Owner L uca l 4/ w . h? ./h4"- ELC Retaining Wall . ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: • Slab SIT • Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall . Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PA BART - FAIL. PLU Beam A Under Slab 6 Top Out I Water Service Sanitary Sewer • Rain - :'ns • Fir= 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 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 [ ] Please call for reinspection RE: [. ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk - Other Date 2/ Inspector Ext� Final PASS PART • FAIL DO NOT REMOVE this inspection record from the -job site.. - . CITY OF TIGARD BUILDING INSPECTION DIVISION - MST 54 - Hour Inspection Line: 639 -4175 Business 639 -4171 • BUP Date Requested z 7' AM PM BLD • Location /)1/f ' Sw 63 `� Suite MEC • Contact Person Ph j7 - c / l f / PLM •q) 6 f -6-6 2e/7 Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing ' Access: Foundation ' I C rd FPS Ftg Drain Q SGN • Crawl Drain - - • Inspection Notes: T � w � ,/ Slab ! �J'I�� - rte SIT • Post & Beam Ext Sheath /Shear Ina Sheath/Shear 1 1 Cre 11 a � v � A L U Framing � X"? S a t vt D c� -LL Insulation . Drywall Nailing )ce�.. / /O J Gr.Q Q V,'C -� Firewall Fire Sprinkler . /� n .� � � _ i 1 S 4 v < < '•e • Fire Alarm , . Susp'd Ceiling C hnr /6 /a_ a 7)-02p. Roof Misc: Final `� i1 PASS . PART FAIL �r ®V J %- - f/'e �radr C-e �r6�� 7Z-e... < 'e - Post & Beam Under Slab (O GI C e ?) ?rO V . ' d-e- 5 Cra ile 1 I A 1 p (.did e - •° l/� E.. Top Out Water Service 'F 1 '"' Sanitary Sewer �I 4 Rain Drains Final PASS PART AIL MECHANICAL • - 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 [ . ] Please call for reinspection RE: • [ ] Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date lO /76 /6/ Inspector /..) 0' , Ext Final PASS • PART FAIL DO NOT REMOVE this inspection record'from the job site.•. .