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Permit CITY TIGARD PLUMBING PERMIT i 4, DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00228 `�'` ''III DATE ISSUED: 5/2312006 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 PARCEL: 2S 103CC -05300 SITE ADDRESS: 13617 SW 121ST AVE ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Replace water service. CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 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: 60 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES CAROL STOTLER 13617 SW 121ST AVE Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 5/23/2006 $72.50 [TAX] 8% State Surcha 5/23/2006 $5.80 Phone : 503 -590 -1071 Total $78.30 Contractor: CASEY'S PLUMBING INC ° PO BOX 30075 PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 253 -0030 FAX 503- 262 -8251 Reg #: LIC 147298 PLM 26 -725PB 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: « r / �(1 Permittee Signature: , t, Call 503- 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. n • I. r .. Plumbing Permit Appl r q . --• , FOR OFFICE USE ONLY City of Tigard Dat «,Bed, , . ` j� _ Date/13 : .1 'v) Perwt o' \ �a: w / 06, " 'Iii 13125 SW Hall Blvd,' Tigard, OR 97223 Yla ❑Rr trn Phone: 503.639.4171 Fax: 503.593.1960 e th ut lr et I'emitt No 24- Hour Inspection Line: 503.639.4175 MAY 1" ` ;,.� Da te R d +7� Da te Rea /B An.; Internet: www.ci- tigard.or.us �� -s ( Y o � I ( � S See moat for �y TIUndili Notified/Mcthod I Supplemental Information j 1 }I c pint:, Tire TOI FEE* SC'HED[7LE El New construction � ' I e l moi ti o ` t `-` " x For special information use checklist. De criMinn I Qty. I Ea. 1 Total XAdditiordalteration/replaccment CI Other: New 1- 2- family dwellings (includes 100 ft_ for each utility connection) CATEGORY OF ('ONSTRU(TION SFR (I) bath 249.20 Sit 1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 CI Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. If.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: r f '3r ly J7 0 , 2\ . Ave_- Catch basin or area drain 16.60 City /State/ZIP: ( - i /�(�� of.., O - I g F � Y � Dr well, leach line, or trench drain 16.60 Suite/bldg. /apt- no.: . J Project name: Footing drain (no. linear t : ) Page 2 J Cross street/directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ti: ) Page 2 Storm sewer (no. linear ft.: ) I Page 2 Subdivision: I Lot no.: . ' Water service (nu. linear it.: C ) } ] Page 2 53 Tax map /parcel no.: Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 '! Si g r o QQ (..„...Y re... Si r... Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 4 PROPERTI OWNER 1:i TENANT Drinking fountain 16.60 Name: CO k � �� Ejectors/sump 16.60 L Expansion tank 16.60 Address: 13 Lo •1 t--1 5su 3 1 l< r - Fixture /sewer cap 16.60 - City /State/ZIP: ------c:‘ c 0 t'L ,, 1 i C -.1‹"-.Q ' Floor drainifloor sink/hub 16.60 Phone: (a4:5) 5 Q S -) -1 ) F ax: ( ) J Garbage disposal 16.60 APPLICANT Hose bib 16.60 A ❑ CONT ACT PERSON Business name: CaS,L . 1 u . ,.,,, I _ ! - 1 C Ice maker 16.60 t� Y 1 V> �[�() Interceptor /grease trap 16.60 Contact name: �IA�.M1 C ash Medical gas (value: S ) Page 2 Y v c--..6i,.. Address: e� g j7 )t ` Primer 16.60 City; State /! lP: ` �-1 -� � Q C^` q Lt. Roof drain (commercial) 16.60 Phone: (s - 0 3 lC 2 53.0030 Fax: Sink/basin/lavatory 16.60 �� ) a - 8� s ( Tub/shower/shower pan 16.60 E -mail: A . ' IL .• a__ ' •I ' it - AL Urinal 16.60 CONTR.- TOR Water closet 16.60 Business name: SAX_ Water heater • 16.60 Address: Other: City /State/ZIP: Subtotal Minimum permit fee: $72.50 `--r Phone: ( ) Fax: ( - ) Residential backflow minimum permit fee: $36.25 I CCB Lic.: 1 14-1 C, PlumbingLic. no.: 0(p- 72s Plan review (25% of permit fee) � -' State surcharge (8% of permit fee) 6 Authorized sienatum: kr n � 0.0-4T1ph C 7g ,' U J TOTAL PERMIT FEE c30 Print narnc:j i ` ` ` l I ' n m p h e_ I i Date: 5/) a /Q(i This permit application expires if a permit is not obtained within 4 180 days after it has been accepted as complete. *Fee methodology set by T'ri- County Building Industry Service Board. is/ Building `.Vermits\ -Pe: nitApp.dec 06105 410-4616T(1 N0LCOM/WEB) L L939 - E09 6uigtunid sAeseo d90 :CO 90 ZZ'eW CITY OF TIGARD BUILDING DIVISION = r PERMIT #: PL.M2006- 00 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/23/2005 Phone: (503) 639 -4171 u�ii�� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5124/2006 TIME: 7:12Atvi PAGE: 55 SITE ADDRESS: 13617 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: STOTLER DESCRIPTION: Replace water service. OWNER: STOTLER, CAROL PHONE #: 503-690-1071 CONTRACTOR: CASEY'S PLUMBING INC. PHONE #: 503-253-0030 Inspection Request Scheduled For: Date: 5/24/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 030486-01 503. 253 -0030 i Corrections/Comments/Instructions: L .Le — ,5 r "ASS iPPARTIAL APPROVAL n CANCEL ❑ NO ACCESS I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: l k Date: Phone #: (503) 718 1/,3/