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Permit 7 4 CITY T•IGARD PLUMBING PERMIT r DEVELOPMENT SERVICES PERMIT #: PL /02/20 -00286 " � ' I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/02/2000 SITE ADDRESS: 16300 SW 104TH AVE PARCEL: 2S114BB -08600 SUBDIVISION: SWANSONS GLEN ZONING: R -12 BLOCK: LOT: 027 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: 1 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: 100 ft Remarks: 100' of storm drain. One catch basin located in rear yard. FEES Owner: Type By Date Amount Receipt STACK, PETER R + JUDY J PRMT JMT 08/02/200C $50.00 0004178 16300 SW 104TH AVE 5PCT JMT 08/02/200C $4.00 0004178 TIGARD, OR 97224 Total $54.00 Phone 1: Contractor: REQUIRED INSPECTIONS 1: Storm Drain Insp Phone Reg 1 : Misc. Inspection Final Inspection 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: Q Permittee Signatur -- Call 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 Recd By TIGARD, OR 97223 "V\ Date Rec'd 8? -vT-) (503) 639 -4171 Date to P.E. Print or Type 111 Date to DST yp Permit # PLm �DOO' - t� ^ . Zgo Incomplete or illegible applications will not be accepted Related SWR # Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job C6 4l Sink 11.50 Address Street Address Suite Lavatory 11.50 Tub or Tub /Shower Comb. 11.50 Bldg # City /State Zip Shower Only 11.50 Name Water Closet 11.50 f C-r-6z C ,-TLk___ Urinal 11.50 Owner Mailing Address Suite Dishwasher 11.50 /G3oo �-(nj ,0 dt1/E kJ7p-sF Garbage Disposal 11.50 City/State Zip Phone Laundry Tray 11.50 rf_ P.� L `. 7 Z -z� Name Washing Machine /Laundry Tray 11.50 .- IA-A.,( 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 Name Gas piping requires a separate mechanical permit. NuN1` MFG Home 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 MO DE 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 g Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' ' 38.00 38 New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential Commercial 0 ' Additional escription of work: Commercial Back Flow Prevention Device 32.00 � Residential Backflow Prevention Device* 19.00 etle re yf GA S /•.1 AbrEp tom- i e-/A.-1/..1 Catch Basin J 11.50 ,/,sZ Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No J 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 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 that plans submitted are in co liance with Oregon State Laws. SUBTOTAL �, Signatur w g Date 8% // / / 8/o SURCHARGE q. er6 Contact Person Name " Phone � I cTt=� P. �"7■c_lc. (,Ey- `a /c,<r() **PLAN REVIEW 25% OF SUBTOTAL 1 BATH HOUSE $178.00 L , r ir Required only if fixture qty. total is > 9 2 BATH HOUSE $250.00 T 5t. 3 BATH HOUSE $285.00 i (This fee includes all plumbing fixtures in the dwelling and the first *Minimum permit fee . 5 8% surcharge, except Residential Backflow Prevention 100 feet of sanitary,sewer storm sewer and water service) Device, which is $25 �i'surcharge "`All New Commercial Buildings require plans with isometric or riser diagram and plan review. I: \dsts \forms\plumapp.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: \dsls \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 O i / AM PM BLD Location /C0 3 6 , 0 5 r-,r f Suite MEC Contact Person Ph .33 G PLM „/G(-U '0 Contractor Ph 9 G 7 SWR 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 ��/ Feji v6�lf ` Fire Sprinkler l (� / Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains A, „ft.; t.; 5 -4„. _ F' ., C�r ' ( FAIL C N 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 [ I-]-Pfease call for reinspection RE: [ ] Unable to inspect - no access ADA —� / • Approach /Sidewalk Date d ' Other Inspector ( Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 • BUP r_ Date Requested g I AM PM BLD Location /4- 3 C y Suite _ Contact Person Ph DO 50 41 L o02f Contractor Ph SWR 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 Misc: Final RT FAIL / G- A--r � �� rAre /z ,40L// c.. eam Under Slab Top Out Water Service /� �,1 !� /� ewer -- L 4 9 SCQ 2 Y Q,' / 4M 6-e � C 6 tU4� 5 /4 . � Drain r � � �+ PART FAIL To 1�'N�� t /� T��C A .C/,o //C /4 ( ANICAL Post & Beam �� y qx Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SS q Irading Sanita Sewer .. ;'k P- [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd ch Basin Fire Supply Line [ ] Please call for r 'nspectio RE: [ ] Unable to inspect - no access ADA /c- Approach /Sidewalk Date 1 pector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.