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Permit CITY OF TIGARD PLUMBING PERMIT u � N DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00284 't' 4 .� �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/22/02 SITE ADDRESS: 12930 SW SCHOLLS FERRY RD PARCEL: 1 S133AD -02200 SUBDIVISION: ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: 0 BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: El FLOOR DRAINS; 0 TRAPS: STORIES: WATER HEATERS: 0 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 0 URINALS: 0 GREASE TRAPS: 0 LAVATORIES: 0 OTHER FIXTURES: 0 TUB /SHOWERS: 0 SEWER LINE: ft WATER CLOSETS: 0 WATER LINE: ft DISHWASHERS: 0 RAIN DRAIN: ft Remarks: Rough -in, underslab only for these number of fixtures: (24) sinks, (25) lays, (12) showers, (20) toilets, (1) Dishwasher, (1) washer, (12) fl. drains, (2) water htrs., (6) urinals, (1) grease trap, Other fix: (4) drinking fountains, (1) sump /ejector, (4) hose bibbs, (10) primers, (1) baptistry. No fixtures are to be set at this time. FEES Owner: Type By Date Amount Receipt WESTGATE BAPTIST CHURCH PRMT CTR 8/22/02 $2,104.80 27200200000 12930 SW SCHOLLS FERRY RD PLCK CTR 8/22/02 $526.20 27200200000 TIGARD, OR 97223 5PCT CTR 8/22/02 $168.39 27200200000 Phone 1: Total $2,799.39 Contractor: WOLCOTT PLUMBING PO BOX 2007 GRESHAM, OR 97030 REQUIRED INSPECTIONS Phone 1: 503 - 667 -1781 Sewer Inspection Water Line Insp Reg #: LIC 23847 PLM 26 -208PB Water Service Insp Top -out Insp Storm Drain Insp Final Inspection 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 m iopies of these rules or direct questions to OUNC by calling (503) 246 -1987. I tied By: ` , %�i � ��(Y� " Permittee Signature: ' . % 4 Call (50 • 9-4175 by 7:00 P.M. for an inspection needed th - ext business day )2 00o ;t- — CO 0-4 Plumbing Permit Application Cl �.4 Tl Si'd Date received:7_ /7— 2- Permit no. riji apps wag $,,4 � - g - -L. Sewer permit no.: Building permit no.: s. Address: 13125 SW Hall Blvd, Tigard, OR 97223 6— Ciry ofTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:' 1. Fax: (503) 598 - 1960 Date issued: By • B Receipt no.: �. Land use approval: R U ?a-° -} - ' Q � Case file no.: Payment type: 111)E OF I'E• Riil I I '-g. ❑ 1 & 2 family dwelling or accessory . ' ommercial/industrial ❑ Multi - family ❑ Tenant improvement $r ;Tew construction ❑ Addition/alteration /replacement ❑ Food service ❑ Other: .1013 SI I E I INFORiNIA THON FEE 5(11II)ULF (fur. special information use checklist) Fee ea. Total lab ddr es�: O - -- Description QtY• � ) '. �/ 3 �W. ten -Y - — -_ New 1- and 2- family dwellings only: . ? Bldg. nb:3 ;;�. I Suite no.: (includes 100 ft. for each utility connection) ' /tax 1 no.: SFR (1) bath Lot: • ''''):q 4 y';'•. Blo cic�, ,,.., , I Sub 'v-4i SFR (2) bath ■ -- r Project name :" rte ,_b hi .�,f/,/,QL - . ,. / SFR (3) bath City/county: 776ik ZIP,: . Z 2-3 Each additional bath/kitchen Dg cription and location of work on preen'�sseq: Ti Site utilities: cr2JO✓L. A-timaAI6 Rye_ , Catch basin/area drain Est. date of completion/inspection: Drywells /leach line /trench drain Footing drain (no. lin. ft.) PI_I (ON l R: \C IOR Manufactured home utilities Ell Business name: / O/,cpi a/ Mb /^/ s 69A/n //VG Manholes M Address: P ,ox sop 7 Rain drain connector City: 0i I State:6/C' ZIP: '77050 Sanitary sewer (no. lin. ft.) Phone:$0j 6674 I Fax( I E -mail: Storm sewer (no. lin. ft.) 3 f¢7 I Plumb. bus. reg. no: 74 -20/4 Water service no. lin. ft. City/metro lie. no.: . ZS + _ 21. _ Fixture or item: U -- , III Contractor's representative signature: 01i ` �� Date: ,� Abso tion valve / Back _A" �'r' t�� ' MM. Backwater v. yeenter �` C I C T PER''ON Basin . avato © ZS' / , 0 d c *i ' //5.0 Name: Clothes washer / . /gyp / Address: Dishwasher 0 . /, 4 . ( 0 /6.0 City: State: ZIP: Drinking fountain(s) ) . ✓ k 4- /d .6 0 66 40 Ejectors /sump X ' /' / /to 40 Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap = Name (print): Floor drains /floor sinks /hub _it���f .20 Mailing address: Garba:edis.osal ' . City: State: ZIP: Hose Bibb .'N Ice maker • Phone: Fax: E -mail: Interceptor /grease trap = FMK • 0 WM Owner installation/residential maintenance only: The actual installation Primer(s) Alirl -.-b WM will be made by me or the maintenance and repair made by my regular drain (commercial MEI employee on the property I own as per ORS Chapter 447. L. ' ), basin(s), lays(s) 'G 'W/P111/13 Owner's signature: Date: p FA�_ ENGINEER Tubs /shower /shower pan •.. ®USTA i. 349 Name: Urinal [11W • V MBE Address: Water closet ,l pia / /A ,. 3- • Water heater W 2 4 4'0 3 ? - City: State: ZIP: Other: fjeei S 0 / /640 16.6a Phone: Fax: E -mail: Total / p Not all jurisdictions s accept t credit cards, please call jurisdiction for more information. Minimum fee $ �/ O / • e O ' O Visa O MasterCard ace p Notice: This permit application Plan review (at _ %) $ 5.1/0 • expires if a permit is not obtained a Credit card number. / / within 180 days after it has been State surcharge (8%) $ i 9 .4 Expires TOTAL $ . Name of cardholder as shown on credit card accepted as complete. Cardholder signature $ Amount l 440-4616 (6/00/COM) 5 —I N CI