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Permit CITY TIGARD PLUMBING PERMIT al'' DEVELOPMENT SERVICES • PERMIT #: PLM2000 - 00044 ` V III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: SITE ADDRESS: 09909 SW LANDAU PL PARCEL: 1S125CD SUBDIVISION: TIGARD WOODS ZONING: R - 4.5 BLOCK: LOT: 005 . 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 Rem arks: Installation of a residential backflow prevention device. FEES Owner: Type By Date Amount Receipt JIM NICOLA 9909 SW LANDAU PLACE PRMT GEO 2/17/00 $25.00 00- 321747 TIGARD, OR 97223 5PCT GEO 2/17/00 $2.00 00- 321747 Total $27.00 Phone 1: 503 - 452 - 5560 Contractor: LANDSCAPE EAST, INC PO BOX 30883 PORTLAND, OR 97294 REQUIRED INSPECTIONS Phone 1: 503 - 256 -5302 RP /Backflow Preventer Final Inspection Reg #: OR G/NAL • This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503 246 -1987. j// Issued B : % f Permittee Signature: Y Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Re eived Feb -02 -00 08:24am from 503 1960 -a LANDSCAPE EAST INC page 2 02/02/00 WED 09:19 FAX 503 598 1960 - C.1.-Tr OF TIGARD _ i 002 CIT OF TIGARD . Permit Applic p Plan Check # 13125 SW HALL BLVD. Commercial and Residents L EV ReC'd By TIGARD, OR 97223 Date Recd (503) 5394171 FEB 16 2000 Date to P.E. Print or Type Date to DST Incomplete or illegible applications wiiMalt C y T Pem,it #19 cx"y5/ Related SWR # "i' Called Name of Development/Project ':FIr$' r I' d -: - �-,,t '.- .. Job Sink � �,�,'�`�:? . MP�'� . , .._ 11,60 Address Street Addre s \ ite Lavatory • 1'!09 .J I�✓IC�l�1 \ _ 11.50 Tub or Tub /Shower Comb, 11.50 Bldg* City/State Zi , -r)9CRCI, 02 ° `17223 Shower Oniy 11.50 Name Water Closet 11,50 Q\ YY\ r1 I CO \Ok Urinal 11.50 Owner ailing Address Dishwasher M 60t I,�) t t c u 151t. • 11.50 Garbage Disposal 11.50 City/State ZI Phone goac�,0� 9 1223 235- 21-1 Laundry Tray 11.60 Name Washing Machine/Laundry Tray 11,50 Floor Drain/Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11,50 City/State Zip Phone 4" 11.50 Water Heater 0 conversion 0 like kind 11.50 Name Gas piping requires a separate mechanical permit. L,o.YAASCrCIPa, 44,3`r, T IC. MFG Home New Water Service 32.00 Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00 Yo SO csSeZ Hose Bibs 11.50 Prior to permit City/State i Phone Roof Drains 11.50 issuance, a copy e a R A0oroi 1' � 25(0 - )2 Drinking Fountain 11.50 of all licenses are Oregon Conet. Cont. Board Llc.# Exp. Da s required if , o \ — j _6d Other Fixtures (Specify) 15.60 expired in COT Plumbing Uc. # p. Date database Name A rchitect Sewer -1st 100' 38,00 Or Mailing Address Suite Sewer - each additional 100' 32.00 Engineer City /State Zip Phone Water Service - 1st 100' 38.00 Water Service = each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New lei Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 61 Commercial 0 Additional description of work: Commercial Back•Flow Prevention Device 32.00 • .9.Ay- cN STE,YYt ' C (. c l0� �[J) 4 - Residential tch Basin 8ackflow Prevention Device' 1.60 i Catch Basin 111,60 Are you capping, moving or rep acing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No 0 ins• -. ions per /hr If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. I hereby acknowledge that I have read this application; that the information QUAN TOTAL { ,.:4111,..§.:::51;„.p,,,,,, ' 1 iven is correct. I am the owner or authorized agent of the owner, and isometric or riser diagram Is required it Quantity Total Is > 9 � i z `: is: that =tans _; ;; ed a in com.,,;;r , ith Ore! on State Laws. & -.. t � ~k *SUBTOTAL �,. �,.. � i YY�' 3t • � Q f oN jr Date 7- t' T;, ; :ire .i., . o O �L 8% SURCHARGE :, :_. rz, , 1 — —Ott _�r;' 71;::.y Contact • arson Na e i :`� ='r 4 " x';. ' '., i, `': CO Phone ;.x:� , . '� t "' PLAN REVIEW 2b / OF � ' i<�'- i 7 it.I' / c'^ r � 'R.C� X5 -,5$O L °° F tiUBTOTAL y:, +„ , / r b 3r.�, , ° s'� , � * * m "`TM , "`mc`o""` � giam ��' ', - Required only if fixture qty, total Is> 1 1 5 ' ; ` " u4 t, r. , '�h �a r 'fr''' "'" � 9r t ' ` ¢ 'k'6 .iR' 3 "'r7 �•.I to i. y ge - , , , w�- *V t io �� �l io N - F TOTAL : fi = , , 1 _ _' :,;t y,� Y a ' °, z S a r� .f x r s . ^ a ti jt� li irk ! . - -,- � id l 0 0 ,: a F4 i ,c-' s-..$° 3? x i U^'F i T (- :Fy.::F�,i ..,_ �,,$ x �, iirt ,.� � is � � n .z � r '� �{ p } � �t "' r � , [..iy.. -,. '' 3 , f A 1 , e rr x < . 9 �i; ,� ; a 4 W l s s • MIntmum permit fee is $50 +814 surcharge, except Residential Baenlow Prevention `,, r. ,c... , , fi` h,: r i i` ," 'f ur 4r ..s"u f4 Device. which Is 525* We surcharge "All New Commercial Buildings require plans with isometric or riser diagram and plan review. , 1:ldstaWormstptumapp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION I" `/C( MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 4/i 00 AM PM BLD G Location l D - I ( � ( ,Y� l euA. 9C ` Suite MEC Contact Person Ph 2-'S(9 'S 3©L PLM 2 3 Contractor - Ph SWR BUILDING ; .w .'; Tenant/Owner 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 f s Fire Sprinkler Fire Alarm `,� Susp'd Ceiling Roof Misc: Final PASS PART FAIL UMBING - 5 Post & Beam Under Slab Top Out Water, Service Sanitary Sewer Rain Drains PART FAIL HANICAL - Post & Beam "g 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 reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk j Ext Date Ins ector � /� Other p / / Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.