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Permit CITY TIGARD PLUMBING PERMIT et DEVELOPMENT SERVICES PERMIT #: PLM2006 - 10053 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/29/2006 PARCEL: 2S 102DC -02400 SITE ADDRESS: 09265 SW MCDONALD ST ZONING: R -4.5 SUBDIVISION: EDGEWOOD LOT: 014 JURISDICTION: TIG Project Description: PRIVATE WATER LINES CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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: 1,600 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES WINDRIDGE HOMES, INC. 11401 NW SKYLINE BLVD. Description Date Amount PORTLAND, OR 97231 [PLUMB] Permit Fee 4/6/2006 $751.00 [TAX] 8% State Surcha 4/6/2006 $60.08 [PLMPLN] Plan Review 4/6/2006 $187.75 Phone : 503 - 978 -0830 Total $998.83 Contractor: POWER PLUMBING CO P BOX 19418 PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 -244 -1900 FAX 503- 244 -8825 Reg #: LIC 52378 PLM 34 -150PB 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: j �� / Permittee Signature: if—A / Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Scue U1/ Plumbing Permit Appl'I _ `I E' E ; ' FOR OFFICIO, USE ONE City Cit of Tigard Received C *J g Date/By �'i I b.. # / ."1 _ J 13125 SW Hall Blvd., Tigard, OR 97223 MAR 2 C Plan Review Phone: 503.639.4171 Fax: 503.598.1960 h1 ( 9 2U 1 % ,, o Other Permit No 24- Hour Inspection Line: 503.639.4175 ■ 4, Date/By. ` l m Internet: www.ct.ti ardor us •._ ^ _ D a Noti fied/Meed /Me thod / /4 S See Page 2 for g CIT O TIG � Supplemental Information TYPE 6kl*611ti DIVISION FEE* SCHEDULE 4 New construction ❑ Demolition For special information use checklist Description I Qty. I Ea I Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire spnnkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 9/ a.s hoc Jj1r►aC- a Catch basin or area drain 16.60 City /State /ZIP: T l (} s or e 9722 1/41 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: hie boll a f wooce_3 Footing drain (no. linear ft.: ) Page 2 street/directions [o job site: r Manufactured home utilities 110.00 Cross slree 9 v` � e � 04 � ( Manholes 16 60 Rain drain connector 16.60 Sanitary sewer (no linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 -^ We9e7D-3 Lot no.: Water service (no. linear ft.. /594 Pagc 2 75/ 00 Subdivision: �6 Dn.v, Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 r e r t U 4-# » o4-e,r j t a C. Backwater valve 16.60 p r -14/ Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 !, Ejectors/sump 16 60 Name: ( I n l it t d 5 r • ,e & v1 e J Expansion tank 16.60 Address: f ( (Q / N (,,,f Ly;i1 C Sli/,( Fixture/sewer cap 16.60 City/State /ZIP: /j r t1- -, d O/C 9 7 2 3 / Floor drain/floor sink/hub 16.60 Phone: (SAC 3 ) .7 g 5<" �5 2 8 Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( ) I Fax::( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: jQc4,,Q•r �l( rie/)2 . Water heater 16.60 Address: Gi 6 I / S1✓ M UC'1"Nd ry '-W f' 1 Other: 9 7 2 2� Subtotal City/State /LIP: b - Minimum permit fee: $72.50 Phone: (s63) 24a1 / 9 0 0 Fax: ( 93) 2 f� 4 / - S 2.- Residential backflow minimum permit fee: $36.25 ?6 Cr" �S 0 O2 Plan review (25% of permit fee) / l . 7 C CCB Lic.: Z 3 Plumbing Lic. no.: 3 / r.7 State surcharge (8% of permit fee) 60 , O$ Authorized signature: (, TOTAL PERMIT FEE ` 9$,.83 Print name: l/` / tc �e J n Date: .-- L 1 ®6 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fec methodoloev set by Tri- County Buildine Industry Service Board. CITY OF TIGARD 92 5 $ w - �c ��.�� lam( s1 BUILDING DIVISION e A , PERMIT #:9), 1 ©Q53 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 �� i Inspection Requests (24 Hrs.): (503) 639 -4175 , .4 'IL INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: I 3-c j OLL -) CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE 94 78Z'' 4t 3 CONTRACTOR: 4 > l `-"' 'e_ PHONE Inspection Request Scheduled For: Date: 3- 30-0 a Pour Time: Code # Inspection Description Confirm # Contact # Message ("S3a) krov-4-e-., [; Corrections/Comments/Instructions: I 1.7.151175P1W i i� Alm V /r /` / L L / / -�i . Amite / i _.,-/ -... , / _�i ,--2„. ( ,_, - . _ ,_/— , . AMWA ' -dier/P --.- - J ' • ' - i ASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: I �� Date: / 3� 6�f Phone #: (503) 718- - W