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Permit • CITY OF TIGARD PLUMBING PERMIT PERMIT #: PLM2001 -00222 yy ' ` jl� J DEVE HO BMENg Tigard, SERVICES 639 -4171 DATE ISSUED: 06/04/2001 SITE ADDRESS: 12401 SW QUAIL CREEK LN PARCEL: 2S103CB -08500 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5 BLOCK: LOT: 034 JURISDICTION: TIG CLASS OF WORK: ALT 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 back flow preventer device. . FEES Owner: Type By Date Amount Receipt • DON MORISSETTE HOMES PRMT CTR 06/04/2001 $36.25 27200100000 4230 GALEWOOD ST 5PCT CTR 06/04/2001 $2.90 27200100000 STE 100 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. Issued By: " i �9/./ [:r/�) Permittee Signatur .GCC /dh Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • Plumbing Permit Application .,, A Datereceived: &2 /ti /p / Permit no.: 1 ) /_9ZZZ 1111 - Ci ty of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall B • Tigard, OR �1 City ofTigard Phone: (503) 639 -4171 F 0a ' Project/appl.no.: Expire date: Fax: (503) 598 -1960 lf1\ Date issued: • Z I Receipt no.: Land use approval: - , ,c-,\A"' Ca 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 INFORMATION FEE SCHEDULE (for special information use checklist) Job addressiQ . ev (aaa e, creez LWICJ . - Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1 - and 2 -family dwellings only: � (includes 100 ft. for each utility connection) r Tax map /tax lot/account no.: J 6_5 SFR (1) bath • Lot: .3'j IBlock: Subdivision: CU-Lai-ad /4 SFR (2) bath - ' Project nameilLact,a l ( UU) 3 I - - • • SFR (3) bath - . City /county:Ti q Cue (,U • I ZIP: 97 `3 - - - • • Each additional bath/kitchen - • Description andlocati n of work on prprnises: - . Site utilities: .. /3/C (C f ) /CZ, Catch basin/area drain • Est. date of completion/inspection: , 3Q p : Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities • Business name: p Grass L- C2/dsCQlk, Zri C Manholes Address: 099 fy 5 ecit.6 16/1 TY1 a& RI) Rain drain connector • City: (_,1) i / $ rn t! t I (G I State:CA.1 ZIP: ?7 C r76 Sanitary sewer (no. lin. ft.) ' Phone E,) - &p7(. I Fax: 6W - ( 47 (el E -mail: - _ Storm sewer (no. lin. ft.) CCB no.: (0/3 & I Plumb. bus. reg. no: - Water service (no. lin. ft.). City /metro lie. no.: (30311 Fixture or item: Absoiption valve , Contractor's representative signature: _ z • Back flow preventer ( .27-55 7, 5S Print name: ewer) , • a t. ) . ' ._ Date: - D I Backwater valve CONTACT PERSON - Basins/lavatory Name: EL/ Yi Spar LO . ; - Clothes washer' , f Dishwasher • Address:9P �)S /CC/1,�1'p 1�i1 .P0 Dishwasher fountain(s) • City: t l )i I glTh i) i //e. State:C) -, I ZIP: 9'7070 ; Ejectors/sump Phone: - _ , .76 • Fax: 6S.- yg E -mail: Expansion tank OWNER Fixture/sewer cap . t Name (print): f))CYl /Y11�/ £self - • Floor drains/floor sinks/hub Garbage disposal Mailing address: L/ 3CU •C/.1 (,Ct /ry e/..)'oea-- St— Hose bibb City: L LL C C) <- I State:C ZIP( /°703 L/ Ice maker - . Phone: I 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 property I own as per ORS Chapter 447. _ Sink(s), basin(s), lays(s) Owner's signature: Date: Sump Tubs/shower /shower pan . 1lNGIIYEER . Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: I Fax: I E -mail: Total Minimum fee 5 a5 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (a[ _ %) O visa O MasterCard expires if a permit is not obtained 40 Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $ Expires TOTAL $ N. IT Name of cardholder as shown on credit card S accepted as complete. Cardholder signature Amount / 440-4616 (6d00/CON!) • • PLUMBING PERMIT FEES:. . • ry �•: v',, 5 . ; - ":•:,.; .> L; -,New.1 and2 -fan ovTioloti ' io -� ° : = _ "" ~4. -,. . ,�� :cr -•e•� .�: P,RICE� ^;;IOTA ,, -- .• -.... ,. 4t��- :. ;7s "` ce ,. 2 4` '�= "r�,f_� `:� _ ;' ��, �, •'.'.4��+�•'r;i" <;x�a,�,.=y ;��:,;�� �rx •� ,�, .,� :r .ti,,,;.�;.•_,<�. -� •� a •• , t, :.,..3±•. :� •y�`:r ; '^ PRICE °z� O '� li -� ..edam ai- ne.;1, 'u ea ;,A MOUN T •? ,(in all igi b t ti „ r e le 3 ,, .;., _ et - , .. TA �FD(TURES :(indivtclual) .,...,..,.�:.....z:� ,:� (� °•_• Y -'F• +K S!" "P X `^ Sink 16.60 ' *th :6; ea e dwelling anti the first100 ft.. : : QTYr c (ea) " ?AMOUNT iiii ch iti/ ire'ai r ';: '' `Yr :�' "' "``' 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 P LEASE COMPLETE: . 3" • 1660 • 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 : .. ,. <�: = :. % :':•.t Quaritity .by Work Performed r; .•. Gas requires a separate mechanical izture . T . ;e: - Nelms ;:Mo Replaced ' :Removed/ permit V t: ,,,, , „,ci , ..: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 • Uririal . 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 - • - - Water Heater - - - • 46.40 "Other Fixtures , . Water Service - each additional 200' . . • • (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 27. 5 5 . 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 _ �,tiv, =: Isometric or riser diagram is required If / "a s Quantity Total Is > 9 ' `SUBTOTAL • " "' - a s . -- _, 8% STATE SURCHARGE .- • 90 **PLAN REVIEW 25% OF SUBTOTAL • Required only if fixture qty. total is > 9 - ,:,x -".:, • TOTAL ".:f1-'" . $ 3c/ /5 * Minimum permit fee is $7 % state surcharge, except Residential Backtlow Prevention Device, whit is $36.25 + % state surcharge. "All New Commercial Buildings require plans with isometric or riser diagram and plan review. . is \dsts\forms \plm- fees.doc 10/10/00 • CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP / Date Requested 7 Z' d l AM PM BLD Location /29 S L u Gr, C re eAuite MEC Contact Person Ph PLA O0 ( - 607 t Z, 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 /f,) 7 V , /► fre 4 k,. Insulation Gt / Drywall Nailing k �' 42 -- VI c Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer in Drains 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 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 D 7 -�7 - 2-- 6 i Inspector ()/ I I /-a- fa j. • E Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • CITY OF TIGARD BUILDING INSPECTION DIVISION MST ,Z�a /.:moo C Z� '24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested AM PM BLD Location / Z v / 5 II) qua 17 Cam► • Suite MEC Contact Person Ph — eeir37 PLM 26. u (- 6'O 7 2 Z Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation / / FPS Ftg Drain Q IA CO h / 7c ( SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing / / C �s� e IO �/'��.e � c e4H/s 4 ( Insulation Drywall Nailing) /"'cc's gee U C ce VZ "r �r 4 Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PA S PART FAIL CPLUMBI Post & Beam Under Slab Top Out Water Service Sanitary Sewer Ra• 1 Drains 40:ir ' • • RT FAIL 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 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: [ I Unable to inspect - no access ADA Approach/Sidewalk ' /) C e Y '� Other Dat Insp i Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.