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9126 SW r urham Road
CITY OF TIOARD __ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: P -002?.2
�r DATE ISSUED: 6/117/027/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S111 DC-14500
SITE ADDRESS: 09125 SW DURHAM RD
SUBDIVISION: STUDIO ESTATES ZONING: R-7
BLOCK: LOT: 003 _ __--.IURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYNE OF USE: SF WASHING MrkCH: 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: SEVIER LINE: ft
WATER CLOSETS: WATER LINE: 70 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of approximate 70 L.F. of domestic v✓ater line.
FEES
Owner: Type By Date Amount Receipt
ALDRIDGE, RHEA L PRMT CTR 6/17/02 $72.50 27200200000
9125 SW DURHAM RD 513CT CTR 6117/02 $5.80 27200200000
TIGARD, OR 97224 —
Total $78.30
Phone 1:
Contractor:
ADAMS PLUMBING
PO BOX 161
DAYTON, OR 97114 REQUIRED INSPECTIONS
Water Service Insp
Phone 1: 503-550-5880 Final Inspection
Reg#: LIC 138047
PLM 36-9713B
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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: 41-4 ;��. _ Permittee Signature: f" '
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Applicati®n
~'- Daterece:ved .-0- Permitno'- )(,' DU
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 _
Projccdappl.no.: Expire date:
Phone: (503) 639-4171
Fax: (501) 598-1960 Date issued: By:6 Rec!ipt no,:
Land use approval: __ __ Case rte no.: Payment type:
Ll i &2 family dwelling or accessory U Commercial/industrial J Multi-Gunily U Tenant improvernent
U New cunstnuti,m U Add itinn/al teration/replacemen, J Frrucl ticreic, J Olhrr - __-
Job address: 2 5 5..- lr r" r -_Nz 11`1 - �. Description Qty. Fee(ea.) Total
Suite no.; New 1-and 2-family dwellings only:
Bldg,too.: -- (Includes 100 A.foreach utility connec(ion)
Tax snap/tax lot/account no.: _ .._ SFR(I)hath
Lol; Block: Subdivision: SFR(2)bath _
Project name: --- SFR(3)bath
Cily/county: Ti .� ch add
ZIP: Eaitional bath/kitchen _
Description an ovation of work on premises: rep r•-_�.r Mteutilitlea:
Catch hasin/area drain
_ `-- -- - - -- — Drywalls/each line/trend: rain
L'st.date o1 completion/inspection , -
Focxinkdrain
Manufactured home utilities
Businessname: ti.-. Manholes _•
Address: 0 �i>� '(f I_ ---�� _ Rain drain connector ,--
_City: A __ State: ZIP: f Sanitarysewer(no.lin.ft.)
Phone: _ - ax: f? mail:
T Storm sewer(no.I n.ft.)
CCI3 no.: p Plumb.bus.reg.no: - Water service(no. lin.ft.
Fixture or item:
City/metro t6.no.: -:l<-cit ` Absorption valve
Contractor's representative signs ure: �'� Back flow�revent^r _
Print name: $. Date; Backwater valve _
t Basins/lava(ory
Name: _ Clothes washer
- Dishwasher
Address: I — Drinking fountain(s)
City: 1, Stale: ZIP: Ejectors/sum
Phone: l Fax: Email: xpansion tank
Fixture/sewer cap
Floor drains/tlt,or sinks/huh
Name(print): Garbage disposal
Mailing addrem: — Huse bibb
City: - State: ZIP: _ ce maker
Phone: Fax: F--Mail: Interceptor/grease trap
Owner instal lation/residential maintenance only: The actual installation Primers) —
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the properly I own as per ORS Chapter 447. Sink(s),basin(s), ays(s)
Owner's si nature: Date: Sump
Tubs/shower/shower pan
Urinal _
Name: --- --_-- --__-_ Water closet -
Address: Water heater
City: State: ZIP: Other: -- -
Phone: E-mail: Total _
Minimum fee................$ 2.1.
Not all jurisdictions accept credit cards,please call jurisdiction rm luxe Information Notice:This permit application
U Visa J MasterCard expires if a permit is not obtained
Plan review(al $
Credit cud num" - -- mL- within I80 days after it has been State surcharg.p
(8%) ....$ —
old. nr ;
accepted as complete. TOTAL .......................
Name of c;�hshown on credit card
_ Cadholder-,.Patwe _ Amount 110-/461,•(~-oM)
PLUMBING PERMEF FEES:
------ _-- �— PRICE TOTAL New 1 and 2-family dwellings oily:
FIXTURES (individual) — QTY ea� AMOUNT OncIL d^.s all plumbing fixtures in I PRICE TOTAL
60 the dwelling and the first100 ft. QTY (ea) I AMOUNT
Sink 16. for each utilityconnection
16.6 0 _—
Lavatory One 1 bath _ $249.20
Tub or Tub/Shower Comb. 16.60 Two(2)bath — $350.00
Three 3 bath $399.00
Shower Only 16.60 —
Water Closet 16.60 —"' SUBTOTAL _
Urinal 16.60 8`/.STATE SURCHARGE
PLAN REVIEW 28%.OF 1 TnT AL
Dishwaaher 16 CO—
T07AL
Garbage Disposal 16.60 —
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 1680 PLEASE COMPLETE:
3„ 16.60
4^ 18.80
Quandt by Work Performed
Water Heater O conversion O Ilke kind 16,60 [Fixture Type•. New Moved Replaced Removed/
Gas piping requires a separate mechanical Capped
ermit --- Sink
MFG Nome flew Water Service 46.40
46.40 Lavatory
MFG Home New San/Storm Sewer Tub or Tub/Shower
Huse Blbs 16.60 Combination
Roof DrainsSho
16.60 wer Oni
— 18.80 — Water Closet —
Drinking Fountain Urinal _
Other Flxti res(Specify) 16.60 Dishwasher _
Garbage Disposa
Lauldry Room Tra
—1 - W.ishing Machine __--
__ Floor Oraln/Sink: 2" —
Sevier-1st 100' 55.00 3"
Sewer-each additional 100' 46 40 4 — ~--�
55.00 U t0ther
Heater
Watdr Seryce 1st 100' FixturesWaterService each additional 200' 4440 if
Storm&Rain Drain-1st 100' 55.00
Storm&Rain Drain-each additioral 100' 16.40
Commercial Back Flow Preventior Device 43.40
Resldenlial Backflow Prevention Uevlce' ?'f 55 —
Catch Basin 1U 60
2 To—
Inspection of Existing Plumbing or Specially 6erthr COMMENTS REGARDING ABOVE:
Requested Inspections ---
Rain Drain,single family dwelling 65.25 ----- —
Grease Traps — 16.60 -----
QUANTITY
Isometric or riser diagram is required If
Quantity Total Is >9 — --— --
*SUBTOTAL — --------- -- --
0%STATE SURCH/ME
"PLAN REVIEW 26%OF SUBTOTAL
Required only II flxlure qty.total Is>9
TOTAL S
`Mlnimum uermlt fee is$72 50.8%slate surcharge,except Residential Backflow
Preventlor.Device,which Is$311 25•8%slate surcharge
"All New Commercial Buildings require 2 sats of plans with isometric or riser
diagram for plan review.
1:\dstslforms\plm fees.dor: 12/26/01
CITY OF TIGA RD 24-Hour
BUILDING Inspection Line: (503)639-4173
MST _ - ---
INSPECTION DIVISION Business Line: (503)639-4171
BLIP -
Received _.__________,_Date Reque$tE;d /� -- AM_ PM f- _ BLIP _
L ocation — _
SUIG�_.. MEC
Contact Person Ph( ) - -_ PLM
Contractor--- - --- - - --- - Ph( ) __ SWR —_
BUILDING Terant/Owner _ _ ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain --�
Slab Inspection Notes: - 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 -
PI�SS PARTFAIL
f LU-MBI
— -- ---- --- -
Post& Beam
Under Slab - - --------
Rough-In __
(Water Se__ ga -- - ---
Sanitary ewer
Rain Drains - -
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Fin - ----- -
AS _PART FAIL
NICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampers --
Final
PASS PART FAIL - �-- - --- — - ------ -- -
ELECTRICAL
Service ----
Rough-In
UG/Slab -- ----------------------- - -
Low Voltage
Fire Alarm
Final Ll Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Flail Blvd.
PASS__ PART FAIL
SITE _ IA Please call for reinspection RE:___ —_—_ Unable to inspect--no access
Fire Supply Line '
ADA
Appi oath/Sidewalk Data.4 � Inspector�_ Ext - --
Other. _ � �--------------
Final DO NOT REMOVE this Inspection record from the job site.
PASS PARI' FAIL