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Permit (58) IL CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2017-00228 TI C1A t D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/08/2017 Parcel: 2S 103C B08900 Jurisdiction: Tigard Site address: 12492 SW QUAIL CREEK LN Project: BORGMAN Subdivision: QUAIL HOLLOW-EAST Lot: 47 Project Description: Repairing 100 ft.of water service. Contractor: 3 MOUNTAINS PLUMBING Owner: BORGMAN, MATTHEW I &AUDREY L 524 N TILLAMOOK ST 12492 SW QUAIL CREEK LN PORTLAND, OR 97227 TIGARD, OR 97223 PHONE: 503-670-1342 PHONE: FAX: FEES Quantity Description Date Amount 100 If Water Service 06/08/2017 $62.54 Specifics: 10 12%State Surcharge- 06/08/2017 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 06/08/2017 $9,96 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: \ Permittee Signature: �/37Are-ZoL.-: k...;:-- Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. From:Bill Kerrigan Fax:(503)765-5512 To: Fax: (503)598-1960 Page 1 of 2 06/08/2017 2:54 PM Plumbing Permit Application . 'IVV 1 'la • Site Utilities AV( 1,41 IF _ FO OFF11(E USF. ONLI Ti 477— .: • I ...._ , •il 3 I 25 S1,V flail Blvd..' gard OR 97223 II , Darc. .,,,,w 2 01 Pin&Mew ar/ i u•nlit No .. 641:2Q42,— P Phone: 503718,2439 Fax: 503.598:196(1 1\,,Iy1 - Othor Nrwit No inspection Line: 503.639.4175 'I-i tiA RD. ' ,,,,A.g3 ;7-141;i3y •rih. 3 8 See Page:2 for i Internet: www.tigard-or.gov i 01,4 1,ik-ir• oppe,,veitk,d- D'' Supplemental information I TYPE OF WORK'. . VtF- 3,''Tt. TV1..-. ' -': '' '' . .''- ..': FEE*.SCRDULE t-- "." ' .. ''''''' i itt'pl\SC-• • ' - : - . -- .... ... . .-1 . .. -. : — . 0, ew er„,„,,,,,,„„ 0 De4iii , .‘., Fpc,special ittfot-tymion tqe checklist. ..._ _ rs;p7 _------- ---------- Description Addition/alteration/replacement 1_,I Other ___________ 24amily dwellings f inclucies 100 or IL feacti h ulity'connection) 1 __________*______,. . __ . , __________•___ , , . •___ • • %CATEGORY-OF-coNnitucTION.:-. .. ''...... .-':: '''.... 1 SFR t I)bath 7 312.707 1, .,.. . .._ '.• ... . ...... . .-__ • i---. ' i SPR(2)bath 437,78 I and 2-family dwelling C]Conintereiallindustrial --,...- El Accessory building — Ll Multi.lainity 0 Master budder jj t)ther7-- - --- SFR(3)bath 500.32 ------------ , Inch additional bathrkitcb—en — 25.02 . _1 i Fire sprinkler r sq.11) •-------- -------- • -- ' . • . JOB SITE INFORMATION AND .LOCATION .... . • . ., ii_.Site ytili:lueis:1 ___ . _,.._ ' ". r a,rea dram 18 76 .. Jo-b site address: iz4a'2„::-.,4,,,,.:i i ,‘, 6414. -- '',"; -' ' ' ,.. •„ ., -------------, _..,.--- . - - ,i- " '' --- Drxwell.leach line,or trench drain il.'ity/Stateil.IP: "--,t r 7' ' -‘'70'1,.., 0/121 ".2 - ---------""7!---.---i--- "_".... ..___-_i _ _ , „...,. 3--,_ .---- , ;,},00ting drain(no,linear tl. ) _ Page 2 Suite/bldg./Not.no.:_ Project I19111c: jisLet5o'',.:2 .hi..-,1y,t4 at ma.,,,faciur,d horrie utilities 0.03 . Crus,s streeUdirections to job site: ,• ___I Manholes 18.76 -- I-”" - __ --- - . —"- . Rain drain connector .---- - " — INtra° Sanitact sewer(no.linear(1,: ) Page 2 AS - -,.- i - v -c----" - ---, .------ Storm sewer(no in--ir it- ' ' t - -' ---1 i• r A1.6j . . , . ...... •,•• ......._.) _ Page 2. •• 1 • ...'. **,...r .--, Water service(no,linear ft.: ' ' I ' ' ' Page 2 r '• f>ft-I, Sttittli visitm: —°AV.. .. it/b 1 1-,01 90.: tin- or itm: ixte• . r Tax map/parcel no.: Back flow preventer _ I 3.).27 r----------77.- —.. .. . • • ..• -- , ..---, : -.. • • Backwater waive 1 12.51 .. . ... ... ' DESCRIPTION OF.WORK ........_ . , "7"--- - • -7' ----,-, _. 1,. , , ..,,,,„, Clothes',wisher 25.01 i ... . . ...,.‘,..,,„:LIT j._Lift-ILA-Al I I ' Dtshwasher -15.0/ ----"1-----7 ,,• i,,,--x,,,,,.4 ry ,, 1., - I _,,„„ ., i,- t•1,4' . ,i, loiti4L i.v u Drinking lininhan 25,02 ._ / --.... „.. F . Ejectors,sr. timp 25.02 Punsioll, ItIlk _,, Name: 'it,, Aii IP A , .1 ' \--”" Fixture/sewer cap 25.0') 1 - t ' -- ____ - Floor drainftloorsinkilM1) __ /5.02 .---1 Address:. • ... (rarbagc disposal 25.0) hose bib -- , - --- ------ _ ' _ _ ___ __ _____ • _. ,.....,„H _ , Plwrie:( . ) It :( , 1 .. ice maker eli 11,5 i ' .APPIKANT CONTACT'PERSON ' . Interceptor/grease trap 25 02 .. . . • , , . ' • . S-. Page Business.nam.c: ,i .y - • ' ../ , - , ,.. .- - --, 1 Primer 2.51 Contact name: • p ' . r , . ' - - - - ---- t • ---- Rani drain(commercia)) 1 12.51 Address: ft) ' i ..-tr' r'' i 1 eft ' Ct. ' -----'-,. .-.._.... Jj I i...ta.uk.i a -- . .. :•7' . 1 7ciinklbasinilavatm' 25.02 - (ity/State/ZIP: '.x'',.. , . - . -1,11,„,.. "---."‘,),,,1:3, . - ACil Li - - - -- /"Nolar units(potable water)- 62.54 .. .. ,,,,, , , ,,_, , 1 .1 1 4 ..... ,...........-_,.... .....,:7 .._____ .._77:....,_ Phone;( /,' , '., -I- , lax;:f ) : lubishower/show,or eau 1 12.51 . _ IT - -"/ 7,--- E-mail: : : '' A A a).- ,.., -, .• - -,if-1 - . , .110. urioal _....._ 25.23._ -' ' . . ," '.- . I '..' 14-4 A ''''- 4'4.. ' i - iniii.' ' j Water clo,,et _..._- _. . ....., , . . 1:ONT.R.A:CTT,R •,1.. , . AIM 111-‘.va-Le---1-heater- ----- $7.52 A .1. . ,,,...,,, _A A, , .,,,r..._ water impingowv Q5 --7±.—. 56-.,19 ............ .,.,_ , Address: _ .5 ci,..p. ,4 .__ '(-)• 1!!r. ' 25.02 -....1 CilY/StatesiZIP: 1 Subtotal 0,2_Pi ...._.....__ ........_ phone:( ) Fax:( ) 1 , _ Minimum permit txt,. S.7 .,',,ti 0 , . -a ,,„ Plan review (25%of permit tec) , lief ,.. , ,plumbing Lie.no..,•., ......i. _,.....frat ---- - . --•---- -„---,... • .__ _.__ ... _ . %lain _ Stutc surcharge,i 12%of permit Ice) A tithorIzed sign_ature: ,tit".,4141 ..:1, .-,- -- rfUrAl.PERM TT FEE ki.'410 l'rint name: I ' , • - , - -.,• 1 -----attie,7,- 1 Date: -1 Ibis,permit application expires if a permit is Rat obtained within i SO dir,t...;, - I b_.... • , .4..... i A. _.. after 0 hi been accepted ax.-complete. *Fee inoho,dology 6,et by"3 31-County Builcimg frdistry Sr is.'3 13oard. ..... i,.B13313333,2,.Perimu,,,P1,301..-Permit31.35?d04; i 01:,I,(0.4 440-4,11:0'i i WO:.C7041.'WFil j City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12492 SW QUAIL CREEK LN, TIGARD, OR, 97223 Record Type: Record ID: Residential - Plumbing PLM2017-00228 Inspection Type: Inspector: 399 Plumbing final Don Sylvester Result: PASS - NoCofO Comments: 1 . Replace existing water service.- approved Violation Summary: Inspector Contractor