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Permit CITY OF TIGARD PLUMBING PERMIT 1 4, DEVELOPMENT SERVICES PERMIT #: PLM2001 -00224 Ail 13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/04/2001 SITE ADDRESS: 12162 SW QUAIL CREEK LN PARCEL: 2S103C6 -10700 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5 BLOCK: LOT: 065 JURISDICTION: TIG CLASS OF WORK: OTR 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: Installation of back flow preventer. FEES • Owner: Type By Date Amount Receipt DON MORISSETTE HOMES, INC. PRMT CTR 06/04/2001 $36.25 27200100000 4230 GALEWOOD ST., STE 100 SPOT CTR 06/04/2001 $2.90 27200100000 LAKE OSWEGO, OR 97035 Total $39.15 Phone 1: 503 - 387 -7538 Contractor: PROGRASS LANDSCAPE SERVICES 29895 SW KINSMAN RD WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone 1: 682 -6076 RP /Backflow Preventer Reg #: LIC 6136 Final Inspection PLM 11558 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. 6 i Issued By : ��� � �! Permittee Signature: i f/ / :/ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day A Plumbing Permit Application __ Datereceived6 % //() / Permit no1L - qj 1/ . '� ` dy .. l �j City of Tigard G Sewer pemut no.: Building permit no.: Address: 13125 SW Hall Blv• ' :arr, SRS223 n % City of Tigard . phone: (503) 639 -4171 N •' Project/appl.no.: Exp , - date: Fax: (503) 598 -1960 ,- `; 44`` �� t� , ° . ' ate issued: al Receipt no Land use approval: 0 Case file no.: Payment type: -- TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement • ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORII'IATION FEE SCIIEDULE (for special information use checklist) Job address: / Q go a S--u) .624.4.4..4.2) 5 62/3,—.0 • - .Description • Qty. Fee(ea.) Total Bldg._ no.: Suite no.: New 1- and 2 -family dwellings only: (includes 100 ft. foreachutilityconnection) Tax map /tax lot/account no.: 6 5 5 . t3 5 SFR (1) bath - Lot: C 5 IBlock: I Subdivision: H //tom FR (2) bath Project name:(LL&L1 14- p1(QL' i • SFR (3) bath - - City /countyT,gevia W4514 ZIP: '7. a- - Each additional bath/kitchen • Description aria locatipn of work on premises: - _Siteutilities: .. 8140c t( -) / t. ' ' Catch basin/area drain Est. date of completion/inspection: (p 30 , Drywells/leach line/trench drain . Footing drain (no. lin. ft.) - PLUMBING CONTRACTOR Manufactured home utilities Business name: pub 6Gra ss Li2 fldJ CaL, Zn C Manholes Address: fl29 >9 5 kJ kL A k))'1 C..A. R.() Rain drain connector • City: (VI I W 1) 1 11 G I State:CfLI ZIP: ' 7 C 7o Sanitary sewer (no. lin. ft.) • • Phonet,0 - 1 I Fax :, , - g7(cJ E -mail: - - Storm sewer (no. lin. ft.) CCB no:: (o/3 t- I Plumb. bus. reg. no: Water service (no. lin. ft.). - City /metro lic. no.: -003x/.. Fixture or Item: - - • Absorption valve Contractor's representative signature: �� • _4- 4-4- C Back flow preventer - • / .27.5s a7, 5S Print name: e / /G.r) , # C(/ it ) . -' -. . Date 0,,If a Oj Backwater valve - ' CONTACT PERSON Basins/lavatory • Name: �� � . f (ir �(�`Z:(7 i - Clothes washer _ Dishwasher Address: gip 51.1-)art Drinkingfountain(s) • City: Ot i cl- l i if //e. I State: le- I ZIP: 9'70'70 Ejectors/sump Phone: -9 _ , ,9(' Fax: 64.-9t7 E -mail: Expansion tank OWNER Fixture/sewer cap • Name (print): �C77'1 inn ►' s - se - Floor drains /floor sinks/hub Garbage disposal Mailing address: t 3C.) SW 6- ,a /e.c.L - ooc4-- Si— Hose bibb City: ULkC O ecru I State:C:1Z ZIPq/703 L7 Ice maker Phone: I Pax: 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 - Minimum fee S as Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application ❑ Visa ❑ MasterCard Plan review (at _ %) $ expires if a permit is not obtained State surcharge (8 %) .... $ �O Credit card number. within 180 days after it has been Expires TOTAL S• t S Name of cardholder as shown on credit card $ accepted as complete. Cardholder signature Amount 440 -4616 (6 G0/COM) i PLUMBING PERMIT FEES: ,:r -. 4 :; .} �'": a w.1 and 2- fatiill d : wellin `s on :�: ,.: : :4 , xik.- ,_- ;� f �:� �- tc�i•; - ..,,_, , i . ; s�:zj ��.,. : TOTAL . Ne _;a,� -r ....w.�.x�� =u�r 9.�.c�, y' � ,PRICE '':��:�; ~% ^, :R::r :x r i d 4 F '-, ;. # . ,. y ri,. :d ' A i . :; .. :� f r *•:' ' ( "4 r t. , .- :FIXTURES ridlvldii ' ah - :_��t ' =.:� :r:QT •:�(e . sA .(includes all plumb)ng �5 • OTAL "• Sink 16.60 ;the dwelling a "nd the.fi ft.••,.:'.; -t QTY :^l(ea).. ;. 'i4MOUN : T . 'for each "u$lity,connectlonj . ... ..'r ' ` s r Lavatory 16.60 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 2" 16.60 PLEASE COMPLETE: • " 16 3" 16.60 4" 16.60 .. ''.:.•-.=.,,'..•,•:::: „•: " :Y::i,..:st `, ;'::: Quantity. by Work Pe ormed ;,:..: Water Heater 0 conversion 0 like kind 16.60 Gas requires a separate mechanical • `Future Type: .,,,,,-...= ^ e •Niiv: •` Moved Replaced _Remove , . r:��• :Capp permit. • 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 16.60 Urinal . Other Fixtures (Specify) 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 - -- - - - 46.40 'Other Fixtures , Water Service - each additional 200' 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 27 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 F. :. Y ,,:.:_ ; ;. :%;.. :::;: Isometric or riser diagram is required if / 'G O -J S Quantity Total Is > 9 *SUBTOTAL . -. ' r • '' ` ....--• , a •S 8% STATE SURCHARGE ..• 90 • "PLAN REVIEW 25% OF SUBTOTAL ' Required only if fixture qty. total is > 9 , ' .,: i:• TOTAL ' • • ' • ,'.,;- -.'''-; $ 3 ,5' `Minimum permit fee is 57 % state surcharge, except Residential Backflow Prevention Device, whit ' is 536.25 + % state surcharge ** All New Commercial Buildings require plans with Isometric or riser diagram and plan review. 1 : \dsts\forms\plm- fees.doc 10/10/00 zLy,p CITY1OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested CA ' `./ AM PM BLD Location / 7 / Z, Ski C26 a r 6--0. -1 Suite MEC Contact Person 771 - V# Ph c-fz PLM 2,my1 Z e( Contractor Ph X( 2 ( 7 SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Slab Crawl Drain Inspection Not : 6/0 1 /' e j Post & Beam 1 SIT Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL Post & Bea • Under Slab ' . l Top Out Water Service Sanitary Sewer Rain Drains F i i n o r 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 Approach /Sidewalk I _ 1 Other Date P./1/4 ( Inspector " ( Ext IC t Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY'OF TIGARD BUILDING INSPECTION DIVISION • 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested AM PM BLD Location / 2/ (o ?- (At , a 44 n f ) I Suite MEC Contact Person . .e ic Ph PLM — Fa) dp 2 Zy Contractor Ph SWR BUILDING 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 /,7rr () 1Pf I-'� l e/'f�l�,2,1 S +KIM O,- d Q - 7D w c- Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out fiat Water Service Sanitary Sewer 2)24); • Rain Drains Fina PART FAIL t ! • NICAL 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 BackfillGrading 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 r l // 1 Other Date ( - b � o / Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF'TIGARD BUILDING INSPECTION DIVISION MST Du% Go %aY 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 /� BUP Date Requested V - AM PM BLD Location /02/6 Z_ 5'2 Q'4 4 € / Cr-' -e k Suite MEC Contact Person Ph Zf y -' '/t,3r PLM 22C) Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: . Foundation _ 2 Sr' FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam c Z O O / — 0 / 0 Ext Sheath /Shear }"T I Int Sheath/Shear f Framing ! /) 72^4-t-r/g_ff , Ce/t 0 14 -Pcri Insulation �j �C� Drywall Nailing V r C » £ir O l S-2� `^� d `� c //v'•*c cam Firewall Fire Sprinkler .2•�) El _ee dj tit it-2,-- .ie c.. / r k � a / CC4 '— Pr* ! h Fire Alarm �Jn I Susp'd Ceiling /� J — L—� t r o-p,. Co /H Roof / J Misc: /� ` � KT� �.0,4., A-cc, / -ems 4l:► L ..7 Final PART FAIL 0 (YG / ° jv j 744 14. 4 e f G`, PL],: IZNZ ht6V Te / ve.. ?&4 ciceS4 -, f� -c st Beam • � Under Slab r' Top Out Water Service Sanitary Sewer Rain Drains QV' PASS PAR FAIL MECHANICAL Tz 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 kr Approach /Sidewalk Inspector ,1,� r ( 1 � g 1 0 1 '4 , 4 Ext Date Other /� Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.