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Permit CITY � TIGARD PLUMBING PERMIT ��U ��K�� U^�� u~m.��n nnn»~n� o SERVICES xv�n�"� PERMIT # • PLM99-0052 •zaw- 13125 SN/ Hall Bhvd.. Tigard, OR97223 (503)639-4171 DATE ISSUED: 02/22/99 PARCEL: 2S111CB-051069 SITE ADDRESS...: 15165 SW 100TH AVE SUBDIVISION ^ PP1997-058 ZONING: R-3.5 BLOCK ^ LOT ^001 JURISDICTION: TIG CLASS OF WORK. . :ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0 TYPE OF USE....:SF WASHING MACH ^ 0 BACKFLOW PREVNTRS..: 0 OCCUPANCY GRP.,:R3 FLOOR DRAINS ^ 0 TRAPS ^ 0 STORIES ^ 0 WATER HEATERS ~ , 0 CATCH BASINS : 0 FIXTURES LAUNDRY TRAYS ~ 0 SF RAIN DRAINS : 0 SINKS ^ 0 URINALS • 0 GREASE TRAPS... ^ 0 LAVATORIES ^ 0 OTHER FIXTURES ^ 0 TUB/SHOWERS...: 0 SEWER LINE (ft)...: 100 WATER CLOSETS.: 0 WATER LINE (ft)...: 0 DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0 Remarks: Installation of sewer line.. Owner: FEES GREGORY M BLAIS type amount by date recpt 15165 S.W. 100TH AVENUE PRMT $ 30.00 DLH 02/22/99 99-313109 TIGARD OR 97223 5PCT $ 1.50 DLH 02/22/99 99-313109 Phone #: 632-6138 Contract or JAMES GRIFFITHS EXCAVATING INC PO BOX 1136 CANBY OR 97013 ' - Phone #: 263-8038 $ 31.50 TOTAL Reg #..: 001043 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Sewer Inspection Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect ion applicable laws. All work will be done in accordance with approved plaVs. 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 952-00014310 through OAR 952-00014380. You may obtain copies of these rules or direct questions to 0UMC by calling (503)246-1987. e Issued By: Permittee Signature: Aur,..., ++++++++++++++++++++++++++++++++++++++++++++++++++++++++ +++++++++++++++++++ �� Call 639-4175 by 7:00 p.m. for an inspection needed the xvext business day ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ • CITY OF TIGARD Plumbing Permit Application Plan Check # 13125 SW HALL BLVD. Commercial and Residential Rec'd By .Z TIGARb, OR 97223 015 //6- Date Rec'd o2m7 (5g3) 639 -4171 Date to P.E. - 3 Print or Type / � Date to DST - ti Incomplete or illegible applicatio s -wiltn Tbe_acc ofd Pem,it# Pvy99 - 005 , g � ! Related SWR Cr/4)499-7,0 9/ /1/6F.7 `vo ©t� /y1ytCL 0 m , Called "TfYMFS - Z�f9�99 Name of Development/Project IFIX TURES '' '` °r 1 ;= ;PRICE ° ��_ - "' �RgAMT, 1 ` �. <.. ,'an.- .,,.,, <3 e .: _. ., s ",a''}xYii# 'r .�`,:3.R£ - i " " =; Job 5��e� l� C,.� e�C\ Sink -.. 9.00 Address Street Address Suite Lavatory 9.00 I Sl (0 5 SL.4 t r Tub or Tub /Shower Comb. 9.00 Bldg # ' City /State Zip Shower Only 9.00 Name Water Closet 9.00 G r (6 to 5 Dishwasher 9.00 Owner Mailing Addre Suite Garbage Disposal 9.00 LS/ (D St,v• (CX)t-h Washing Machine 9.00 CitX /State i Zip Phone T o 0 2, 1 )C 3 CO3 'D_(4)r38 Floor Drain /Floor Sink 2" 9.00, Na 3" 9.00 1�-- ?G�'Mt. A S t-�‘- 4 " 9.00 Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00 Gas piping requires a separate mechanical permit. City/State Zip Phone Laundry Room Tray 9.00 Urinal 9.00 Napie. 'trS ( f . `` _ \ C `e � Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 Ro, ( » la y y 9.00 Prior to permit City /State Zip Phone Sewer -1st 100' / 30.00 issuance, a copy ra rAn o' � q-) 013 ,p(0-3-8(Z9 y Sewer - each additional 100' 2500 of all licenses are Oregon Const. Cont. Board Lic.# BD. Date required if f rr. f - . 3- c Water Service - 1st 100' 30.00 expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00 database Storm & Rain Drain - 1st 100' 30.00 Name Storm & Rain Drain - each additional 100' 25.00 Architect Mobile Home Space 25.00 Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device Engineer City/State Zip Phone Residential Backflow Prevention Device* 15.00 (Irrigation timing devices require a separate Describe work to be done: restricted energy permit.) New ,6 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00 Residential 0 Commercial 0 Catch Basin 9.00 Additional description of work: Insp. of Existing Plumbing 40.00 per/hr Specially Requested Inspections 40.00 per /hr Rain Drain, single family dwelling 30.00 Are you capping, moving or replacing any fixtures? Grease Traps 9.00 Yes 0 No If yes, see back of form to indicate work performed by QUANTITY TOTAL `` fixture. FAILURE TO ACCURATELY REPORT FIXTURE : -, :';Y . „, Isometric or riser diagram is required if Quantity Total is > 9 ,;., . , ;r. WORK COULD RESULT IN INCREASED SEWER .FEES. *SUBTOTAL f " , '"t - - I hereby acknowledge that I have read this application, that the information 3 0. given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE 9V! . -# ` ° „` =y= that plans submitted are in compliance with Oregon State Laws. .r" ' 7 SC) Signat e of Owner/Agent -� Date ** 25% ` n <u' ,; V , � PLAN REVIEW 25 /o OF SUBTOTAL '` �'''� "��, I,`'1 / _9 Required only if fixture qty. total is > 9 'kW* 1 TOTAL ,-7,:i. , ;; , ,. ` ; 14. g ..co Con ct erson Name Phone M " t - e l , _ , *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow J a �� C S `� Prevention Device, which is $15 + 5% surcharge **All New Commercial Buildings require plans with isometric or riser diagram and plan review I:kiststplumapp.doc 7/2/98 PLEASE COMPLETE: ......................................................................................... •-• •• • ••• • • • • • ...... . " .... ...:.... • - • •• . . .. ........................................................................................... . Replaced Removed/Capped Sink Lavatory Tub or Tub/Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain/Floor Sink 2" 3 „ 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: • \dsts \plumapp.doc 7/7/98 CITY OF TIGARD BUILDING INSPECTION DIVISION ST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP AN L/ci'bate Requested , t.)./0)-S - 79, AM X M BLD Location /.S76,5 moi6 -e Suite ME Contact Person -&-L Ph - LM . $ / ` 2. Contractor - /l. Ph �,...3 7 tO BUILDING. : w ti ' ' " Tenant/Owner A6-61' t0tt2 ELC Retaining Wall J ( ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear / Int Sheath /Shear /'a �� N ( Z — 0 \ 1 Framing T �J Insulation Drywall Nailing .r i ! , Fire Sp " / V CL../A-/ , _� , Fire Sprinkler � A-A-'—' Fire Alarm l V Susp'd Ceiling Roof Misc: Finalr c l - L 1111W PASS PART FAIL Post & Beam 56- Z/k---.J` Under Slab - -- Top Out I Water Service t' Sanitary Sewer - Rain D PART FAIL HANIGAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRIC AL ,. ' : , Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE ,, ' ,v , 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 Otheoach /Sidewalk Date 2 , C vq 5 Inspector �S Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .