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Permit CITY OF TIGARD PLUMBING PERMIT . ,I , DEVELOPMENT SERVICES PERMIT #: PLM2000 -00431 VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/27/00 SITE ADDRESS: 10620 SW WALNUT ST PARCEL: 2S102BC -02005 SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -4.5 BLOCK: LOT: 024 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 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: Sewer reversal under house for connection to USA sewer. FEES Owner: Type By Date Amount Receipt FRISBIE, OWEN P JR AND PRMT CTR 11/27/00 $72.50 27200000000 E L 5PCT CTR 11/27/00 $5.80 27200000000 10620 S 10620 SW WALNUT TIGARD, OR 97223 Total $78.30 Phone 1: Contractor: LARRY CAMERON PLUMBING 1812 SE 158TH AVE PORTLAND, OR 97233 REQUIRED INSPECTIONS Phone 1: 503 - 256 -2705 Sewer Inspection Reg #: LIC 49792 Final Inspection PLM 26 -366PB 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: "1 i _ Permittee Signature. �� �J Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b i ss day A Plumbing Permit Application 1 Date received: Pennit no.Pm 2, -a9 y3/ - , ,. City of Tigard �! `, g 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: I Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT 1 I & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi family ❑Tenant improvement New construction ❑ Addition/alteration/replacement ❑Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special iuforn ation use checklist) Job address: /04?.r.) Sic) 4.4-z12/4// Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. 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: I ZIP: Each additional bath/kitchen Description and location of work on premises: Site utilities: 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: ,dip /y. cow/el-21,9A) a4 , Manholes Address: /02i y S 0 - Axj,C Rain drain connector City: 4j/2 State:on I ZIP:972„ / & Sanitary sewer (no. lin. ft.) Phone:477-2s •77 Tax: t r I E -mail: Storm sewer (no. lin. ft.) �6 3(06 �� Water service (no. lin. ft.) CCB no.: S - 2/ Plum bus. re g . no: 0 74 lic. no.: 6 7t, Fixtu a or item: Contractor's representative signature: `r . • _ , Absorption valve at Back flow preventer Print name: /, I r 9 " I _ , Backwater valve CONTACT PERSON Basins/lavatory Clothes washer Name: 44-4/1.4 t!°� f71�}u10 Dishwasher ` Address:A z / ti 5e il t /,e s✓ .5c Drinking fountain(s) City: isteR-r V I StateaL I ZIP:92 21 (/ Ejectors/sump Phone: - Ls'b - 27 : E-mail: Expansion tank Fixture/sewer cap Name (print): Floor drains/floor sinks/hub Garbage disposal Mailing address: Hose bibb City: I State: I 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 healgr City: I State: I ZIP: Other.. 7JL Phone: I Fax: I E -mail: Total Not all information. jurisdictions accept credit cards, please call jurisdiction for more infoation. Minimum fee $ 2-- Z Notice: This permit application Plan review (at _ %) $ C1 Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) $ Expires TOTAL $ 7? . 3 U Name of cardholder as shown on credit card accepted as complete. w $ Cardholder signature Amount 440-4616 (6100/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 Lavatory 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 2" 16.60 3" 16.60 PLEASE COMPLETE: 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 Other Fixtures (Specify) 16.60 Urinal 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 Water Service - each additional 200' 46.40 Other Fixtures (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 , Quantity Total is > 9 - *SUBTOTAL 1 , .-.. 8% STATE SURCHARGE ' ' **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty total is > 9 TOTAL $ u * Minimum permit tee is $72.50 + 8% state surcharge, except Residential Backflow / 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 \forms\plm- fees.doc 10/10/00