Permit _4 1 ,, CITY OF TIGARD PLUMBING PERMIT
i1tj DEVELOPMENT SERVICES PERMIT #: PLM2000 -00074
E 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 11690 SW 92ND AVE PARCEL: 1S135DC 06100
SUBDIVISION: BARBEE COURT ZONING: R -7
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace an existing gas water heater with like kind.
FEES
Owner:
Type By Date Amount Receipt
STACEY MCCORMACK PRMT GEO 031081200C $50.00 0000537
11690 SW 92ND AVE 5PCT GEO 03/08/2000 $4.00 0000537
TIGARD, OR 97223
Total $54.00
Phone 1: 503 - 598 -0205
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone 1: 643 -5535 Final Inspection
Reg #: LIC 001009 (CORRECT #10967)
PLM 34 -42PB
QR IGLNAL
This permit is issued subject to the regulations contained ii e Tigard Municipal Code, S :te of OR.
' Specialty Codes and all other applicable laws. All wor ill be done in accordance with app •ved plans.
This permit will expire if work is not started within 1 1 days of issuance, or if work is suspend =d for more
than 180 days. ATTENTION: Oregon law requir s you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in AR 952 - 0001 -0010 through OAR 952-0001-1080.
You may obtain copies of these rules or direct estions to OUNC by c. (ling (503) 246 -1987.
. , /,'
Issued By _� ..�j \ ermittee Signature: = -
Call (503 .39-4175 by 7:00 P.M. for an inspection needed • e next b • ' a - .7111111111111111,
CITY OF TIGARD Plumbing Permit Application Plan Check#
T3125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Rec'd
(503) 639 -4171
'y Date to P.E.
Print or Type Date to DST
•
Incomplete or illegible applications will not be accepted Permit # PG-friR WO - coa . 9y
Related SWR #
Called
Name of Development/Project , h' FIXTURES (individual)''" " .QTY , riCE ".- AMT
w..xtw,•�.,•= , ., ..,v,s ..�.•'i,'..� - `> >., .;<�:�v i� .•:; +�i.,, 'RI -,. _F,.,,x, . .
Job Sink 1'1.50
Address Street Address / ,, Suite Lavatory 11.50
(� ga
Q �� "a 4" Tub or Tub /Shower Comb. 11.50
Bldg # Ci State Zi , a 3 Shower Only 11.50
Name sa d Water Closet 11.50
S•ac \C Cofrna I Urinal 11.50
Owner Mailing Addresa G� Suite Dishwasher 11.50
11 6c `0 ,5 up 9at1 r' Garbage Disposal 11.50
City /Saff Zip Phone Laundry Tray 11.50
1 kc� O TPA -3 , jq g , o � 05
Name Washing Machine 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 dike kind 11.50 I 1 ,5D
Name Gas piping requires a separate mechanical permit.
K� e Y \t\QGtI, ?l u YY\bt MFG Home New Water Service 32.00
Contractor Mailing Address ` Suite MFG Home New San /Storm Sewer 32.00
1 `\R5 St.() - Cn(rT\ !i F/' Hose Bibs 11.50
Prior to.permit City /Sate Zip ' Phone Roof Drains 11.50
issuance, a copy t /'-(1 C' - DDS
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
• required if l Qcj 61 -03
Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
•
database 3 - t Z'Pd 00
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' 38.00_
Engineer 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 16, No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
V P `� Residential Backflow Prevention Device* 19.00
Catch Basin 1'1.50
Are you capping, moving or re lacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 ND 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 by :V.
"
I hereby acknowledge that I have read this application, that the information to- •;f °
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 a ,< ,.N,.
that plan ubmitted are in compliance with Oregon State Laws. *SUBTOTAL P '
Signatu Owner/Agent D to " ;u.," `
g C.� 61 DG 8% SURCHARGE z.:W ', ^" , 00
Contact P rs
n Ka it'
onon Name \ ' Phone 55 Y.
�e r � l� Ss 0.3 3 5 * *PLAN REVIEW 25% OF SUBTOTAL ,' ,,- ;., ` <<
Required only if fixture qty. total is > 9
� . � � �� k £ ��� � q Y q1'
BATkI E � � H OUS 25000 ' . �
2 TOTAL
t 3�8ATH Qp4g4485 G0 �: ` 4 r
40 fee �ACIIrdeS i ii0ii 1� : iRiii S Iri the dwelling aftLi:iii4 Irti a *Minimum fee is $50 + 8% surcharge, except Residential Backflow Prevention
z �ef88 • '1 �:= 88WBCf&t rO er 4:101 Water,BetMI x ,,, Device, which is $25 + 8% surcharge
..,..
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:\dsts \forrns\plumapp.doc 12/17/99
.. -
PLEASE COMPLETE:
Ilett;:Fili,
Ah - Ft -
'11*, 9Y4,2,,t 5
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: kists \forrns \plumapp doc 12/17/99
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 .
BUP
Date Requested / C�0 AM PM 1, 'f"e. BLD
Location 1 1 (1' 4 D q jj . ite Suite MEC
Contact Person Kvul, Ph C � r SS' � PLM •2OD 7 /
Contractor Ph SWR
BUILDING_ x Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: n c 3 c -0q1 G
Slab J if SIT
Post & Beam fr c7 i tu A C
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
- P PART FAIL
kUMBIN
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Fin.
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 inspect - no access
ADA
Approach /Sidewalk !� /
Other
Date ' f l 6 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.