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Permit . CITY OF TIGARD PLUMBING PERMIT PERMIT #: PLM2003 -00364 x�y DEVELOPMENT SERVICES DATE ISSUED: 7/25/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11825 SW LYNN ST PARCEL: 2S1036A -00143 SUBDIVISION: LERON HEIGHTS NO. 2 ZONING: R -4.5 BLOCK: LOT: 033 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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 Remarks: Install 60 ft of water service FEES Owner: Description Date Amount BARKER 11825 SW LYNN STREET [PLUMB] Permit Fee 7/25/03 $72.50 TIGARD, OR 97223 [TAX] 8% State Tax 7/25/03 $5.80 Total $78.30 Phone : Contractor: KENNEDY PLUMBING 13985 SW FARMINGTON RD BEAVERTON, OR 97005 REQUIRED INSPECTIONS Phone : 643 - 5535 Final Inspection Reg #: LIC 10967 MET 00003528 PLM 34 -42PB • 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 Issued By: Permittee Signature: 11 _% I>> `= Call (503) 639 -4175 by 7:00 P.M. for an inspection neede • the next business day I ~ Plumbing Permit Appliccation . Date received: - 7 a 03 Permit no.:pLvfl ab x ,, 36 y t , if, City of Tigard and , .:)1' `J Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT „V--1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement U New construction 0 Addition/alteration /replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (forr special information use checklist) Job address: / / ,2 .5 • SW X yhN 57' Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 R. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath City /county: T 5n.41 1 4 I ZIP: 9) 2 2'1 Each additional bath/kitchen Description and location or work on premises: Site utilities: Q4_ /4 if.., , 1 S 4v/ei4 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: 4.4.44- Q / vii 4'+j Manholes Address: / 3 9 05- f`„ i^ Rain drain connector City: / de—Ad I State: ZIP: 9JC.„0,51 Sanitary sewer (no. lin. ft.) Phone: a ; . 3 3S-I`Fax *- 66.33?.tE -mail: — Storni sewer (no. lin. ft.) CCB no.: / 96 i I Plumb. bus. reg. no: 39 - y 2 Mater service (no. lin. ft.) 6 City /metro lic. no.: / 3,3 Fixture or item: Absorption Contractor's representative signature: Back flow flow valve preventer p 'Pi ,4 Print name: / (4 Date: _ Back Backwater valve • CONTACT PERSON Basins/lavatory Name: eg, r?j ,g,ge_,¢' Clothes washer Dishwasher Address: 5 #11°- Drinking fountain(s) City: tate: I ZIP: Ejectors/sump Phone: 6 .SS�3S Fax: 6f/j S "E Expansion tank , OWNER Fixture /sewer cap Name (print): 420A...9 Floor drains/floor sinks/hub Mailing address: a_6--- Garbage disposal — Hose bibb _ City: S te: ZIP: Ice maker _ Phone: 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 y, Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ Z' S 0 Visa 0 MasterCard Plan review (at _ %) $ expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires TOTAL $ 79 . O Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 410 -4616 (6N0/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 Lavat 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 z 16.60 PLEASE COMPLETE: 3" 166.60 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 Urinal Other Fixtures (Specify) 16.60 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 Sg- Water Heater Other Fixtures Water Service - each additional 200' 46.40 (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 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 SS-. Quantity Total is > 9 *SUBTOTAL • 8% STATE SURCHARGE . ,, . !- L / KD "PLAN REVIEW 25% OF SUBTOTAL • • ' - Required only if fixture qty. total is > 9 . TOTAL $, , tie, 'Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backfiow Prevention Device, which is $36.25 + 8% state surcharge. "All New Commercial Buildings require plans with isometric or riser diagram and plan review. i:\dsts\forrns\plm- fees.doc 10/10/00 ~- CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line! (503) 639 - 4171 MST BUP Received Date Reques ed -- 3° \ AM PM BUP Location 1 a s Suite MEC Contact Person Ph ( ) =S 3.5 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: 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 ofr PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In r- i Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: C r PART FAIL CHANICAL 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 reins s ection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Inspector T % Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL