Permit CITY OF TIGARRIGINAL PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2000 -00241
� ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/00
SITE ADDRESS: 16460 SW 72ND AVE B -06 PARCEL: 2S113AA -00800
SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: I -L
BLOCK: LOT: OOD JURISDICTION: TIG
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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 SPOT 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.
Issued By: Permittee Signature: �' = I /-
Y - -
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
TIGARD, OR 97223 Date Recd o
(503) 639 -4171 11 l7 / , _Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # Punn�cL� - �a�/
Related S 0
Called
Name of Development/Project • FIXTURES (Individual) • QTY PRICE AMT
Job _ L"T e. S E .%) tr c Sink 11.50
Address Street Address Suite Lavatory 11.50
J 4 1 4 6 o St a 72 I Tub or Tub /Shower Comb. 11.50
Bldg # 6 I City/State t Zip Shower Only 11.50
' 6-A 70 'x' 9 Water Closet/Urinal (Specify) 11.50
Namep r
Dishwasher 11.50
Owner Mailing Address nn Suite 300 Urinal 11.50
/53 ,5w $ kO /4 r Garbage Disposal 11.50
City/State Z P P one
11.50
` rie - A L ' `, q7 4 (pot3 °( 36 Laundry Tray
Name Washing Machine/L.aundry 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.
l J t •A1g fiv p� .Q p ,G . MFG Home New Water Senrice 28.00
Contractor M 'ling Address Suite (� MFG Home New San/Storm Sewer 28.00
I " � 0 3, Hose Bibs 11.50
Prior to permit /State Zi Phone Roof Drains 11.50
issuance, a copy g r 9 7 o2: ; '(i'Q prinking Fountain 11.50
all licenses are Oregon Const. cont. Board Lic.# Exp. D to
required if
® /� ) a / Other Fixtures (Specify) 15.00
expired in COT Plumbing . b O 3 P� E�. ate
ye
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' MO 38.00 3$
Engineer Water Service - each additional 200' 32.00
Des ' work to be done: Storm & Rain Drain - 1st 100' 38.
New • Repair 0 Repla with like kind: Yes 0 No Storm & Rain Drain - each additional 100' 32.00
Res e I 0 Commercial Commercial Back Flow Prevention Device 32.00
Additional description of work:
Residential Backflow Prevention Device' 19.00
� e� ea lGt� Catch Basin 11.50
Are you cappin , 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 in ica 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 rise diagram is required if Quantity Taal is > e y�'j
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL �Q, /�
that plans submitted are in comp!' . nce with 0 • State Laws.
Signature of Owner /Ag =a Data 8% SURCHARGE , / ,-,,e1 ✓ //, . 6 - AI `'� .ice
Contact Person _ A Q344.--411 - " . f $ "PLAN REVIEW 25% OF SUBTOTAL
R equired only if fixture qty. teal Is > s
_, . �'F; , , 7}-171,77 ... TOTAL
c i ;.:;h 11 , _V. ', 0-1-'-'t , Y -,l h l i .. _ 1, � 'Minimum permit feels $50 + 8% surcharge, except Residential cJd
Residential Babw Prevention
' C Nt :',0 ti_r3 A
'. _ 1
t .. 1. 5 . a fx: r.. * vx.r
', +f1: Device, *filch is $25.8% surcharge
'WI New Commercial Buildings require plans with isometric or riser diagram and
plan review.
tldstslformslpiu mapp.doc 1W1/99 - . .
•
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:
1: ldstsVannslplumapp.doe 1011199 - -
CITY OF TIGARD BUILDING INSPECTION DIVISION sT
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 8 — / v -� AM PM BLD
Location / 0460 5(✓ 7 7 ..- / Suite , MEC
Contact Person Ph 2.3.6 -4{/ .S Z PLM G Gd 29 /
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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
To
1Water Sery
Sanitary Sewer
Rain Drains
Fin
ASS PART FAIL
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 Date l v !o Inspector l Ext
Other
Final
PASS 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
It, 460
ate Requested 2- AM PM BLD
Location w 7 Z-4-1-2? Suite L - u" MEC
Contact Person 11 -r. (.4>a fr Ph 43C- PLM 2ovo -
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
P RT FAIL
S PLUMBING
est -B� am
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
AS 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 � I �✓� ‘..)/ Approach/Sidewalk Date LI U Inspector J / Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.