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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2000 -00176 --! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/01/2000 SITE ADDRESS: 11975 SW PACIFIC HWY PARCEL: 1S135DD -05000 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM 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: 80 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace and repair existing water line. FEES Owner: Type By Date Amount Receipt DORN, FRANK D + RHODAJANE TRS PRMT GEO 06/01/200C $50.00 0002626 do TRENARY, BRYAN W /JUDITH A 5PCT GEO 06/01/200C $4.00 0002626 WEST, ROBERT C BEAVERTON, OR 97007 Total $54.00 Phone 1: Contractor: ROTO ROOTER SERVICE + PLUMBING HOFFMAN SOUTHWEST CORP 4248 NE 148TH AVE REQUIRED INSPECTIONS PORTLAND, OR 97230 • Phone 1: 682 -9774 Water Line Insp Reg #: LIC 00013989 Final Inspection PLM 37 -76PB ORIGINAL - 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 oft ese rules or direct questions to OUNC by calling (503) 246 -1987. Issued By i •10 Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan Check# 13125,,,S,VV-4-IALL BLVD. Commercial and Residential Rec'd By TIGARD, OR 97223 Date Rec'd (503) 639 -4171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# R# Zoea - Related SW # Called Name of Development/Prro FIXTURES (individual) QTY PRICE AMT Job Sae y • / l/e I' 1,t)a/ i( Sink 11.50 Address Street Addres ,.., . Suite Lavatory 11.50 11' 7,- Sk) (1.te4 C IG - i Bldg # City /State Zip Shower Only 11.50 • ! c1a..v 77 22.3 Water Closet 11.50 Name �i< ���. Urinal • 11.50 Owner Mailing Address Suite Dishwasher 11.50 Garbage Disposal 11.50 City/State Zip Phone / -711 , r I 99 06 7 Laundry Tray 11.50 Name Washing Machine /Laundry Tray 11.50 Floor Drain/Floor Sink 2" 11.50 Occupant Mailing Address Suite 3° 11.50 4" 11.50 City/State Zip Phone - Water Heater 0 conversion 0 like kind 4 11.50 me Gas piping requires a separate mechanical permit. e � - bs . e.o.Y MFG Home New Water Service . 32.00 Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00 ZSS9 q Sh19.c. Ve - (3 Hose Bibs 11.50 Prior to permit City/State Zip Pone Roof Drains 11.50 issuance, a copy f tut /.pul f4 97, 0 as tc. Drinking Fountain 4 11.50 of all licenses are Or gon Const. Cont. Board Lic.# Exp. Date . required if /59A)9 Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date database Name ' Architect Sewer - 1st 100' 38.00 Or • Mailing Address Suite Sewer - each additional 100' 32.00 C ity /State Zip Phone Water Service - 1st 100' 4;50 / / 38.00 Engineer Water Service - each additional 200' 32.00 Describe work to • - d• • -: Storm & Rain Drain - 1st 100' 38.00 New 0 Repair • Replace wi like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 0 ommercial Additional description of work: Commercial Back Flow Prevention Device 32.00 � G �rc� C 4 AAP/9/4 � . N � c � Residential Backflow Prevention Device" 19.00 �7 � L Catch Basin 11.50 Are you capping, moving or eplac" by fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes O Inspections per/hr If yes, see back of form to indica e 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. • QUANTITY TOTAL I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL that plans submitted are in compliance with Oregon State Laws. 5_0 SI lure o Own r /Agent Date 8% SURCHARGE II Contact Person Name phone SGd1T Ntri gZ V% ""PLAN REVIEW 25% OF SUBTOTAL 1 BATH HOUSE $178,00 , Required only if fixture qty. total is > 9 2 BATH HOUSE $250.00 TOTAL rL/� 3 BATH HOUSE $285.00 (This fee Includes all plumbing fixtures In the dwelling and the first 'Minimum permit fee is $50 + 8% surcharge, except Residential Back low Prevention '' 100 feet of sanitary sewer storm sewer and water service) Device, which Is $25 + 8% surcharge "All New Commercial Buildings require plans with Isometric or riser diagram and plan review. i:tdstsvormstplumapp.doc 11/18/99 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved I Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Floor Sink 2" 3 „ 4" Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I: VdstsVormaplumapp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP 7(3 C Date Requested Z— AM PM • BLD Location / /l 75 � j kJ PA1L/ Suite MEC Contact Person d Ph PLM Contractor 12. / • ems✓ Ph SWR BUILDING Tenant/Owner ��7 /�a�u,,./j� 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 Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final - PASS —PART FAIL /f�I1MBINC� Post & Beam Under Slab Top Out Sanitary Sewer Rain Drains 1V--W PART FAIL HANICAL Post & Beam 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 i Inspector /` � Approach /Sidewalk Other J" D Itor /�b Ext? Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.