Permit ; ,.
44 .
_____ . CI OF TIGARD P LUMBING PERMIT
Ijl� DEVELOPMENT SERVICES PERMIT #: PLM2000 -00263
r . I
' '" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/13/00
PARCEL: 1 S125DB -03300
SITE ADDRESS: 09380 SW 74TH AVE
SUBDIVISION: BOULEVARD HEIGHTS ZONING: R -4.5
BLOCK: LOT: 015 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: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: INSTALLATION OF 40 FT. OF NEW WATER SERVICE
FEES
Owner: T By Date Amount . Receipt
SETTLE, TERRY + SALLIE A PRMT BLD 7/13/00 $50.00 0003696
9380 SW 74TH AVE 5PCT BLD 7/13/00 $4.00 0003696
TIGARD, OR 97223
Total $54.00
•
Phone 1:
•
Contractor:
BILL GIBBS
401 SW CORNELIUS PASS RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone1: (,1#. c•VV is 6
Reg #: LIC 104318
PLM 5540JP
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: 6 (503) w� V'� Permittee Signature:
�l (r
C all 503) 6 639 -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 (9 4--
TI OR 97223 Date Rec'd 7 r, -62°
(503) 639 -4171 Date to P.E.
•
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# PRWI 2m00 -0 0263
Related SWR #
Called
Name of Development/Project
-p FIX
-. TU (I1ndivtclual) . m_ TY Q ,PRICE 1 11i1T''
Job Se+lie 441 ! 1 ern Sink 11.50
Address Street Address '/
i Suite Lavatory 11.50
St3 O Sit 7 � Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip
T; Q n O✓ I 7Z Z � Shower Only 11.50
y � C Water Closet 11.50
Name r IV S- e /
, � Urinal 11.50
Owner Mailing Address - Suite Dishwasher 11.50
eon .£d) 7i Garbage Disposal 11.50
ciV/State Zip Phone Laundry Tray 11.50
Na
I r4orfd d ,- Q 7Z Z3 Vii-3415
a Washing Machine /Laundry Tray 11.50
TL° r S.o -e Floor Drain /Floor Sink 2" 11.50
Occupant N],a3n Ad ?till Suite 3" 11.50
/State Zip Phone 4 11.50
Cit
'-- qa� 7 i zi 3 2 -.3r/ 5 Water Heater 0 conversion 0 like kind 11.50
NaMe 1 6 r b $s Gas piping requires a separate mechanical permit.
MFG New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00
Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy •
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database
Name '
•
Architect Sewer - 1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
Engineer City /State Zip Phone Water Service - 1st 100'
neer 1 38.00 ( ?9a
g Water Service - each additional 200' 32.00 `'
Describe work to be done: • Storm & Rain Drain - 1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes • No O Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow 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 0 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
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9 q,
that plans submitted are in compliance with Oregon State Laws. S
Signature of wner /Agen Date c ISaov
r I f�� 7-0 -a0 8 /o SURCHARGE
Contact P rson N. Phone 61'00
' FE ' Y SE r7ZrE tta 3 e/C "PLAN REVIEW 25 % OF SUBTOTAL '',. `° "_
1 BH HOUSE $178.0 0 Required only if fixture qty. total is > 9
AT
2 BATH HOUSE $250 00 : TOTAL C y
i 3 BATH HOUS $285`00 t \
(This fee plu
� mbin g fixtures In the dwelli ng an he t first R� s *Minimum permit fe is $50 + 8%' §urcharge, except Residential Backflow Prevention
100 _feet'of sanity sew storm se wer and water servce) .M >.,..
i , Device, which is $25 + 8 o sn"rchharge
"AII Commercial Buildings require plans with isometric or riser diagram and
plan review.
I: \dsts \forms\plumapp.doc 11/18/99
PLEASE COMPLETE:
Fixture Type fi o ' Quantity by W6i*Ps r ormed - s
e ced R�e moved Ca�P
w _� �MoVedg Re
P a _- � a � /
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3 „
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I: \dsts \forms \plumapp.doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7 _1 fY AM PM BLD
Location Q 3 ) 54-a 7 y Suite MEC
Contact Person Ph y6- J,$ /) PLM , 1,P— ® a 4
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation / FPS
Ftg Drain `h
Crawl Drain Inspection Notes SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _ /f!/ I r
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
LUMBING>
os eam r
Under Slab 3 , �,
Top Out
Water Service Huidi4
Sanitary Sewer
Rain Drains
Fin
AS 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date I . Inspector Ext
Other , I
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.