Permit A - CITY OF TIGARD PLUMBING PERMIT
A OW I DEVELOPMENT SERVICES PERMIT #: PLM2000 -00163
,- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/19/00
SITE ADDRESS: 14905 SW 104TH AVE PARCEL: 2S111CB -01308
SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5
BLOCK: LOT: 015 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:
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Permit for less than 100' of sewer line to newly installed sewer lateral, no reversed plumbing. Reimbursement
fee of $8,000.00 paid on 5/19/00, receipt # 0002327 .
FEES
Owner:
Type By Date Amount Receipt
LAPIDUS, DAVID J /KAY W PRMT DEB 5/19/00 $50.00 0002327
14905 SW 104TH 5PCT DEB 5/19/00 $4.00 0002327
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
PHIL PAULSON EXCAVATION
1939 SE BROOKWOOD AVE
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone 1: 693 -6610 Sewer Inspection
Reg #: LIC 141383 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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Iss ed By: 1 Permittee Signature: y ail 4/IQ--
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the nextness day
CITY OF TIGARD Plumbing Permit Application PlanC -ck#
13125 SW HALL BLVD. Commercial and Residential Rec'd ty _ ,_
TIGARD, OR 97223 Date Rec'd " "/ , JO
(503) 639 -4171 Date to P.E.
________
Print or Type Date to D
Incomplete or illegible applications will not be accepted Permit# - ®b /6�c
Related SWR #0./Y Yj DD VD*
Called
Name of Development/Project FIXTURES (individual) , QTY PRICE AMT
Job " �°/ , W Sink 11.50
Address St et q,,�-� Suite Lavatory 11.50
\ 1Y7�5 JO 1 ijv� Tub or Tub /Shower Comb. 11.50
Bldg # Cityy / Zi `� Shower Only 11.50
776 �' �� � ` Water Closet 11.50
N l2 j ,D( Urinal 11.50
Owner Maii'nngAddress (( �! r1 Suit Dishwasher 11.50
/ / l (ySS� I� m� Garbage Disposal 11.50
/ Cit /State I L Phone 6�o 4p`f t
Laundry Tray 11.50
- nom 0y2._ 1
Name Washing Machine /Laundry Tray 11.50
54101E_ Floor Drain /Floor Sink 2" 11.50
X 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.
*I/ A40.8akl P �el6 MFG Home New Water Service 32.00
Contractor Ili Addres �/� Suite MFG Home New San /Storm Sewer 32.00
r 8 g1 P e ptimvj co Hose Bibs 11.50
Prior to permit C'ty /State Zip / P ne • Roof Drains 11.50
issuance, a copy e/� er 13 ' - i 6(0
Drinking Fountain 11.50
of all licenses are Oregon Cocist. Co Cont. Board Lic.# Exp. ate
required if r / 32 3 U3 07 02
Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # , Exp. D t
database G
Name
Architect Sewer- 1st 100' ti 38.00 a"
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
New 0 Repair 0 Replace with like kind: Yes 0 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
J Residential Backflow Prevention Device* 19.00
i ' 6.00-)0..-1-10/U
02 S' tO ` Catch Basin 11.50
Are you capping, moving or 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
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 lans submitted are in compliance with Oregon State Laws. *SUBTOTAL
Sig ure of r nt Date 8% SURCHARGE 1/, 0° cfAxx
Ci Contact n l P knts Phone � Volb(
**PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9 _ /
2 BATH HOUSE $250.00' TOTAL l�.a�
`3 BATH HOUSE $285.00 - /
(This fee includes all plumbing fixtures in the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
!00 feet of sanitary sewer storm s ewer and water service) Device, which is $25 + 8% surcharge
� �� a "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:ldsts\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 t� Z AM PM BLD
Location / 5 4) /0 VII-1 Suite MEC
Contact Person Ph 3 3 D &2-2 PLM 2 t 22 -A!9/6".7
Contractor Ph SWR J /9D.- fX.)/aC.
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 � ii /. / � /i�� Air /1
Roof
Misc:
Final
FAIL
OSEUM
Parrlleam
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
Backfi ing
anit Se
rain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk � }'1
Other Date Inspector // / 0 Ext
ry ' f
Final
PART FAIL ' 0 NOT REMOVE this inspection record from the job site.