Permit CITY TIGARD PLUMBING PERMIT
A I DEVELOPMENT SERVICES PERMIT #: PLM2000 -00358
- '- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/22/00
SITE ADDRESS: 10349 SW 71ST AVE PARCEL: 1S136AB -04900
SUBDIVISION: MAPLELEAF ZONING: R -4.5
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow device.
FEES
Owner:
Type By Date Amount Receipt
INMAN, DAVID S + CHERYL F PRMT CTR 9/22/00 $36.25 27200000000
16622 SW 88TH PL 5PCT CTR 9/22/00 $2.90 27200000000
TIGARD, OR 97224
Total $39.15
Phone 1: 503 - 684 -5947
Contractor:
OWNER
REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: Final Inspection
Reg #:
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 - - ,ing (503) 246- 87.
Issued By: y� Permittee Signature: gg-
Call (503) 639 -4175 by 7:00 for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13.25.SW HALL BLVD. • - Commercial and Residential Rec'd By
Date Rec'd V 2a /may
TIGARD, OR 97223
(503) 639 -4171 ' Date to P.E.
lJ Date to DST
Permit #/ .fig'
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
r Name of Development/Project FIXTURES (individual) Qty Price Total
Job Sink 16.60
A Address Street Address f t, /) Suite Lavatory 16.60
103 Y 9 S w 1 J - `�-y Tub or Tub /Shower Comb. 16.60
Bldg # City /State Zip
Shower Only 16.60
e T l I BLS d (9 9 7 Z z Water Closet 16.60
a.A 6 7 m d7 ✓l Urinal 16.60
Owner Mailing Address r Q J Suite Dishwasher 16.60
/0399 5 v+' 7 ' 1 "^ Garbage Disposal 16.60
C Zip Phone c Laundry Tray 16.60 lc) Ciftl y e
Na vie Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
Occupant Mailing Address Suite 3" 16.60
4" 16.60
City /State Zip Phone -
Water Heater 0 conversion 0 like kind 16.60
Name Gas piping requires a separate mechanical permit.
` l e W/l7e7 7 _ MFG Home New Water Service 46.40
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 46.40
Hose Bibs 16.60
Prior to permit City/State Zip Phone Roof Drains 16.60
issuance, a copy
Drinking Fountain 16.60
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Other Fixtures (Specify) 21.75
expired in COT Plumbing Lic. # Exp. Date
. database
Name
Architect Sewer -1st 100' • 55.00
Or Mailing Address Suite Sewer - each additional 100' 46.40
Engineer City /State Zip Phone Water Service -1st 100' 55.00
n
9 Water Service - each additional 200' 46.40
Describe work to be done: Storm & Rain Drain - 1st 100' 55.00
New 0 Repair 0 Replace with like kind: Yes 0 No O Storm & Rain Drain - each additional 100' 46.40
Residential 0 Commercial O
Additional description of work: Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* l 27.55 2.7 -55
Catch Basin 1 16.60
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 72.50
Yes 0 No 0 Inspections per /hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 65.25
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 16.60
WORK COULD RESULT I, INCREASED SEWER FEES. QUANTITY TOTAL
1 h: - • a r owledge that ave - - d this application, that the information
Isometric or riser diagram is required if Quantity Total is > 9
e' en i - co = � am e owner it authorized agent of the owner, and -
th . t • I. ns ff • mi S3 are i complia ce with Oregon State Laws. *SUBTOTAL
Ow r/A c = Date
�`'� �'� _ej_ ®Q 8 %SURCHARGE
\ tact rson Name Phone „r' a 1 V A dl Z `/ L1-0 9 Y3 *''PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $249.20 Required only if fixture qty. total is > 9
2 BATH HOUSE $360.00 TOTAL 39./5-
3 BATH HOUSE $399.00
(This fee includes all plumbing fixtures In the dwelling and the first "Minimum pe e s rcharge, except Residential Backflow Prevention
_ 100 feat, Of sanitary,sewer Storm sewer and water service) Device, which 1 t36.25 + 8% surcharge.
"All New Commerclaaeun wr m
e plans with isometric or riser diagram and plan review.
I:ldstslformstphdnapp_rev.doc 9/8/00 SO • .25
a_9v
W 39 • /s
PLEASE COMPLETE:
Fixture Type '; Quantity by Work Performed
New Moved Replaced.. Removed/Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet _
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray -
Washing Machine _
Floor Drain /Floor Sink 2"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
•
I: Sdstslformslplumapp_rev.doc 9/8/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection pm Business Line: 639 -4171
(� J BUP /
Date Requested y /q AM PM BLD arm
Location I D ( L q ..5u) -• 4d1 Suite MEC
Contact Person Ph 4
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation ' FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PAM__ PART FAIL
•
UMB
Pram
1 ■
Under Slab 6 1.64.
�` • Q
Top Out Z
Water Service rat()
Sanitary Sewer R
Rai Drains
PART FAIL
M = " ' NICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL •
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA I ( 1
Approach /Sidewalk Date v Inspector 1 6 t Ext
Other
Final
PASS PART FAIL D ' NO REMOVE this inspection record from the job site.