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11385 SW Fonner Street
CITYOF TIGARD _ _PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: /12/ 002 OC189
6
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6112/02
PARCEL: 2S103AC-01200
SITE ADDRESS: 11385 SW FONNER ST
SCBDIVISION: ZONING: R-4.5
BLOCK:_- LOT: JURISDICTION: TIG _
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE ()FUSE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURE. LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: 150 ft
WATER CLOSETS: WATER LINE: 410 ft
DISHWASHERS: RAIN DRAIN: 120 ft
Remarks: Site utility installation for minor land partition, services fr. (2) lots.--
Owner:
ots. _Owner:
Type By Date Amount Receipt
JOHN STARK PLCK CTR 5/29/02 $64.45 27200200000
PO BOX 23215 PWAT CTR 6/12/02 $350.00 27200200000
PORTLAND, OR 97281 5PCT CTR 6112/02 $28.00 27200200000
PI_C2 CTR 6112/02 $23.20 27200200000
Phone 1: 503-544-6840 Total $465.65
Contractor: ^_—
LUTZ JETTE, INC
16928 SW BEEF BEND RD
EHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: "13-590-7521 Sewer Inspection
Sewer Inspection
Reg #: L,C 80585 Water Service Ince
`Nater Service Insp
Storm Drain Insp
Storm Drain Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Cc de. State of OR.
Specialty Codes and all other applicaL'- laws. All work will be done in accordance, with annrovr d plans.
This permit will expire it work is not started within 180 days of issuance, or if work is s-.1spended for snore
than 180 days. ATT-ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001 -0010 thrcugh OAR 952-0001-0080.
You may obtain copies of these rules or direct questions io OUNC by calling (503) 246-1987.
}� r Permittee Si ne'ure: (Q
Iss d By: I4X _ g - ----
-- Call (503) 639-4175 by 7:00 P.M. for an inspection needed the nex siness clay
Plumbing Permit ARplication
ate received: Permit no.: 8 g
City of Tigard . 0_..
Address: 13125 SW Hall Blvd,Tigard,OR 7223 Sewer permit no.: Building permit no.:
�i1t�t11 --
CirynfTigard Phone: (503) 639-4171 MA1� 2 !� /till[ Ptoject/appi.no.: _ Expired are: _
Fax: (503) 598-1960 Date issued: By:61/I Receipt no.:
Land use approval: �1 'L�''Q� 3,�:.;�.^ Casc file no.: Payment type:
U I &2 family dwelling or accessory U Commercial/industrial U Multi family U Tenant ill ,mrvemcal
U New construction U Ad(lition/alteration/replacement U Fool service U Other:
1 1 ' 1 1 t
3�^�j - `((`p.� 1°YIUr1Gi Description _ Qty. f ec(ca.) Total
Job address: / 5t.t [ r !►c"
B14g.no.: --�1 Suite no.: �-� I 1-and 2-family dwehintw only-
Taxmap/tax lct/accountno.: / — O (includes 10011.for each utilityConnect ion)
Lot:fkSFR(!)hath
xCci &?;i Block: Subdivision: - - -- - - -
SFR(2)bath
Project name: ✓14crk- t _ SFR(3)bath
City/county: i�,. j , b IASq- Each additional bath/kitchcn
Description and Id ,►tion of work on premises: r Siteutilities:
/Zt:J Catch basin/area drain
Est.date of com Iction/inspertiotr: Drywells/leach line/trench drain
1 '
Footing drain(no,lin.ft.)
: Manut'actured home utilities
Business name '
tT7 ;� L`Z Manholes
Address_ _ Rain drain connector _
City: State: 7,IP: Sanitary sewer(no. lin. ft.)
Phone: Fax: E•muil: Storm sewer(no.lin.ft.)
CCB no.: Plumb.bus.reg.no: Water service(no. lin.ft.)
City/mrtto lie no.: Fixture or item:
Contractor's representative signature: Ahscrlrtion valve
Print name: Date: Back flow reventer
Backwater valve
Basins/lavatory ---- _
Name: 0V Clothes washer
Address:_ Dishwasher
r � " a' Drinking fountain(s)
City I State: I ZIP: -—
Phone: Fax: E-mail: — Ejcctors/sump
Expansion tank
Fixture/sewer cap _
Name(print): 04n, kA m E/Y^U Floor drains/floor sinks/hub
Mailing address: 3 (� Garbage disposal
Cil State: a Ilcsr,bier
Y_ r}tiG�! X12. ZIP_ Ice maker
Phone: tid Q2 yt,I Fax: E-mail; Interceptor/grease trap
Owner installation/residential maintenance only: '1 he actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) AE
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s) ---iiia
ure: _ Date: Sump
Tubs/shower/shower art _
Name: fl Urinal
y - Vr'ater closet
Address:
��)� Water heater
City_ 1 State: ZIP: r v r her:
Phone: K -,944V Fax: E-mail: Titdl
Not all Jurisdictions arcept credit cards,please call Jurisdiction for mrar inromtatian. Minimum fee................$ -7
Notice:This permit application -
U Msr U MasterCardPlan review(at _ %) $
expires if a permit is not o',tained �
Credi(cord numMr _ � within 180 days eller it has Seen Stale surcharge(8%)....$ `DZ le Z,
splr.•s y
Name or c"iti m r a s on credit card accepted as complete. TOTAL .......................$ 4Q,
S
- cordholder sipature Amouni It/�: v "_f L v t�r 4441616(tL WOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only: -
FIXTURES individual- QTY eaL_ AMOUNT_ (includes al'plumbing fixtures In PRICE TOTAL
Sink 1660 the dwelling and the first100 ft. QTY (ea) AMOUNT
16.60 for each utiles connactlo>n �__
t.avatory -- _ $249.20
rub or Tub.Shower Comb 16.00 Two 2 bath $350.00
Shower Only 16.60 Three 3 bath $399.00
Water Closet 16.60 -� - -
_ SUBTOTAL
Urinal 16.60 _ 8%STATE SURCHARGE
Dishwasher -- 16.60 PLAN REVIEW 25%OF SUBTOTAL _
Garbage Disposal 16.60
Laundry Tray 16.60
Washing Machine 16,60
FloorDrain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
q' 16.60
Quantity b I Work Performea
Water Healer O conversion O like kind 16.60
Gas piping requires a separr to mechanical Fixture Type: New Moved Replaced Removed/
Capped
permit
MFG Home New Water Service - 46,40 Sink
MFG Home New San;Slorm Sewer 46.40 Lavatory _
Tub or Tub/Shower
Hose Bibs 16.60 _ Combination
Roof Drains 1660 Shower Only
- --_
Drinking Fountain 16.60 Watir Closet _
16.60 Urinal
Other Fixtures(Specify) _ _ Dishwasher
_ - k -iarbage Disposal
Laundry Room Tray _
-- --- Washing Machine -_
_ - Floor Drain/Sink: 2" --- - --_
Sewer-1St 100_ --- -55.00 /r; n g^
Sewer-each additional 100' 4640 1 ry 14,. _
x Water Service-1st 100' 55.00 _ Water Heater
-- 46.40 Other Fixtures
Water Service-each additional 200' _ (Specity) _
Storni&Rain Drain-1st 100' 5510
Sl nm 8 Rain Drain-each additional 100' 46.40 'A ;
Commercial Back Flow Prevention Device 46.40 ---- - --
Residential Backflow Prevention Device' 27.55 - -
etch Basin 16.60 —
11 spection of Existing Plumbing or Specially 62.50 L-E-E
"
Peguesled Inspections __-- erAv _ COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 __--
Grease Traps �- 16.60 �- -- - --- - -
QUANTITY TOTAL
Isnrnelric or riser diagram Is required if — —,
_ Quantity Total is ?9 ,___, ---- — ----�
`SUBTOTAL y,.- e. - - - -- - ---
- 8%STATE SURCHARGE n� -- -- --
** LD,N REVIEW 25%OF SUBTOTAL - p7r
Re�c uued only If rlxture qtY total is`9
TOTAL - $`,/
6J.
"Minunum permit fee is$72 50"8%state surcharge,except Ressdential Bacl flow
Prevnnlion Device,which is$36 25+8%state surchpige
"All New Commercial Buildings require 2 sets nr plans with Isomphic or riser
diagram for plan review.
is\dsts\forms\pim fees.doc 12/26101
CI'T'Y OF TIGAlR€) 24-1-10u1 77
BUILDING Inspection Lin-: (503)639-4175
INSPECTION DIVISION Business Line- (503)639-4171 MST
BUP
Z
Received -..Cate Requested �'�� G AM ___ _PM BUP _
Location �lr,��'S� 5wn � SJR _Suite MEC
Contact Person _ -_- Ph(_ ) _3-1l y- G�K 0 PLM
Contractor_-- --_- -_-_ --- Ph( ) _--_ - -_ - SWR
BUILDING Tenant/Owner - ELC
Footing
FoundationELC
Access:FigDrainDrain ELR
Crawl Drain _--
Slab Inspection Notes: SIT
Post&Beam -- --- ------- -- —--
Shear Anchors - - - ---
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -- — _
Firewall �j00,
�
Fire Sprinkler -T
Fire Alarm
Susp'd Ceiling —-- --
Roof
Other:
Final
PASS PART FAIL
11MBl``NGf _
Post&Beam
Under Slab
Rough-In
Wa'er Service -------
Sanitary
_.-- -Sanitary Sewer
Rain Drains --- -
Catch Basin/Manhole
—
Shower Pan
Other: ---- ------ --- -
Fin
A PART FAIL --
CHAWCAL
Post 3 Beam
Rough-In - --- -----
Gas Line
Smoke Dampers
Final
PASS PART FAIL - -- -
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dats ___-_ Inspector Ext
Other
Final VO NOT REMOVE this Inspectlon record from the job site.
PASS PART FAIL