Permit - n CITY OF TIGARD PLUMBING PERMIT
.,ip DEVELOPMENT SERVICES DATE PERMIT P 2 00 -00187
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14485 SW 100TH AVE PARCEL: 2S111 BC -00400
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 1
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connection of existing single family residence to newly installed sewer lateral. Plumbing needs to be reversed
under the house. Reimbursement fee.
FEES
Owner:
Type By Date Amount Receipt
UNTALAN, JOSE C + JUANITA F PRMT DEB 6/7/00 $88.00 0002773
TRUSTEES 5PCT DEB 6/7/00 $7.04 0002773
14485 SW 100TH
TIGARD, OR 97224 Total $95.04
Phone 1:
Contractor:
LARRY CAMERON PLUMBING
1812 SE 158TH AVE
PORTLAND, OR 97233 REQUIRED INSPECTIONS
Phone 1: 503 - 256 -2705 Sewer Inspection
Reg #: LIC 49792 Misc. Inspection
PLM 26 -366PB Final Inspection
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You obtai .opies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issue /4 Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed he next business da
L P I AAA- ) ?.— h--k/■Y■.(1-Ntl-1■\
CITY OF TIGARD Plumbing Permit Application Plan eck#
13125.SW HALL BLVD. Commercial and Residential Rec'd y i
TIGARD, OR 97223 Date Rec'd (p-7 -c'-
(503) 639 -4171 Date to P.E.
Print or Type Date to D
Incomplete or illegible applications will not be accepted Permit # c - N9 - oo!$e,0
Related SWR# r 7&'
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Streel Address / 'I Suite Lavatory 11.50
/0_,) V D ,, ) W/fL /" t Tub or Tub /Shower Comb. 11.50
Bldg # CU /State Zip Shower Only 11.50
1 IL
! Water Closet 11.50
N
L- ` . . � Urinal . 11.50
Owner Mailing Ads � � � Suite Dishwasher 11.50
L Q 5 1.1 Garbage Disposal 11.50
Cit /State Zip Phone
�r /' ^ U n Laund Tray 11.50
Na e i Washing Machine /Laundry Tray 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
Gas piping requires a separate mechanical permit.
Name
Y4' t> Cl * MN() ° f' 4 }(C. >I< MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00
n4/AS‹ Al. S (_WYYA SX Hose Bibs 11.50
Prior to permit City/State Zii. Phone _ Roof Drains 11.50
issuance, a copy t slf� \)� q 2. 2:57 -65
Drinking Fountain 11.50
of all licenses are Oregon Cost. Cont. Board Lic.# Exp. Date
required if ) 1 Q 3' , I--1 1 1.2. .--0) Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database
Name
Architect Sewer - 1st 100' 1 38.00 = `)y.)
or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone
9 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 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential A Commercial 0
Additional escription of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* 19.00
C C, ,N \ C .'A--y 5 Y 477. Catch Basin 11.50
Are you capping, moving 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
I hereby acknowledge that I 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
that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL
Si na ure of Owner/Agent Date
t...1"--L g� C� h _07_tr0 8% SURCHARGE 7 .
Contact Person Name Phone
G 39 S 29A * *PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00 TOTAL ,r) CO
3 BATH HOUSE $285.00
(This fee includes all plumbing fixtures in the dwelling and the first *Minimum permit tee is $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer,and,water 8 ..ice) : Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
` - plan revie
r \dsts \formslplumapp.doc 11/18/99 � � % ' � �'
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
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
/470 BUD
Date R e�quested (/ AM PM BLD
Location (LI "1 g a / Suite � MEC
Contact Person Ph q 3 Cl - S (D PLM 2e00 - 00/0
Contractor Ph SWR 2DOQ - 001
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 f;
Misc: � ✓ J
Final - 0
/
PASS PART FAIL Y
I C —a ( Beam
Under Slab
Top Out
Wa ice
anitary Se
Rai _ rains
AS PART FAIL
ANICAL 17/
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 / / 1
/ � , Inspector JJI7 Ext
Final
PASS PART FAIL D • NOT REMOVE this inspection record from the job site.
06/09/2000 17:13 5032515428 STEVE MCBEE PAGE 01
-44N AtE_ SItyr 139,
Invoice
JAMES G ila F IT HS EXCAVATING, ING, INC. —
N Sites 0 Date
O+s � �--� /4C, Pnone 9_3P c i4
City — r � � _ lnft(al Tess On Acct.
State
C. - Zip code / �
Prlaf Amount
. ,
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* NOT RESPONSIBLE FOR LANDSCAPING
*A movie. Charge of 1 1129L. per month wilt be charged on ell past due accounts. -
A fee of $10.00 will be charged on all returned checks. Not responsible for ettarney's fees. Iota ---
ApprQVal
By: AM—
Customer :.nature
P.Q. Box 1139 ' Canby, OR 97013
CCB #104320 (503) 263 -8038 • Pager (503) 818 -9368 ?Fiantyou