Permit C ITY OF TIGARD PLUMBING PERMIT
14 DEVELOPMENT SERVICES PERMIT #: PLM2000-00230
• DATE ISSUED: 06/20/2000
W 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 •
SITE ADDRESS: 11475 SW 94TH AVE PARCEL: 1S135DB
SUBDIVISION: MILLER ZONING: R - 4.5
BLOCK: LOT: 005 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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repair existing sewer line.
FEES
Owner:
Type By Date Amount Receipt
LANG, GIANG KIEU + PRMT GEO 06/20/200C $50.00 0003128
LANG, LE + 5PCT GEO 06/20/200C $4.00 0003128
TRAN, HOI .
TIGARD, OR 97223 Total $54.00
Phone 1:
Contractor:
RESCUE ROOTER
PO BOX 1728 -- _.
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Sewer Inspection
Phone 1: 243-1172
Final Inspection
Reg #: LIC 127325
PLM 34 -168PB
0
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 4 - 987.
Issued B � 4 F ( � Permittee Signature:
■
Call (503) •39 -4175 by 7:00 P.M. for an inspection needed the next b iness day
CITY Or.7IGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 °T14-- Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# St/IXX?) - ee l a
Related SWR #
Called
Name of Development/Project ` F,IXTURES;.'(individual) a "` " ; , 1 ^ PRICE1 funv
Job Q ye - Sink 11.50
Address Streef(Address J Suite Lavatory 11.50
l i L 1 3 " Ti "'we Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip Shower Only 11.50
i 1c ner'l 0 • 91,22-5
Water Closet 11.50
Name U
QN /e �m, Urinal , 11.50
Owner Mailing Address Suite Dishwasher 11.50
5i XAAASL , Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
(393i3
Name Washing Machine /Laundry Tray 11.50
�� M ( t� ^y � Floor Drain /Floor Sink 2" 11.50
Occupant Mailing Address d Suite 3" 11.50
4 )/ A "A 4" 11.50
City /State Zip Phone -
• Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
.O LNA MFG Home New Water Service 32.00
Contractor Mailing K Address Suite MFG Home New San /Storm Sewer 32.00
1 U `' e x T+i, 022. Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy ( ) 4 4 vi JI..e,aa 9 7 a L.1 3 - I F72.
Drinking Fountain 11.50
. of all licenses are Oregon Conet. Cont. Board Lic.# Exp. Date
required if \21325 l 2_ Z Op Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database 3y “73 Pa 3-3) -6 1
Name
Architect Sewer - 1st 100' ' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone Water Service - each additional 200' 32.00
• Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential It Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* 19.00
o�QOA\'( r tr-P bF ' - 5- 4...,o_Ar 1 ■ 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 - n M
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 ,,.`3 .j ,,
given is correct, that I am the own r authorized agent of the owner, and *SUBTOTAL '''` -, k:,-.. ` ; ''
that plans submitted are in com ian 'th Oregon State Laws. l L, T -.. �Q -
Signature of Owner /Agent Date 8% 6-26o6 8/a SURCHARGE TO14 r ,r _-
Contact Person Name Phone 3t0°1° ` ;`°;:'jZ Li
� � .143- * *PLAN REVIEW 25% OF SUBTOTAL J I , z �`
' HO Required only if fixture qty. total is > 9 %&:;:1114 ''
71,1BATH`HOUSES17809 d .
TOTAL ri r.. °. ;_; ,, - VJK 4SE 25 '
iiiSif ie4ii lucles-all p lumbing fi�ctures in the dweilmg and first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
- < , , mss.r n,'w_ , -z , s_s .* . s y ` 1A P 9 P
2.91,2et Of�San =ws 3 r 11 ffie , @r. nd YVa Service , , k u, _ N ' Device, which is $25 + 8°10 surcharge
-� se��, ,...
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I: \dsts \forrns\plumapp.doc 11/18/99
PLEASE COMPLETE: Mod
■:
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 Vorms\plumapp doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�dG
6 ,-� BUP
1aq/9`T Date Requested AM PM BLD
Location // V rt., Suite MEC
Contact Person 67 11 Ph 793 a 5713 PLM 4244" .~
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: b x
Foundation / FPS
Ftg Drain SGN
Crawl Drain Inspect on Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall �_
Fire Sprinkler � 410 _
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PAS PART FAIL
Post & Beam
Under Slab
Top Out
Wate vi,
r
Drains
PART FAIL
CHANICAL
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 Inspector / ' Ext
Final
PASS PART FAIL _ DO NOT REMOVE this inspection record from the job site.