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CITY OF T I G A R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00042
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/7/01
PARCEL: 2S 102CC-06200
SITE ADDRESS: 13625 SW GARRETT CT
SUBDIVISION: BEREA ZONING: R-4.5
BLOCK: LOT: 023 .JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR. DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BA--'NS:
FIXTURES_ _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIX'URES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: It
DISHWASHERS: RAID DRAIN: fl
Remarks: Installation of residential irrigation backflow prevention device.
_ FEES _
Owrinr:
Type By Date Amount Receipt
KAT, , ANITA LORRAI NE PRMT CTR 2/7/01 $36.25 27200100690-
13625 SW GARRETT CT 5PCT CTR 2/7/01 $2.90 2720010001'0
TIGARD, OR 97223 --
Total $39.15
Phone 1:
Contractor:
ON THE MARK ENTERPRI SES INC
25?5() SW GARDEN ACRE RD
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone 1: 503-682-0469 Final Inspection
Reg#: LIC 58836
PLM 5860LCB
'EXPIRED
This permit is issued subject to the regulations contained in the Tigard Municlpa! Code, State of OR.
Specialty Codes and all other applicable laws. All work wil! tie done in accorJanee with approved plans.
This permit will expire if work is not started within 180 days of issuance, or ii work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notif.ation 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.
- C
Itisued By;, :3-'� Nennittee SignatUrt:
call ('503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
1
Plumbing Permit Application
-- Datelecerved:,� %�d / Permitno..�j�::'Op/
City of Tigard Sewer permit no.: Building permit no.:
M Address: 13125 SW Ball Blvd,Tigard,OR 97223 project/appl.no.: Expire date:
n
Cay ofTlgard phone: (503) 639-4171
Fax: (503) 598-1960 Date issued: Byj., [receipt no.:
( Land use approval: J_ case rile no.: Payment type:
U I &2 family dwelling or accessary U l'anuncrcull/indu`u al U Multi-family 0 Tenant improvement
U New construction U Addition/alteration/replacement ❑Food service U Other:
1 '
Description Q1Y. Fee(ea.) 'halal
�V Job address: � Z, �w.1 t�Ru-�CC New 1-and 2-family dwellings only:
Dldg,no.: Suite no.: (includes 100 P.foreach utility connection)
Tax map/tax lot/account no.: SFR(1)bath
�_ Block: Subdivision: SFR(2)bath
Project name: r SFR(3)bath
City/count):''' L.Io. ZIP: "1 Each additional bath/kitchenSk
_
Description and location of work on premises: Catcchh bbaasisinn//
`A�� J r �•,,„ 1NSrn�(DT1CaN _ Caarea drain
Drywells/leach line/trench drain _—
Est.date of completion/inspection: Fcxrting dram(no.lin.ft.) —
Manufactured home utilities
Business name:Cj14_ Bk1R-rL. E.u+T• n -r-trI Manholes _
Address: - 5,4 GtatT-D 1��-�+>� Rain drain connector
City: c x State:N- ZIP:q_ ( Sanitary sewer(no.lin.ft.) _
Fax: -p1 E-mail: Storni sewer(no.lin.ft.) __
Phone: Water service(no.lin.ft.)
CCB no.: Plumb.bus.reg.no:lL-g 4'" Fixture or item:
City/metro lie.no.: Absorption valve
Contractor's representative signature: Bu k flow preventer
Ihirl nanrc 4�tr�tz Date: ? .-7)01Backwater valve
Basins/lavatory
Clothes washer
Name:
Address: _ — Drinking fountain(s)
City: _ State: I/II' Ejectors/sump
Phone: Fax: 1 nseil Expansion tank --
Fixture/sewer cap _
Floor drains/floor sinks/hub
Name(print): —_ - Garbs a1 spos,al
Mailing address: _ Nose bibb
t•ity: State: ZIP: ice maker
Phnne: I Fax: E-mail infero for/grease trot)
owner installation/residential maintenance only: The actual installatim, Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee an the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's si mature: Date: I Sum
Tubs/shower/shower pan
Urinal
Name: _ Water closet
Address: — Water heater
City: _ State: — ZIP: Other
� _ ——
Phone: Fax: E-mail: Total
Minimum fee..... ....... ..$
Na all Jurisdicauos*Telx credll cards.please cell}uritdicuon rex more Information. Notice:This permit application Plan revitw(at _ %) $
U Visa U MnsterCard expires if a permit is not obtained State surcharge(8%)....$
Credit card number. _ — �splrc - within Igo days after it ha
Num s been TOTAL $
Naof cardholder arkr shown oa Il car
c d � t
accepted as complete. ....................... /
-� Cadholdr dry-:oo '-- Amount �_ _�`��� 410-1616(ti�UM:gM)
�IY�71i
PI-LABING PERMIT FEES:
-- �'—PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES 1individua!) QT" ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL
.�mPk� 16.50 - the dwelling and the first100 ft. OTY I (ea) I AMOUNT
16.60 "— for each_utility connection __
Lavatory -1 - -- -� One 1 bath _ 5249.20
t 0.60 —� L -
Tub or TublShorCo
womb. Tido 2 bath $350.00
Shower Only 16.60 Three 3 bath -$399.00.-
Water Closet 16 60 SUBTOTAL
Urinal 16.6u4 j-%STATE SURCHARGE _
Dishwasher 16.60 PLAN REVIE"125%OF SUBTOTAL
--- — _ TOTAL
Garbage Disposal 1660 - - -
I.aundry Tray 16.60 —
Washing Machine 16.60
Floor Drain/Floor Sink 2" 1s.3
0 - - PLEASE COMPLETE:
3" 16.60
q" 16.60 ---- ---- ---- -
Quantity b Work Performed
Water Heater O conversion O like kind 16.60 _
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 46A0 Lavatory
_ _ Tub or Tub/Shower
Nose 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 _
- — Washin Machine
Floor Drain/Sink: 2" _
Sewer-1 st 100' 55.70 3" _
Sewer-each additional 100' 46.40 _4"
Water Service-1st 100' 55.00 Water Heater _
Other Fixtures
Water Service-each additional 200' 4640 (Specify)
Storm&Rnin Drain-1st 100' 55.00 _.
Storm&Rein Drain-eauh additional 100' 46.40
Commercial Back Ftow Preventlon Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60 1, El-
Inspection of Existing Plumbing or Specially 72.50
Requested Inspectionsper/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
8%STATE SURCHARGE T --- ----- ` -
"PLAN REVIEW 25%OF SUBTOTAL
Required only II fixture qty total Is>9
-�� TOTAL $
"Minimum permit lee is$72 50-8%state surcharge,except Residential Backflow
Prevention Device,which is$38 25+8%state surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan inview
is\dsts\fonns\ptm•fees.doc 10/10/00