Permit CITY OF TIGARD ORIGINAL PLUMBING PERMIT
,�;� DEVELOPMENT SERVICES PERMIT #: PLM2000 -00240
" '� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/00
SITE ADDRESS: 16416 SW 72ND AVE B -05 PARCEL: 2S113AA -00700
SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: I -L
BLOCK: LOT: OOD 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
5PCT DST 6/28/00 $4.00 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.
Issued By: P Permittee Signature:
Ca 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 #
13125 SW HALL BLVD. Commercial and Residential Rec'd By J
TIGARD; OR 97223 Date Rec'd (0 la7 /0 0
(503) 639 -4171 Date to P.E.
6" Date to DST
Print or Type Permit WM Zaa� - CO 2
Incomplete or illegible applications will not be accepted Related : �i
Called r ? 'y ylit.
Name of Development/Project • FIXTURES (individual) • QTY PRICE AMT
Job _ . - L cj
.0 tg Sink 11.50
Address Street Address j Suite Lavatory 11.50
J q 1 Go 5 w - 7a I Tub or Tub /Shower Comb. 11.50
Bldg # City/S to Zip Shower Only 11.50
�'� Water Closet/Urinal (Specify)
Water Name th sr Dishwasher 11.50
Owner Mailing Address Suite . 3C C Urinal 11.50
/5?52 5 Soytte 4 Pkwy Garbage Disposal 11.50
O a/ 7 L4 / Plfone
_RI -11 &300 Laundry Tray 11.50
ame /"50� (v -1 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
Nam Gas piping requires a separate mechanical permit.
0 N � pisb; ^ MFG Home New Water Service 28.00 Contractor Mailing Address y� Suite MFG Home New San/Storm Sewer 28.00
3t L I SE. /3 Hose Bibs 11.50
Prior to permit y /State Zip Phone ! Roof Drains 11.50
issuance, a copy 0� A,36;-- i o� Drinking Fountain 11.50
ill licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if 2 11 a MI/ R3100 Other Fixtures (Specify) 15.00
expired is COT Plumbing Uc. ' Pi Ex elate
database p�, / �v /�
database
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' )t0 38.00
Engineer Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New ' Repair 0 Repla like kind: Yes 0 Noo Storm & Rain Drain - each additional 100' 32.00
Resider al 0 Commercial Commercial Back Flow Prevention Device 32.00
Additional descri tion of work: �`
�� - � y,,,q Residential Backflow Prevention Device' 19.00
l p-1 �/r` Sale. 0 ` E 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
I hereby acknowledge that 1 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 4223g----
that plans submitted are in comce • on State Laws. ° ✓ `�
Signature of Owned Date ` 8% SURCHARGE e; O�
Contact Person mew (a blot✓
_ P a G LCA "PLAN REVIEW 25% OF SUBTOTAL
t h . , _,� � f .. , .� r _ Required any If fixture qty. total is > 9 •
TOTAL .?".f"
tt : ::.;t::!:::1- .'
x , + •, ).- I l e Eli' k , i r; ii` >' . , : I ' 'Minimum permit fee is 850 + 8% surcharge, except Residential BacWlow Prevention
('. c..1... ' a 1.2::_,.:. : � x . ,.,,.t..:1 7 1,, r .. ; +.rd': a DOVke, which is 125 + 8% surcharge
"Ail New Commercial Buildings require plans with isometric or riser diagram and
plan review.
-
ldstsVamaplumapp.doc 1011/99
F. _ .
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:
t dsbVamslpk4mapp.doe 1W1/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639-4171
BUP
Date Requested AM PM BLD
Location l (o ((j b S A✓ 2 Z Sure 5 MEC
Contact Person Ph 13c,- (// S Z- PLM 2094- -O 2 t/
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
Vei
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PAS - FAIL
Post & Beam
Under Slab
Top Out
r Servic
anitary Sewer
Rain Drains
Fin
ea�a PART FAIL
MECHANICAL
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 l d
Other Date l V Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.