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Permit CITY OF TIGARD OR 1 GINA L PLUMBING PERMIT 1411 DEVELOPMENT SERVICES PERMIT #: PLM2000 -00238 '' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/00 SITE ADDRESS: 16200 SW 72ND AVE B -02 PARCEL: 2S113AA -00400 SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: I -L BLOCK: LOT: 018 JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B 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: 100 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Water Service FEES Owner: Type By Date Amount Receipt PACIFIC REALTY ASSOCIATES PRMT DST 6/28/00 $50.00 0003345 15350 SW SEQUOIA PKWY #300 -WMI PORTLAND, OR 97224 5PCT DST 6/28/00 $4.00 0003345 Total $54.00 Phone 1: Contractor: DEAN WARREN PLUMBING 3111 SE 13TH PORTLAND, OR 97202 REQUIRED INSPECTIONS Phone 1: 236 -4152 Water Service Insp Reg #: LIC 172 PLM 26 -83PB 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: Permittee Signature: / / �• Call ( 03) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan Check II 13125 SW HAIL BLVD. Commercial and Residential Rec'd By TIGARD, OR 97223 Date Recd 6 o (503) 6394171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Pe""it *PLA a' Related Celled a -7 » Name of Development/Project _ FIXTURES (Individual) - . CITY PRICE - AMT Job _ i �'� s 5,41) 1, 010 Sink 11.50 Address S treet Address Suite Lavatory 11.50 1(• a0 D J 1...) . 2Q, °°- Tub or Tub /Shower Comb. 11.50 Bldg a City/State , Zip Shower Only 11.50 ok aa 7, a a Water closet/Urinal (Specify) 11.50 7 ) � Dishwasher 11.50 Owner ailing Address C� Suite 3 Urinal 11.50 15 3549 S“) S E9Llfi I A- PK1�/ Garbage Disposal 11.50 Ci�t /Slat Zip Phone Laundry Trey 11.50 Ni ` er �} Zgy - q 7 aaq tRy - (03 Washing Machine/Laundry Tray (Specify) 11.50 Floor Drain/Floor Sink 2' 11.50 Occupant Mailing Address Suite 3" 11.50 4' 11.50 - City/State Zip Phone • Water Heater 0 conversion 0 like kind 11.50 Name Gas piping requires a separate mechanical permit. DE-A") g• J 6 � MFG Home New Water Service 28.00 Contractor Mailing Address t � Suite MFG Home New San/Storm Sewer 28.00 311 t SE ) 3 Hose Bibs 11.50 Prior to permit /State Zip Phone / I Roof Drains 11.50 Issuance, a copy VD ierL.Ai ' t q7 23 2 L I /Si, Drinking Fountain 11.50 all licenses are Oregon Const- Cont. Board Licit D to required if ©l'7 aa3 166 Other Fbctures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. ate 1 database R 6g3 P8 bl3o Name Architect Sewer - 1st 100' 38 or Mailing Address Suite Sewer - each additional 100' 32.00 C ity /State Zip Phone Water Service - 1st 100' `t 38.00 33 Engineer Water Service - each additional 200' • 32.00 Des be work to be done: Storm & Rain Drain - 1st 100' 38.00 New Repair 0 Replapewith Eike kind: Yes 0 No X Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commercial X. Commercial Back Flow Prevention Device 32.00 Additional descri lion of work: T� sae t . cdE, Residential Bacitflow Prevention Device* 19.000 Catch Basin Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No Inspections per/hr If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required 11 Quantity Total is 2. 9 given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL that plans submitted are in compliance with Oregon State Laws. Signature dAg Dlotel.4 ` 8% SURCHARGE ' CID Contact Person Name �'�/ , I" �' • 3rfr ( 5:q "PLAN REVIEW 25% OF SUBTOTAL T' n 7 t :! 1 -t7i,. i ( r J _ - .. � r T Requited only if fixture qty. total is > 9 b TOTAL Sget) i k, 3: 1 � 9 1 1 T ' k'k_�: ' 6 ,I - � ,� t ° F ti 1� *Minimum permit feels f50 + 8% surcharge. except ResWerdiel Beddow Prevention ` ' (;: .• F. .i ', wit /,:. - ti . , ' � :Ill . !� % - r° E: '2:2 r , , •~iy = Device, whirl) is $25. surcharge "A11 New Commercial Buildings require plans with isometric or riser diagram and plan review. 1.1datslMrmslpkmapp.doe 10/1/99 - ' " • PLEASE COMPLETE: Fixture Type - . Quantity by Work Performed New Moved I Replaced Removed/Capped Sink Lavatory Tub or Tub /Shower Combination • Shower Only Water Closet Dishwasher Urinal Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Floor Sink 2" 3 " 4" Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: (— i dststfor nslplumapp.doc 1011/99 - CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested F --/ 0 AM PM BLD Location / � 1-C-) G $ w Su �'� - MEC Contact Person Ph 73 If/ S PLM emu/ G v2 3 j- 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 o fiA : Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL (�LUMBI P ost & Beam Under Slab Top Out / tar Sa V Sanitary Sewer Rain Drains Fi PART FAIL ME ANICAL 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 Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk , � � Other Date Inspector "g e_o Ext Final SS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: • 639 -4175 Business Line: 639 -4171 BUP Date Requested 7-2-00 AM PM BLD Location /6 2 ©u S w 72- Suite ,` MEC Contact Person Pea 4.)4. rr ebN P /cc 016 I •i Ph 03C- Y o s PLM Zvi 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 pZSS--eART FAIL :PLUMBII 3—' Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final S PART FAIL CHANICAL 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 • Otheoach /Sidewalk Date A Inspector #76/0 Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.