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1202G SW Karol Court
CITYOF TiG�4RD PLUMe;ING PERMIT _--
f PERMIT #: 7/11P[-M2002-00276
DEVELOPMENT SERVICES
,�`► DATE ISSUED: 11'i10'L
/ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S1026B-00411
SITE ADDRESS: 12020 SW <AROI- CT
SUBDIVISION: KAROL. COURT ZONING: R-4.,,
BLOCK: LOT: 010 —_ —__JURISDICTION: TIG
______— JURISDICTION:TIG
CLASS OF WORK: REP GARBAGE DISPOSAL.�,i: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING �liACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR LRAIN,:';; TRAPS:
STORIES: WATER HEATEr`f .). CATCH BASINS:
_ FIXTURES .AUNDRY TRAY: SF RAIN DRAINS:
S',NKS: T URINALS. GREASE TRAPS:
LAVATORIES. OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: 35 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DR/SIN: ft
Remarks: Replace approximately 35' of sewer line.
TEES
Owner:^ Type By _ Date Amount Receipt
BRENNAN, MABEL G PRMT CTR 7/11102 $7250 27200200000
12020 SW KAROL CT 5PCT CTR 7/11/02 $5.80 :'_7200200000
TIGARD, OR 97223 -- —
Total $78.3030
Phone 1:
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES 1�
1:x.33 SE MCLOUGHLIN BLVD #344 RFQUIRED INSPECTIONS
MIL.WAUKIE.., OR 97267 ------ —
Sewer Inspection
Phone 1: 503-653-5301 Final Inspection
Reg #: LIC 138941
PLM 3-434PB
This permit is issued subject io the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other appl;cable 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 renter. Those ruses 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)246-987.
Issued By: : / _ _ _ _ Permittee Signature:
Call (503) 639-0,175 by 7.00 P,M, for an inspection needed the next business aay
Plumbing Permit Application
pDatereceived: // Q? Pcrtnitno'
City or Tigard Sewer permit no.: Building permit no.: /
Address: 13125 SW Hall Blvd.Tigard,OR 97223
City,tf Tigard phone: (503) 639-4171 1'raject/appl.no.: _ G circ date:
Fax: (503) 598-1960 1 Date issued: H ,�l� Receipt no.:
✓ 1 / Case file no.: Payment tyre:
Land use approval: . �;�
OF
I &2 family dwelling or accessory U Cuunnerccd/industrial U Muhl Ionil` J I rn;uu nnpn�,cment
U New construction J Addition/.alteration/replacement U I,r.,d ,r•r " h SITEINFORMAON. FEE SCHEDULE
JOR
r r
, use clieckliht)
Joh address: saU c:, bra \ Y --- _- 1lexcriptiou (1ty.Ihec(ea.) 1'olal
Bldg.no.: Suite no.: Ne" 1-and 2-family dneilings only:
11_ (includes loo fl.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/co_unty: ZIP: 9 7zkEach additional hath/kitchen
Description and locati of work on premises: Cta��� 4. Site utilities:
» w `nl• _ Catch basin/area drain
Es►.dale trf cnmpletionlinsh c ti„ra Drywclls/Icach line/trench drain
Footing drain(no.lin.ft.)
Y Manufactured home utilities -
7Addrcss:
� w i� -c- \ ,�,.�,�. --_-__ Manholes - -Rain drain connector�„_�.o Stat . ZIP: Sanitary sewer(no.lin.ft.) ?c
_Phone: t,-; �,,, Pax: S 3 5 E-mail: Storm sewer(no.lin.ft.) --
CCB no.: 1 �j yam_ Plumb.bus.reg.no: _ Water service(no, lin. ft.)
Cit /metro : Fixture or Itemlir, no. :
City/metro �.-1`i Absorption valve
Contractor's representative signature: Back flow preventer
Print name: l�at'' r~ - Backwater valve
Basins/lavatory
Clothes washer
Name:_ ( A , _- Dishwasher _
Address: Drinking lountain(s)
(lily: Q_n/t�- State:- ZIP:
_ _ �'_-- - --- Ejectors/sump
Phone: Fax: r. m,ii Gxparlsion tank --
11110 Fixture/sewer cap
Floor drains/floor sinks/hub
Name(print): -�-- Garbage disposal
Mailing address: _ Hose.hibb
City:,,— _ �� State: ,1ZIP:` _ Ice molter —
_Phone: 1"ax: E mall: Inlerce tat/grease trap
Owner installation/residential maintenance only: The actual inst:allatioe Primer(s)
will be made by me or the maintenance and repair made by my regulp, Roof drain(commercial)
employee on the property i owr as per ORS Chapter 447. Sink(s),basin(s),lays(s)
�Owrerl's si na':.arc: _ Date: Sump � —
Tubs/shower/s ower tan
Urinal _
Name: -__ -- ai�V ter closet
Address Water heater
City: State: ZIP: Other:
P',tone: Fax: E-mail: Tota
Na ell
dons accept credit cards,please call Jurisdiction fox more Ins rnvni;; Minimum fee................ r
t tx Notice:'oris permit application
O Visa O MasterCard expires if a rermil is not obtaiae•1 Plan review(at — %) $ r
Credit card number.__--�_----.—_—__------_ —+�--L--
within 180 days after it has been Stale surcharge(8%)....$
Fspares Y'oTAL . $
Name nr'cardholdrr esihown on ctr&cad
accepted as complete. """""""""""
$
Cardlrulder aiiaature --_— --- Amount 1 40M16(61000M)
.:r
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 a2
nd -family dwellings only.
FIXTURES individual QTY e8 AMOUNT (Includes all plumbing fixtures in 1 PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each 0111ty connection) _
One 1 bath _ _ $249.20
Tub or Tub/Shower Comb. - 16.60 Two 2 bath _ x350.00
Shower Only 16.60 Three 3 bath $399.00
Water Closet 16.60 SUBTOTAL -
Urinal 16.60 P.A STATE SURCHARGE
Dishwasher 16.60 PLAN_R_EV_IEW 25%OF 3USTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 1600
Floor Drain/Floor Sink 2" 16.60
3" 16.60 - PLEASE COMPLETE:
4 16.b0
Water Heater O conversion O like kind 16.60 _ Quantic by Work Per.'ormed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
ermlt. - _ _Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or TubiShower
Hose Bibs 1660 Combination
Roof Drains 16.60 Shower Only _
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 16.60 Urinal _
Dishwasner _
_
Garbage Disposal
'-
Laundry Room Tray
Washing Machine
Sewer-1st 100' 55.00 Floor Drain/Sink: 2"
3"
Sewer-each additional 100' 46.40 - 4"
Water Service-1st 100' 5.5,00 Water Heater _ __-
Water Service-each additional 200' 4640 Other Fixtures
Storm&Rain Drain-1 st 100' Y 55.00 (Specify)
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 62.50
Requested Inspections perthr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.R0 __-
QUANTITY TOTAL
Isometric or riser diagram Is required If
Ouantny Total Is >9 --- - -
*SUBTOTAL - -•-
8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Roqulied onllit fixture qty.total Is>9 _
'TOTAL Minimum permit permit fee Is$72 50.8%clate surcharge,except Residential Backflow
Prevention Devire,which Is$36 25•8%state surcharge
**All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
I;\dsts\forms\plm-fees.doc 12/26/01
C ,TY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP -
Received -- - __.____ Date Reque /6_ AM-_--__ PM . BUP
Location b - _ Suite MEC
—d7�
Contact PersonPh( ) L( C�• PLM
Contractor__ Ph( _) — SWR --
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain / ELR _
Crawl Drain
Slab Inspection es: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing -— -- - - -----
Firewall
Fire Sprinkler - - - — -"
Fire Alarm
Susp'd Ceiling
Roof _
Other: -
Final
PAS RT FAIL
Poet&Beam r-
Under Slab -- -- -- — -
Rough-In
Water e -
ewer
Rain Drains —`- --`- -
Catch Basin/Manhole
Storm Drain -- —
Shower Pan
Other:
Z
PART FAIL -
ANICAL� _.� -- -- ---- — ---- --- --_— -
Post&Beam
Rough-In
Gas Line
Smoke Dampers - ---- -- - ---- -- ---
Final
PASS PART _FAIL -- ---- --- _._----- _—___—_ ___ ------__.----- ._----
ELECTRICAL-
Servire
Rnugh-In
UG/Slat,
Low Voltage
Fire Alarm
Final C] Reinspec► n fee of$—____ required before next inspection. Pay at City Hall, 13125 SW Hrai Blvd.
PASS PART FAIL
SITE_ _ _�_ C] Please call for reinspe.,.tion RE: Unable to inspect-no access
Fire Supply Line i
ADA
Approach/Sidewalk Date
Final DO hOT REMOVE this Inspection recc-i'd from thn job site.
PASS PART FAIL