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Permit .. . A ' CITY OF TIGARD PLUMBING PERMIT PERMIT #: PLM2001 -00437 w � l � j DEVE H BMENg r So R9 SERVICES 639 -4171 DATE ISSUED: 9/12/01 SITE ADDRESS: 11622 SW WOOD DUCK PL PARCEL: 1S133CD -15900 SUBDIVISION: PEBBLECREEK NO. 3 ZONING: R -25 BLOCK: LOT: 049 JURISDICTION: TIG CLASS OF WORK: REP 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: 60 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace 60' of water service. FEES Owner: Type By Date Amount Receipt MCALLISTER, PATRICK J + AURORA PRMT CTR 9/12/01 $72.50 27200100000 11622 SW WOOD DUCK PL 5PCT CTR 9/12/01 $5.80 27200100000 TIGARD, OR 97223 Total $78.30 Phone 1: Contractor: ACTION PLUMBING & HEATING 19587 SW RED OAK LN ALOHA, OR 97007 REQUIRED INSPECTIONS Phone 1: 503 - 356 -9630 Water Line Insp Final Inspection Reg #: LIC 138159 PLM 34 -369PB 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 ay ob a'• copies of these rules or direct questions to OUNC by calling (503) 246 -1987. OP • Iss e By: , , ,'/ , � � .2_,A. „� .A. J. Permittee Signature: , - Call (503) 63• = 75 by 7:00 P.M. for an inspection needed the next business day , . ,._ . 4111,,, .. Pl Permit Application D ate received: "' 0 P ermit no.: G a / -- ee ; 7 .- 41 C of Tigard 44- Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigars :r. ='vtr» City of Tigard Phone: (503) 639 -4171 / Project/appl. no.: Expire date: Fax: (503) 598 - 1960 J i j ► Date issued: By: Receipt no.: Land use approval: 1 � Case file no.: Payment type: • ' T YPE OF PERMIT • m 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 infort ation use checklist) l d. d. \ Job address: e 1 Otti ( Description Qty. Fee (ea.) Total Bldg. no.: I 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: p n.. c k - e. ‘‘ C tn C0. \V %,, 5 --c-t/' SFR (3) bath City /county: \ z , C c,,,T c x ZIP: a'1'L'2r Each additional bath/kitchen Description and location of work on premises: 16 vA•. 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: —p A=L -e e V-........= - t v. -4=A _ Manholes Address: Vl. % \ SW -&' 0.-� L ". , Rain drain connector City: rL\ Jv. ` I StateO , I ZIP: CZ'Apo`1 Sanitary sewer (no. lin. ft.) Phone: '3k c t C I E -mail: Storm sewer (no. lin. ft.) CCB no.: cl $ \ S ck I Plumb. bus. reg. no:`3\-‘ 3b9 is Water service (no. lin. ft.) C-0 City/metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve _Back flow preventer Print name: 0,, . o ,� Date: Backwater valve • CONTACT PERSON Basins/lavatory Name: T t.v.n. 2S ..\__, .S v., Clothes washer Address: VC, c \1.j \ v_a Wc_ Dishwasher ��� Drinking fountain(s) City: K. ■ 0 \A_Q A I State(R I ZIP: q-lk,o -1 Ejectors/sump Phone: --°\ _ i Fax: E -mail: Expansion tank OWNER Fixture /sewer cap Name (print): V , Q. ‘-‘r : L Y I \ C.c.- \ . , , S t c ( Floor drains /floor sinks/hub Mailing address: \ �`�� �W '- .wo d �A Hose bibb Garbage disposal dd _ k City: \ t - SCE R_ State ZIP: �'��,Z.`'S 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 heater City: I State: I ZIP: Other: Phone: I Fax: I E -mail: Total y 0 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ / �•� Notice: This permit application Plan review (at _ %) $ O Visa 0 MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ S • € V I` Expires TOTAL $ 7 $ • 3C5 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount _ 440-4616 (6/00 /COM) - 1 PLUMBING PERMIT FEES: z ' PRICE TOT AL 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 - 16.60 for each utility connection) , Lavatory 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: 3" 16.60 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 Urinal 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 Other Fixtures Water Service - each additional 200' 46 40 (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 i Grease Traps 16.60 QUANTITY TOTAL , Isometric or riser diagram is required if _ . Quantity Total is > 9 *SUBTOTAL - - 8% STATE SURCHARGE . **PLAN REVIEW 25% OF SUBTOTAL - - Required only if fixture qty total is > 9 TOTAL - $ * Minimum permit fee 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. is \dsts \forms\plm- fees.doc 10/10/00 • 0.0( CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 , �y► C BUP 3 � Date Requested /— ( AM L— PM BLD Location 11 (a 2-7 -- e- OM', 4) Lte4_ a Suite MEC Contact Person Ph Z S _ 3a PLM ?IOC)/ Od 4/37 Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing' Foundation AC ess: [ J'� Cv>"." FPS Ftg Drain Ccf / pW S — i t '„ c �l co 1 < — 74(/ Ccr44.•r„, Slab Crawl Drain Inspection Notes: �T, SGT Post & Beam /► SIT Ext Sheath /Shear L ti 1 — le I Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler . Fire Alarm Susp'd Ceiling _ Roof . Misc: Final PASS • PART - FAIL PLUMBING • Post & Beam Under Slab Top Out (MierServi� Sanitary Sewer Rai ' ains • t PART FAIL HANICAL Post & Beam Rough Gaa Li 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 Other Date 9' 'V d / Inspector 23/ I I / 1.--$2 Fv ''e Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. . - . .