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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: P 8/2004 -00256 -I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/8/2004 SITE ADDRESS: 11620 SW LOMITA AVE - PARCEL: 1S135DD -03620 SUBDIVISION: LOMITA TERRACE ZONING: R -4.5 BLOCK: LOT: 009 JURISDICTION: TIG 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: 1 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: Replace water heater in duplex unit addressed as 11600 SW Lomita Ave. FEES Owner: Description Date Amount WANG, PING -JUI KAI 22600 SW 93RD TER [PLUMB] Permit Fee 6/8/2004 $72.50 TUALATIN, OR 97062 [TAX] 8% State Surcharl 6/8/2004 $5.80 Total $78.30 Phone: Contractor: OWNER REQUIRED INSPECTIONS Phone : 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(10_01_01I0. You may obtain copies of these rules or direct questions to OUNC by calling (503) 2 6 -6699. ia sued By: 1 *I i�� i l a f Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b e s day Plumbing Permit Applicatio® _ ": ', ' • . , FOR OFFICE USE O ■Ll • City of Tigard Received d (1 Permit No.. 0 / . 49t0 OO 13125 SW Hall Blvd., Tigard, OR 97223 Date/By Plan Review v �r++``�"` �� Phone: 503.639.4171 Fax: 503.598.1%0 / ca e- Date/By: Ot Permit No.: 24- Hour Inspection Line: 503.639.4175 '� Date Ready/By. kais: 0 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method. Supplemental Information ... w> _ TYP OF WORK: _ , ,.. k f K l FEk - 7.571IED IILE ". 1 i`` ' ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ki Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) . .. 1 a 'CATEGORY O,F CONSTRUCTION , ; " ; y: .. �,., .) SFR (1) bath 249.20 X 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building 12 Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2 - ,: , , °. �J SITE IN ATIO 'AND�LO AT N O, tr'4 Site utilities Job site address: ! ' 600 S(A) Leryy z,J', Ave _ Catch basin or area drain 16.60 City /State /ZIP: ' 7 j a 1 .... 0 ( i Q j '9° D7Q023 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: %fic ocre /!� fpm Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Ty6wt 6 t•ee btu J f -> S (A.) .. q0 Aire -+ Rain drain connector 16.60 Loll, i Ave.. ,. Av (- 6y *lam 132. s ar fm tG7 GrfJ'h e4- Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear It: ) Page 2 Subdivision: L)'W‘ 1411% Te c /� I Lot no.: CI Water service (no. linear ft.: ) Page 2 Tax map /parcel no 1 1 s q ✓54)1)03 620 Fixture or item �, Absorption valve 16.60 ,?:•:,.11h! n = A •IP.. A ir. ° . DESCR W ORK �vi�ri w / yti -. Backflow preventer Page 2 KP ( ace c (c( Q�CX��C r z "cQ W (�-• -- ke%cie,t, Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 n iter f TROP RTY OWNER t �� I � r ®TENANT Drinking fountain 16.60 �� ..: �..��,.k .- ......,,,, Ejectors/sump 16.60 Name: -re t � t_J j u , (�� i �I Q /}. Expansion tank 16.60 3rd Address: apt 6 O 0 .5 Lt/ . `J % Fixture/sewer cap 16.60 City/State /ZIP: ' -&, // Q. , Q 9 o G A) -�a /, Floor drain/floor sink/hub 16.60 Phone: ( ) 6 q r - b 7 4..D Fax: (§-b3 ) 6 9 l -6 ' 74,--o .� Garbage disposal 16.60 �` , a LI A�N'P g ems' w # ifilmi rteeiiRSO -Asia Hose bib 16.60 % 4 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: A_s A b 0 v E. Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax :: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 � :<�,, ,w +�� � Fs.�. >. z - �,� .,-� -- -,�.�. � - +.: t° < -er a ♦, ; `� �a> : CONTRACTOR• '. a ,, R ^ " W ater closet 16.60 Business name: Water heater 16.60 Address: Other: City/State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 (c2t 11 y. CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: [�� D TOTAL PERMIT FEE ( t 0) Print name: [ � f � j J 11 � Date: 0 6 f a ��2 o This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 - 4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received ate Requested AM PM ! ° BUP Location J / &' "firel Suite MEC Contact Person /k -L/ Ph ( ) 297" 74E© PLM v`{V Z2 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection otes: l�CJ QiCQ.A.] 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 �U MBING� P os t & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan de PART FAIL MECHANICAL 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 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA q / J lam Approach /Sidewalk Date / Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL