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12153 SW 125TH AVENUE 12153 3W 1,25"' Avenue CITY OF TIGAR® - PLUMBING PERMIT — PERMIT#: PLM2')C2-00442 ©i_VF! OPMENT SERVICES DATE ISSUED: 11;1602 131 :5 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S10366-03700 SITE. ADDRESS: 12153 SW 125TH AVE ZONING: SUEDIVISION: JURISDICTION: _ BLOCK: LOT: -- - -- ---- —� CLASS OF WORK: REI' GARBAGE DISPOSALS: MOBILE HOME SPACES: TYFE OF Ut E: SF WAS�;ING MACH: BACKFLOW PREVNTRS: p FLOOR DRAINS: TRAPS: OCCUPANCY GR R3 STORIES: WATER HEATERS: CATCH BASIN ': _ FIXTURES ___ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS! GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: 30 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replaaement of -iprpo,,,imately 30 feet of sewer service. FEES_ Owner: ____— - -- Description Date _ Am ount I_AUZON, 1-HOMAS CI'LliM13J Permit fee 11118102 $72.50 12153 SW 1251H AVE �PLUMB] Permit Fee 11/18/02 $0.00 TIGARD, OR 97223 [TAX]81%,State Tax 11/18102 $5.80 [TAX] 9%,State Tax 1 0.18/02 $0.00 Phone 1: Total $78.30 Contractor: --- AMERICAN G%AIN MARIO DA S11 ` A !FRANCISCO 2205 SE 10TH ST 7�cQUIRED INSPECTIONS GRESHAM, OR 97080 -- Sewer iocrcctiott Phone 1: 503-6t)5-6576 Final Inspection Reg#: LIC 147863 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. P! work will be done in accordance with approved plans. This permit will expire if work is I taw(thin requires you to follow rules adopted by the Oregon days of issuance. or if work is formore than 180 days. ATTENTIONOregon Permittee Signature: issued By: d Call (503)639-41 5 by 7:00 P.M.for an inspection neu a next business day Building Fixtures Plumbing Permit Application MIN Date received: Permit no.: L� liLYl City of Tigard _ Address: 13125 SW Hall Blvd,'Tigard,OR 97223 Seger permit no.: Building permit no.: City of Tigardphone: (503) 639-4171 Pro;ect/appl.no.: a date: Fax: (503) 598-1960 Date issued: BI Rcceipt no.: Land use approval: _ - Case file no.: Payment type: TYPE OF PF 11!�T 7&72family dwelling or accessory U'Commercial/industrial U Multi-family U Tenant improvement struction UAdiition!alteration/replacement U Food service U Other: 40BIS111TE 1,NFqIkMA13Or4i t t Job address: . I_ `�� ,4 S ( Description Q11-. Fee(ea.) I Total rew 1-and 2-family dwellings only: Bldg no.: \ Suite no.: (includes 100 R.for each utility connection) Tax map/tax lot/account no.: i � SFR(I)bath Lot: Block: Subdivision: SFR(2)bath _ Project name: Ve-Q SFR(3)bath Cit /county: \ Each additional bath/kitchen Description and location of work on premises: Site utilities: Catch basin/area drain Est.date of c mpletion/in�pccli(m D wells/leach line/trench drain CONTRACTOR Footing drain(no.lin,ft.) Manufactured home utilities �-N Business name: �� — _�..� ����r � Manholes i Address: C, Rain drain connector City: V.-. State:M_I ZIP: '* Sanitary sewer(no.lin,ft.) Phone: ax: E-mail: Storm sewer(no. lin, fl.) _ CCB IF,umb.bus,reg.no: Water service(no. lin. ft.) Cite/metro lic.no.: rP G Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print came: Date: l - Backwater valve 1 Basins/lavatory Nerve: �Q�1� Clothes washer Address: Dis washer Cit State: ZIP: _ Drinking fountain(s) Electors/sump Phone: Fax E-mail: Expansion tank UJI01 Fixture/sewer cap Name(print): CFloor drains/floor sinks/hub _ Garbage disposal Mailing address: \ t.v }lose bibb — CiV k tat State ZIP: Ice maker Phone: Fax: E-mail: Interceptor/$rease trap t)caner instal latiott/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) Owner's si nature: _ Date: _ Sump Tubs/shower/shower pan Name: Urinal _ --- — ---- -- — Water closet Address: watereater City: - --- Stater- ZIP: 6ther, Phone: Fax: E-mail: Total NW all Jurisdictions accept credit cards,please call Junuticuon for more Information _ Min'mum fee................ S Notice: This peumit application o n Viso U MuterC'ud expires if a permin is not obtained Plan re-lew(at _ /o) S credit cud number within 1 A0 days after it hes been State sun I arge(8%).... S _ Rplftl Com tete. TOTAL....... ...............S Name o uobe rd r u rhown on ecardaccepted It eaas p G er atwture V' V Amount PLUMBING PERMIT FEES: — PRICE TOTAL WWW- 4 and 2-family dwellings only: FIXTURES (individual— QTY ea AMOUNT f (includes all plumbing fixtures in ?RICO TOTAL 1660 the dwelling and the first100 ft. QTY I (ea) AMOUNT Sink for each utility connec_tion) —�-- Lavatory --- 16,60 _ One(1)bath _ __ $249.26 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 SURCHARGES Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL . _ TOTAI ---t-- Garbage Disposal 16.60 -- -- ---� Laundry Tray 16.60 Washing Machine 16.60 Floor Draln/FloorSink 2" - 1660 -- PLEASE COMPLETE: 3" 1660 --- Cuartft b Work Performed Water Hoater O conversion O like kind 16.60 Gas plying requires a s3parate m:' ,tanical Fixture Type: New Moved Replaced Removed! _ Ca ed ermit. Sink MFG Home New Water Service 46.40 46.40 Lavato _ -- MFG Home New San/Storm Sewer _. Tub or Tub/Shower Hose Bibs 16.60 Combination — -- -- Roof Drains 16.60 Shower Onl —. --- - 16.60 Water Closet —-- Drinking Fountain Urinal Other Fixtures(Specify) 16.80 Dishwasher -- Garba a Dis oral _ — Laundry Room Tray _—.— _, WashingMachine Floor Dra'n/Sink: 2" Sewer-t at 10U' 55.00 3" — Sewer-each additional 100' 48.40 4" —-- 55.00 Water Heater -- Water Service-1 st 100' Other Fixtures Water Service each—additional 200' 48.40 S eCl -- Storm 6 Rain Drain-1 sl 100' 5500 — storm 6 Rein Drain-each additional 100' 48.40 Commercial Back Flow Prevention Device 48.40 Residential Backflow Prevention Device' 16.55.60 — Catch Basin 18 — -- Inspection of Existing Plumbing or Specially 6250 Requested Inspectionsper/hr COMMENTS REGARDING ABOVE: Rain Drain,single famlly dwelling 65.25 — — ------------- Grease Traps 16.60 — -- -_ -- QUANTITY TOTAI. — Isometric or riser diagram Is required It - Quantity Total Is >99 ,SUBTOTAL -- 8%SI ATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL Required only if axlure gtY 10101 Is 1 9 — TOTAL s *Minimum permit its is 172 50•a%state surcharge.except Residential Backflow Prevention Device,which Is 139 25 4 a%slate surcharge "All New Commemlal Buildings require 2 sets of plana with isometric or riser diagram for plan review. 1:\dsts\forms\plln-fees.doc 12/26/01 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST _-- IN=SPECTION DIVISION Business Line: (503) 639-4.371 BLIP _-- _--- Received -- -- --- Date Requested AM PM ------- BLIP ----------- --- Location L S 3 S ,,✓ Suite MEC —_ Contact Person _ _ _ Ph{ ) 13 A- 413 PLM L.4114) L Contractor —_ Ph( —) SWR - BUILDING `-_ Tenant/Owner A " 10-06. a C ELC Footing _ ELC - Foundation Access: Ftg Drain / / -S ELR Crawl Drain Slab Inspection Notes: SIT Post Beam Shear Anchors - -- Ext SheatIVShear Int Sheath/Shear Framing - - -- -- -- - Insulation Drywall Nailing - Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling -- - Root Other: --- -- - Final f� PASS PART FAIL �.'i�l""_"tea--_ ----- --- -- ------------- Post& Beam Under Slab ---- - Rough-In Water Service ---- -- -- a rains --- -- --- - Catch Basin/Manhole Storm Drain Shower Pan Other: FinaPn AS PART FAIL - -E _A_NICAL ____ ------- _---__-- _ - Post& Beam - Rough.In - - Gas Line Smoke Dampers ------ - - - - - Final PASS PART FAIL_ - ---- ----_.- - ELECTRICAL _ Service -_ - - �..------- -- �� Rough-In - UG/Slab Low Voltage Fire Alarm Final F1 Reinspection fee of$-_ required before next inspection. Pay at City Hall, 13125 SW Hell Blvd. PASS PART--FAIL -- SITE Please call for reinspection RE: - Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk DOW Inspoetor _ Ext Other: Final _--- DON T REMOVE this inspection rezord from the job site. PASS PART FAIL