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Case File fY fl F IAp`r i i N �1 v � � h i i 12137 5W All ia4 UR _ 7 § % § CO E 0 / / § / # } j ( k § ( w f 9 « w $ ) \ \ $ - - 2 3 m # ° ` 2 f G 5 ƒ ( @ m £ E ¥ f } y 2 � 0 _ ■ � © m @ 2 § § § $ \ E 0 % § § § / ° ~f7 CD 0§ m 0 ` 0 f � � \ \ \ \ \ / p cn « m tn � 00 � ; i c UL _ = z to CL % $ _ ° _ $ � & \ § § § » & £ o w \ § E K w w § w w E m M 0 § § K j \ / 2 2 § § 2 = / / \ UP( OF T I G A R D PLUMBING PERMIT DEVELv^ryMENT SERVICES kERMIT#: PLIVI2001 00509 1'125 SW Hall Br.." . Tigard, OR 97223 (503) 639-4111 DATE ISSUED: 10/9/01 SITE ADDRESS: 12137 SW ANTON DR PARCEL: IS134CB-14000 SUBDIVISION: ANTON PARK NO. 2 ZONING: R-7 BLOCK: LOT: 067 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BP,KFLOW PREVNTRS: 1 OCCUPAN(. f GRP: R3 FLOOR DRAINS: TRAPS: F'DRIES: 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: Installation of backflow preventer. FEES Owner: �_— - - -- —i Type By Date Amount Receipt BRICKLEY, GERALD J + MARGIE A PRMT CTR 10/9/01 $36.25 27200100000 12137 SW ANTON DR 5PCT CTR 10/9/01 $2.90 27200100900 TIGARD, OR 97223 _ _ Total $39.15 Phone 1: Contractor: MODERN PLUMBING 11120 SW INDUSTRIAL WAY TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone 1: 691-6166 RP/Backflow Preventer Reg #: LIC 87906 Final Inspection PLM 34-25CPB 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 ii work is not started within 180 days cf issuance, or if work is suspende,, 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 952-0001-00lU !hrk-ugh OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by call ng (503) 246-1987. Issued By: _ �ceLf`, ✓C'_ Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the 6ezt�business day Plumbing Permit At pllcat'on ------- ( 1. "Dateived:110/A,3Permit no. I m City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW I lall Blvd,Ti ard,OR 9 3 - CigofTigard phone: (503) 639-4171 Project/appl,no.: Expire date: Fax: (503) 598-1960 Date issued: eceipt no.: Land use approval: Case rile no.: Payment type: 0NNKUA9JLQ=_ - -7 W 1 dot 2 family dwelling or accessory U Commercial/industrial J Multi-lami:y U Tenant improvement U New construction id Addition/alteration/repl icement U Food service U Other: _ II SITE INFOWATIONr r t Job address: �,a) Av4aK _ _ IPcscripfion Qty, Fm(ea.) "1'olal Bldg.no.: Suite no.: New I-and 2-family dnellings only: (includes 1000.for each utility connection) Tax map/tax lot/account no.: _ SFR(1)bath Lot: Block: Subdivision: - - - ----.-- -_ -- - -- - SFR(2)bath Project name: SFR(3)bath City/county: LJ a.ZE1 ZIP: Each additional bath/kitt.hen Descript' n and location'df work oA t►remises: Site utilities: 144 g AX-Ce4_6 e;_ Catch basin/area drain Est.date of completion/inspection: _ Dryw, .,/leach line/trench drain 111 Footing drain(no.lin.ft.) Manufactured home utilities _ 1311siness name: j Manholes Address: Q .1 (�j. ll,q Rain drain connector _ City: _ State: r-I ZIP: Sanitary sewer(no.lin. ft.) - Phone: lag Fax E-mail: Storm sewer(no. lin.ft.) CCB no.: % Plumb.bus.reg.no: Flim r service(no.lin.ft.) City/metro lie.no.: Fixture or item: Contractor's representative signatu Absorption valve Print name �l ,l'./ Date: p 101 Back(low reventer - i Backwater valve Basins/lavatory _ Name: Clothes washer ------- ---- Address: Dishwasher _ _ _ - — --- City: �State: LIP: Drinking fountain(s)Ejectors/sump _ Phone: -- I a E-mail: Expansion tank Fixture/sewer cap Name(print): r( l f Q Floor drains%floor sinks/hub Mailing address: Garbage dissalHose bibb City: State- Z1P: Ice maker _ Phone: Q I Fax: I E-mail: Interceptor/grease trap _ owner installation/residential maintenance only: The actual it stallation Primer(s) will he made by me or the maintenance and repair made by m; regular Poof drain(commercial) employee on die property I own as per ORS Chapter 447. Sink(s).basin(s),lays(s) Owner's signature: Date- Sump Tubs/shower/shower part Urinal _ Name: —_ Water closet _ Address: _ Water heater City: State: ZIP. 01her: _ -- Phone: Faz: E-mail: Not all JI"Wictiom wce0 ctedil.artL,please call jun fiction for more inrotmation. Minimum fee................ Notice:This permit application U Visa U MaaterCard expires if a permit is not obtained Plan teview(at _ %) $ Credit cwd mrmtax: —L—L— within 180 days after it has been State surcharge(846)....$ - Name of cardholder u aho vu at crtdit cidExpiresaccepted as asmplete. TOTAL .......................$ _ S -- Cardholder asFVW a Amount 4404616(15KIWOM1 PLUMBING PERMIT FEES: ��-- - PRICE TOTAL New 1 and 2-family dwellings only: p FIXTURES individual QTY ea AKIOUNT (includes all plumLing fixtures in PRICE TOTAL L__.__ ) Sink 16.60 the dwelling and the firs1100 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 350.00_ _Shower Only 16.60 _Thee(3)bath _ _ $399.00 Water Closet 1660 - - --- SUBTOTAL Urinal 16.60 81/.STATE SURCHARGE Dishwasher 16.60 1 PLAN REVIEW 25%OF SUBTOTAL _ Garbage Disposal 14.60 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 O conversion O like kind 16.60 Quantity b Work Pertarmed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed! permit. __ - - Ca ed MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory T�b or Tib/St-_wer Hose Bibs 16.60 i Combinati n Roof Drains 16.60 Shower 0n1-y Drinking Fountain 16.60 Water Closet _ 16.60 Urinal Other Fixtures(Specify) 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 _ S eci _ Storm 8 Rain Drain-1st 100' 55.00 _ Storm&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 4640 -- - Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 - Inspection of Existing Plumbing or Specially 7250 Requested Inspections perthr _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 6525 Grease Traps 16.60 --- --- _ QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is >9 *SUBTOTAL ------ -- - - 8%STATE SURCHARGE -__-- `PLAN REVIEW 25%-6F SUBTOTAL Required only if fixture qty total is,9 _ r-- TOl•AL E *Minimum permit fee 19 f72 50+8%jWe surcharge.except Resdentlal Backflow Prevention Crevice.which iss;,�_Q..'�'r 88%iNa surcharge. "All Now Commercial nunemQsTequire mans wxh isometric or riser diagram and plan review IAdst:lforms\plm-fees.doc 10/10/00 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -- / BUP Date Requested/` Z I ----AM--.—PM BLD Location 7 (fee n __- -- Suite MEC -- Contact Person --_ Ph PLM Contractor - __ Ph SWR BUILDING Tenant/Owner —_— ELC -- _ Re'aining Wall ELR Fooling Access FPS Foundation Fig DrainN • ?4 �e `ck. �,, ` Z I SIGN --- - Crawl Drain r'1s� ctlon Notes. Slab _------- --- --- — - SIT _ ------ - Post& Beam Ext Sheath/Shear -' - - -- - - -_ Int Sheath/Shear Framing Insulation - Drywall Nailing - Firewall r Fire Sprinkler — -- Fire Alarm Susp'd Ceiling — - -- - - - Roof Misc --- Fina! �, Yf / �l 1 L'�j S /I r ---- PASS PART FAIL Post Beam �C 4 - _-- _--- Underr Slab Top Out Water Service - Sanitary Sewer >ia-Drains - ---------- ----- - ----- - <1final ------ ---- ------ - - — -- --- s PART FAIL Mk MANICAL Post g Bean, _-._-------_ ----- -- _Rough I n --------- ---. ----Gas Line Line --_.---.___-- - -- ISmoke Dampers --_ —. Final --------------- -- PASS PART FAIL -- — ELECTRICAL. -------—----- -- -----�- Service --- Rough In ---- -- UG/Slab ---`-- L ow Voltage Fire Alarm Final PASS PART FAIL -- SIS E �� - ---- - ---- ..-— _---- -- --- Backfill/Grading ---- Sanitary Sewer Storm Drain [ ]Reinspection fee c'. $ required before next inspection. Pay at City Nail, 1?125 SW Hall Blvd Catch Basin [ J please call for reinspectioi RE: _ [ J Unable to inspect-no access Fire Supply line ADA � Approach/Sidewalk Date _ � I nspectarExt _ Otiie� [FinalS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY CSF TIGARD COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Nell Blvd.Tigard,Orego,i 97223.8199 (503)839-4171 1 �_ (0.*;""1 TY 0 F T I CARD COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Heil Blvd.Tigard,Oregon 97223.8199 (503)8394171 A I I It - i PI_NCK RLCT # `� -S 5)C CITY OF TIGARD Tigard,o«IlI1SS rcgon9771nz /3 PERMIT N c �i r—0-2 2F� COMMUNITY !)I VELOPMENT DEPARTMENT (503)6]9- 171 DATE ISSUED JOB ADDRESS: ��/ �� �_L�-�"'J ����-- TAX MAP/LOT f5/ 3Y-2V /WOO SUB: a -SLOT: _���_ _ LAND USL: h '7 VALUATION: _ OWNER SPECIAL NOTES NAME: REISSUE OF: ADDRESS: 5 ,,�� _� LAST REISSUE: ._------- --_--- FL000 PLAIN/ PHONE: _ ____ '�L'Z-Z'- — �--- __ SENSITIVE LAND: CONTRACTOR APPROVALS REQUIRED `7 G1f�t12' � NAME: � ��G T PLANNING: ETA ADDRESS: _ _ ENGINEERING: —_ FIRE DEPT: PHONE: _ — OTHER: CONTR. BOARD : f6.3 .�_ EXP DATE: ITEMS REQUIRLD I SUBCONTRACTORS: PLUMB: LIST/SUBCONTRP.CTORS: _�--------- MECH: _ — Lam' BUS TAX: ----- -- — - -- - ARCH ENGINEER CALCULATIONS: -- NAME: TRUSS DETAILS: -- ADDRESS: _ — _— OTHER: —_—_ — PHONE: - PROPOSED BLDG. USE: ---- COMME.NTS: 0 2- ------- / �� �/alt -�te•►..1��1.�.�,.�..c..r� APPLICANT SIGNATURE --'----_--- - -- —'-- Received B ` _ __-____ _ _�__ _ Date Received: S —07 PERMIT h ACCT # DESCRIPTION AMOUNT fAOUNT PD. BAI . DUE ` y? 10-432 00 Building Permit. Fees 3L7, 10-431 00 Plumbing Permit Fees 10-431 01 Me( 'ianical Permit Fees �' 'v 10-230 01 State Building Tax (5%) �7�• 3 ---- '1 '''3 BuiI(,ing Plumbing zy Mechanical o 05 Sc�• � � L�C� /U, /3 10-433 00 Plan,, Check Fee % - -�- Building _! 0 PI urb i ng / Mechanical 10, 13 10-230 06 Fire / S"r,.R43 -o 711 30-202 00 Sewer Connection ;V0 30-444 UO Sewer Inspection 25-448-02 Commercial TIF Fees - --- 25-448-04 Industrial TIF Fees 25-448-06 Institutional TIF Fees — 25-448-03 Office TIF Fees _ 25-448--01 Residential Traffic fees 1 5o /35o 25-448-05 Mass Transit TIF Fees -2/1) /--�O--- 52-449 00 Parks System Dev Charge (PDC) S vd S G u 31-450 00 Storm Drainaqe Syst Dev Chrg (SSDC) 24-445-01 Water Quality (Fee in lieu of) 24-445-02 Water Quantity (Fee in lieu of) IOIAF � • aU � . . nm/3587P.WPF