Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2000 - 00179
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/5/00
SITE ADDRESS: 14830 SW 104TH AVE PARCEL: 2S111 CB -01302
SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5
BLOCK: LOT: 020 JURISDICTION: TIG
CLASS OF WORK: ALT 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: 150 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 150 ft of sewer line. No reverse plumbing required.
FEES
Owner:
Type By Date Amount Receipt
FRY, HERMAN W JR + BETTY JU NE PRMT KJP 6/5/00 $70.00 0002682
14830 SW 104TH 5PCT KJP 6/5/00 $5.60 0002682
TIGARD, OR 97224
Total $75.60
Phone 1:
Contractor:
PHIL PAULSON EXCAVATING
1939 SE BROOKWOOD AVE
HILLSBORO, OR 97224 REQUIRED INSPECTIONS
Phone 1: 503-693-6610 Sewer Inspection
Final Inspection
Reg #:
OR6%WAL
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: Permittee Signature: A /�/ i rjr A 4 At
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Or ,
CITY OF TIGARD Plumbing Permit Application Plan Check#
131Z5 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Recd
(503) 639 -4171 Date to P.E.
Print or Type Date to DS
Incomplete or illegible applications will not be accepted Permit #i d 1 Zc)zt7 -OW 7q
Related SWR # .S;J/2 2 ot 0 :10 i S
Called
Name of Development/Projf FIXTURES (individual) QTY PRICE AMT
Job /. optiik l � l _ � Sink 11.50
Address Stte% s , ( 1 S uite Lavatory 11.50
3 (J City/State Zip Tub or Tub /Shower Comb. 11.50
Bldg #
A n �Jl-� Showe O 11
rwi P/ (/ dC / Water Closet 11.50
Name
L � Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
• Garbage Disposal 11.50
City /State Zip Phone D� Laundry Tray 11.50
Name �J Washing Machine /Laundry Tray 11.50
5 62-011"-- 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 Phi j p i �� Gas piping requires a separate mechanical permit.
Name/7 g4Mit-- Home New Water Service 32.00 C
Contractor ailin dd (j Suite MFG Home New San /Storm Sewer 32.00
�a t{ cJl= ��� �� Hose Bibs 11.50
Prior to permit C'ty /State Zip o ne Roof Drains 11.50
issuance, a copy ,e pg 7/ (R3 v 3/ 7/44.
L �". Drinking Fountain 11.50
of all licenses are Oregon Conet. Cont. Board Lic.# Ex Da
required if / t7'/ 3 23 q ,5 Li, ` 1 Q Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database
Name
Architect Sewer- 1st 100' 38.00 j
Or Mailing Address Suite Sewer - each additional 100' 32.00 I 7 .-
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 f work: Commercial Back Flow Prevention Device 32.00
'•• Residential Backflow Prevention Device* 19.00
d jP.(,UW - 1,0 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 t J
given is correct, that I am the owner authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
that plans submitted are in compli nc with Oregon State Laws. "SUBTOTAL
Si• t4P / / t reofO • • g i
• Date %j��
I vii..) A / ID 8% SURCHARGE - 4.0
C. n • ct Person me P `: 4. O
` /
/ **PLAN REVIEW 25% OF SUBTOTAL
BATH HOUSE $178.00 " / R equired only if fixture qty. total is > 9
;•2 BATH HOUSE $250.00 TOTAL 7 5(=
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
w 00 feet Of sanit3r)I sewer storm sewer and water service) Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
C1dsts \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:
1ldsts \ormstplumapp.doc 11/18/99
•
'CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested W)/00 AM PM BLD
Location I J 0 10t-OK A/(J-C Suite MEC • Contact Person (94V IA, Ph (0 2,2, PLM — 0817
Contractor Ph SWR ZOCO 0117
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 l _
Firewall
Sp rinkler
Fire Sp 5eP7 -7 c ! J Al P I" / I)
Fire Alarm
Susp'd Ceiling
Roof Y6' C r° O� �
Fina
Final
PAU_ PART FAIL
LUMBING>
Post & Ffeam
Under Slab
Top Out
Water Service C, ,.k-
- • -
4 ) - ART FAIL
ANICAL
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
Final Date b1 I n spector 7 �� (� Ext
\
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.