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Permit s" e, " 4,, CITY.OF TIGARD0 R I G I \ A I PLUMBING PERMIT s r DEVELOPMENT SERVICES PERMIT #: PLM2000 -00239 ''I �! 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/00 SITE ADDRESS: 16300 SW 72ND AVE B -03 PARCEL: 2S113AA -00300 SUBDIVISION: ZONING: I -L BLOCK: LOT: OOA 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 5PCT DST 6/28/00 $4.00 0003345 15350 SW SEQUOIA PKWY #300 -WMI PRMT DST 6/28/00 $50.00 0003345 PORTLAND, OR 97224 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. 0 Issued By: — Permittee Signature: � _ Z ' C I ( 503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan Check 13120 SW HALL BLVD. Commercial and Residential Recd By TIGARD, OR 97223 Date Rec'd !o MOO (503) 639 -4171 11 �/ Date to P.E. Print or Type V Date to DST Pemtit itl11POO -MAW Incomplete or illegible applications will not be accepted Related VI s Called a-? ??1/.6 Name of Development/Project FIXTURES (individual) ' QTY PRICE AMT Job _ A- • S •� i. C� -t Sink 11.50 Address S treet Address _ _„,, Suite Lavatory 11.50 Roca 00 skz 7a °s+ I Tub or Tub /Shower Comb. 11.50 Bldg # I City /S).ate Zip Shower Only 11.50 cf 7 Water Closet/Urinal (Specify) 11.50 Name - r S LA sr Dishwasher 11.50 Owner Mailing Address Suite 3co Urinal 11.50 /S 7 SiA) Sec? L4■ IA Play Garbage Disposal 11.50 City /Stat Ziipps �0 Phone - 7 - . ) Laundry Tray 11.50 � I � �� -- 103 Name 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 Gas piping requires a separate mechanical permit. M 14/A M EN P14 « MFG Home New Water Service 28.00 Contractor Mailing Address Suite MFG Home New San/Storn Sewer 28.00 3l I Q.E. ).3 Hose Bibs 11.50 Prior to permit Cjbr©ta C '1 Phone � Roof Drains 11.50 Issuance, a copy �J ticiylpr "f Drinking Fountain 11.50 tll licenses are Oregon Const. Cont. Board Uc.# Ex o. DWe required if 6)) - 7A 1aZ a3fe/2 Other F'octures (Specify) 15.00 expired in COT Plumbing Uc. # ei P � Exp. 3 Pate database p� t�Jb �p / /��Iv /C Name Architect Sewer- 1st 100' 38.00 or Mailing Address Suite Sewer - each additional 100' 32.00 C ity /State Zip Phone Water Service - 1st 100' l49 38.00 3 8' Engineer Water Service - each additional 200' 32.00 Des . work to be done: Storm & Rain Drain - 1st 100' 38.00 New Repair 0 Repla with like kind: Yes 0 Nor Storm & Rain Drain - each additional 100' 32.00 Resider al 0 Commercial Commercial Back Flow Prevention Device 32.00 Additional descri•tion of work: g ,1 ,: S � L GE Residential Badcflow Prevention Device' 19.00 • Catch Basin 11.50 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 1 hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL cl PG-�p that • lans submitted are in corn. ance * •' on State Laws. �D Signature of • 710 / / / ; � �� �� 8% SURCHARGE O� 3c-- Contact Person Name P ron e SUBTOTAL 7 �� %� - a31(0-41 I "PLAN REVIEW 25% OF SUB � „'' _ -.. ,., r ,. Requited any M fixture qty. total is > 8 , TOTAL 5/ •C° �. ,t v . y - i (v -",f , l_• 1. [ R i. ► l_'1,17,4,.. P.„' ,. •Minimum permit fee is $50 + 8% surcharge, except Residential BacJdiow Prevention -1 . ``",..:• a, i ; 'Y+'.+ . �....�..` . � , . "',.af;_i. '7:.!..: a a : ' ~ : 'nt<1 <1 - : , ' ' ' . Device. wMth is $25+8% surcharge ••A11 New Commercial Bulldings require plans with isometric or riser diagram and plan review. I:tdstsiformsipAanapp.doc 10/1/99 - - • 4 • PLEASE COMPLETE: . Fixture Type • . Quantityby Work Performed _. . New Moved { 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: 1AdstsVorms■plumapp.doc 1011199 - • CITY OF TIGARD BUILDING INSPECTION DIVISION D 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 / BUP Date Requested � / v AM PM BLD Location / C) GU -SL✓ , Z- ' Suite '�7_ = – MEC Contact Person Ph j – WS Z — PLM 2 o06 -00-2)7 Contractor / Ph SWR 0_41/ BUILDING Tenant/Owner II ( L c-ri Ahl G ,1 ELC Retaining Wall -,4•-e-e^ Q 1 r•PU`(•-•-• 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 P • • ' T FAIL Post & Beam Under Slab To Out ater Servicel ant Sewer Rain Drains Fi I PPS /PART FAIL HANICAL 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 'f - no access ADA Approach /Sidewalk Other Date PO e Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.