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Permit a S'r • CITY OF TIGARD PLUMBING PERMIT "'1 DEVELOPMENT SERVICES PERMIT #: PLM2002 -00137 Alf 0,'L DATE ISSUED: 4/25/02 ---' 13125 SW Hall Blvd., T OR 97223 (503) 639 - 4171 SITE ADDRESS: 08465 SW LANGTREE ST PARCEL: 2S112CC 10000 SUBDIVISION: LANGTREE ESTATES ZONING: R - BLOCK: LOT: 032 JURISDICTION: TIG CLASS OF WORK: ADD 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: Install backflow preventer device. FEES Owner: Type By Date Amount Receipt YOST, JEFFREY W + PRMT CTR 4/25/02 $36.25 27200200000 YOST, STACIE L SPOT CTR 4/25/02 $2.90 27200200000 8465 SW LANGREE ST TIGARD, OR 97224 Total $39.15 Phone 1: Contractor: OWNER REQUIRED INSPECTIONS RP /Backflow Preventer Phone 1: Final Inspection Reg #: 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: Permittee Si nature:f._. �Q,.�1 ', 4 g � ..J1 lam( Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day U ` PlumbingPermit Application , . Ci of Ti and � C Date received: � ©y Permit no.: f a -QO 3 7 ; :� �� �J' g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 972 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: ByT Receipt no.: • Land use approval: Case file no.: Payment type: TYPE OF PERMIT . . yll 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family LI Tenant improvement ❑ New construction A Addition/alteration /replacement LI Food service ❑ Other: • JOB SITE INFORMATION - , FEE SCHEDULE (for special information use checklist) q Description Qty. Fee(ea.) Total Job address: t{ lQs SW) l�Q v>fd Q - f_, S Ti JQ rd Bldg. no.: uite 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: IBlock: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: I ZIP: Each additional bath/kitchen Description and locatioil,of wor1c on premises: Site utilities: i �v 1 j ise 7—t se __ Q,, Catch basin/area drain Est. date of completion/inspection: U Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: 0 (j ) J - Manholes Address: Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print name: Date . Backwater valve CONTACT PERSON Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture /sewer cap Name (print): Sket (f. f (D S f Floor drains/floor sinks/hub Mailing address: (4 ( S14) l a v1 4 Q, ' S -- Garbage disposal 4 Hose bibb City: - q r�( I State: 0J ZIP: d 1 a— `t Ice maker Phone: So Q (p$= ] ax: 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 prope I own as per O hap er 447. , J Sink(s), basin(s), lays(s) Owner's signature: Date: `� a Sump - Tubs/shower /shower pan Urinal Name: Water closet . Address: Water heater City: I State: I ZIP: Other: Phone:. I Fax: E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ ? 2 -�f Notice: This permit application Plan review (at %) $ Cl Asa- O- MasterCard _ expires -if -a permit.is- not.obtained Credit card number: / i within 180 days after it has been State surcharge (8 %)... $ ,D .g Expires accepted as complete. TOTAL $ �� G . Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4616 (6/00 /COM) PLUMBING PERMIT FEES: Y `- ., sa 0 .. #1 a -nd'2=famil dweilin% s oul` : ,, $ : ' ` , r .� -��. ';,,, ,�.., `�' �;� 'PRIC tOTAL, � �, � � y : .�re Yfi ° x � " w��'" . �� "FIXTURES ' individ`ual)`�" ,° . ° 'tQTY _ 16.60 the dwel and the f t irst1 00 ft ' QTY tea) `•A MOUNT2 Lavatory 16.60 _for;each' utility connecion) - s 7 ,, _. ', . • One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL '`' Urinal 16.60 8% STATE SURCHARGE 7 4; .. Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL - ° - Garbage Disposal 16.60 TOTAL - *. - Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 'rr .,; ,w -`4 . ?' •'' ; ; , 14$ •' y - ° . Performed , : Gas piping requires a separate mechanical Fixture Type: rt:. -�;` -, N ew "' ` M " 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 Backflow Prevention Device* 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 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 ' ' 1 Quantity Total is > 9 fi.�. >. ' - „ f 1 , *SUBTOTAL AV,r ,-';�.._ ', 8% STATE SURCHARGE zi ' ` 1 Evito **PLAN REVIEW 25% OF SUBTOTAL ,e': %;`O.fk r Required only if fixture qty. total is > 9 ;, ,;.J.:,,N '.,: i TOTAL , . ,,;;. °,° _, n3; , 1 $ * Minimum permit fee is $7 + 8% state surcharge, except Residential Backflow Prevention Device, whic ' $36.25+ % state surcharge. ** All New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. . is \dsts \forms \plm- fees.doc 12/26/01 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested ` Z I AA PM BUP Location S .' %! -e ._4 • ' +�- Suite MEC Contact Person Ph ( ) PLM c2 J / 37 Contractor Ph ( ) SWR BUILDING Tenan • q(o, F - 7 7 ELC Footing ELC Foundation g Access: / � ��i� ELR Ft Drain Crawl Drain Slab Inspection ote �/ SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING - Post & Beam - Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Q ` " r, Other: /d � ''Fi S 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: Unable to inspect — no access Fire Supply Line Inspector - l `. Ext Approach /Sidewalk Date Other: Final DO NO REMOVE this inspection record from the Job site. PASS PART FAIL