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Permit CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2000 -00333 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/8/00 SITE ADDRESS: 14785 SW 104TH AVE PARCEL: 2S1 11 CB 01311 SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5 BLOCK: LOT: 022 JURISDICTION: TIG CLASS OF WORK: NEW 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: Connection of existing residence to newly installed sewer lateral. No reversed plumbing, septic tank is to be pumped, filled and inspected or removed. Reimbursement district fee of $8,000.00 paid on this date. FEES Owner: Type By Date Amount Receipt MARGESON, ERIC C + DEBRA J PRMT CTR 9/8/00 $55.00 27200000000 14785 SW 104TH 5PCT CTR 9/8/00 $4.40 27200000000 TIGARD, OR 97224 Total $59.40 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 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: Ls. Permittee Signature: e. tv. _v Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application PlanCh 73125 SW HALL BLVD. Commercial and Residential Recd By Date Rec'd 9 - $-Co TIGARD, OR 97223 Date to P.E. ^ (503) 639 -4171 Date to Dv Permit # t- I'l4$ ,53.5 Print or Type Related SWR #U n -OOaB< Incomplete or illegible applications will not be accepted Called Name of Development/Project FIXTURES (individual) Qty Price Total Job Sink 16.60 Address Street Address 7-1-1 Suite Lavatory 16.60 ,- 14 s4) toil -ate _ Bldg # City /State Zip Tub or Tub /Shower Comb. 16.60 T( I? I \ C 1 { Z Z Shower Only 16.60 Name ( Gt .fL q he.6 A 1- `Ar-G.E50r� Water Closet 16.60 Urinal 16.60 Owner Mailing Address Suite I415 5ti; 10°l T�. kE Dishwasher 16.60 City /State Zip Phone Garbage Disposal 16.60 TtGAIZ a ell 77 5q9 -5ZI Laundry Tray 16.60 Name Washing Machine 16.60 Mailing Address Suite Floor Drain/Floor Sink 2" 16.60 a Occupant 3" 16.60 City /State Zip Phone 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Name Gas piping requires a separate mechanical permit. p T (4 L � p.OLN 1 SF E 1(' C A 1) , MFG Home New Water Service 46.40 Contractor Mailing Addre s Suite MFG Home New San/Storm Sewer 46.40 11.5 a k 1j/k e, w oo?D It}u 16.60 Prior to permit City/State D Zip PI / � ! o a Hose Bibs issuance, a copy / LL S &g D/2 97/2, 6 e5 -46.,6 Roof Drains 16.60 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date Drinking Fountain 16.60 required if Other Fixtures (Specify) 21.75 expired in COT Plumbing Lic. # Exp. Date database Name Architect or Mailing Address Suite Sewer- 1st 100' 55.00 5s,� Sewer -each additional 100' p 46.40 Engineer City /State Zip Phone Water Service - 1st 100' 55.00 Water Service - each additional 200' 46.40 Describe work to be done: Storm & Rain Drain - 1st 100' 55.00 New O Repair O Replace with like kind: Yes O No O Residential O Commercial O Storm & Rain Drain - each additional 100' 46.40 Additional description of work: deau I .i7 7 -6 t o [ ji)L }/ Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device` 27.55 / A.) hTl+l. - t a>f u ? f Are you capping, moving or replacing any fixtures h Basin 16.60 Cat Yes O No O Insp. of Existing Plumbing or Specially Requested 72.50 If yes, see back of form to indicate work performed by Inspections per /hr fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 65.25 WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 16.60 I hereby acknowledge that I have read this application, that the i nformation QUANTITY TOTAL 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 compliance with Oregon State Laws. *SUBTOTAL 65 in Si . ture of Owne / gent Date Cam e _ q- € V O 8% SURCHARGE !1, lfv Contact Perso Name Phone T , 7 CIZic, r `A 6. 7 O� 505 SCI$ -rt L1(o ••PLAN REVIEW 25% OF SUBTOTAL r • = t R equired only if fixture qty. total is > 9 l�� , �� : , TOTAL " 4 IA �� l. . � i l '1'A. 50 i' J// rA 'J ` � i ,' t4 j ; 4 y , ' ' ' a ` 'Minimum perm meda +8% surcharge. "All New Comme Buildings require plans with isometric or riser diagram and plan review. /t,�3• r�1r g eve, - * /Y/NiMU/cJ , ,.-6--&- ,,/L /eE sa'E - A/ T/6 1 L- I:tdstsVormslplumapp_rev.doc 8/29/00 c 5'G, �N � , , 3pQ - /3/1f�KF�PO "Aes/E/VT/o At 2)c-v/ d E /.S LGC.�CJC - J L)sP 3S - -1 3G , a s r'' i qa • - g 9� � /0,06 6 ` " P/ = 410, 3 YY' CITY OF TIGARD BUILDING INSPECTIbN DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 � 03 BUP — Date Requested "'� AM PM , BLD Location / 1 7 5 / L t Suite MEC Contact Person Ph PLM Contractor Ph SWR Z0G'� 'G Z 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 Ala Fire Alarm Susp'd Ceiling Roof Misc: Final P T FAIL LUMBIN Beam �• Under Slab Top Out 's4,4 Water Servi 'T� Sanitary Se r App. Rain Drains Fin PART FAIL MECHANICAL 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 Date /3 Inspector Ext Other 1 - Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. - ' - mu . . . . . „ . . . . . a ....„ . , h ■ e . . , t , 1 I . . '. • 7,' -''`' . . .— . . , •, r*" ■ . , . . • ... . . 1 A ' - ' ■ ' . t _ ... s • ., ■ I r . , . . , . . 9. . . i . ' d.....) .,. . . i .., . . . . , . ,. .. . ,.„ . .,,,. . . . ... i i . ' • ' i ' 4 . 1 , • . • 42' _ '. - ...- ' ' .: '-",` '. - ' Vill'ilmilkoaika4Aildift.t.mgialbaditilik _,, -0..-_diaillialliiiiiiiiiiiiiiiiillibiiliklit=ett - CITY OFTIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 • BUP Date Requested 9 -- AM PM - BLD Location l q 715 5 w/ O 7 Suite MEC Contact Person Ph 330 G Z 2y' PLM -no 33, Contractor Ph SWR 2UO"1' ( .2fr6 BUILDING Tenant/Owner ELC Retaining Wall .,OG1 S e ELR Footing Access: Foundation //24/'e4-r' 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 • / /A.! Roof Final PAS;—PART FAIL LuMB Post & Beam Under Slab Top Out Water Service Rain i rains d ille 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 /7224,- Approach /Sidewalk / Other Date / 2 /( Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.