Permit I l CITY OF TIGARD PLUMBING PERMIT
. DEVELOPMENT SERVICES PERMIT #: PLM2000 -00249
�'J J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/5/00
SITE ADDRESS: 10967 SW 111TH AVE PARCEL: 1S134AC-07600
SUBDIVISION: JEFFREY ESTATES ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
THOMSON, LINDA M PRMT DEB 7/5/00 $25.00 0003443
10967 SW 111TH PL SPOT DEB 7/5/00 $4.00 0003443
TIGARD, OR 97223
Total $29.00
Phone 1:
Contractor:
JOHN WATTS LANDSCAPE SERVICE
PO BOX 1426
LAKE OSWEGO, OR 97035 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 312-6470
R Final Inspection
Reg #: LIC 10574
0‘
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 m in copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: 2 ;t/�222 Permittee Signature: A //// ..14.4 , _ L / / I %../
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the .F business day
CITY OF TIGARD Plumbing Permit Application Plan C eck#
13125 SW HALL BLVD. Commercial and Residential Rec'd L
TIGARD, OR 97223 Date Rec'd 2 - 5 - O 0
(503) 639 -4171 Date to P.E. _ -- -
Print or Type Date to D T -
Incomplete or illegible applications will not be accepted Permit # l`f0 '(x)2(/9
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Li 1.1P,4 j owwSoi -( 12a-S)13E4Ci12. Sink 11.50
Address Street Address Suite Lavatory 11.50
1 C ( j 6' 7 Su) / // a. Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip -
7 G2QRD . tZ el7 -223 Shower Only 11.50
Name ' Water Closet 11.50
)--1 /■I DA 7 Alt S64 Urinal . 11.50
Owner Mailing Address Suite Dishwasher 11.50
/G 90 1 S,W. I 1 /714 IL Garbage Disposal 11.50
City/State
- Zip 2 3 Phone &Ili- Laundry Tray 11.50
7764 rzt� OR_ q7- � l-
Name , Washing Machine /Laundry Tray 11.50
`ji4 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.
.36 kr4 wATS LA �(��APL v/� MFG Home New Water Service 32.00
Contractor ailing Address Suite MFG Home New San /Storm Sewer 32.00
6' ,i / 47-4p Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy LA 1 ( OS>o560 9 � jl 31 .2_ 1 p � 70
Drinking Fountain 11.50
of all licenses are Oregon Const. Oont. Board Lic.# Exp. Date
required if / b S14-t ' 3 3 1 o I Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Ex . Date'
database
Name
Architect 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
Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New k Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential . '00 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* ,^ 19.00 /,' OOt
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No q 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.
I hereby acknowledge that I have read this application, that the information 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 C16
I. ature t Own
`/ -- ge Oat:
/i% 7 6 v. 8% SURCHARGE
C. .' t ll
Person Name • one
* *PLAN REVIEW 25% OF SUBTOTAL
=ATH HOUSE $17$.00 Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00 TOTA 6 9 7 co
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
100 feet of sanitary 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 .
l: \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:\dsts \forms\plumapp.doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP A lb/
Date Requested f - Y AM PM BLD
•
Location /0 7 S w %/ l Suite MEC
Contact Person Ph 3/i < t( 7 C- PLM ,20 0 41 y 9
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: n
Foundation /-161c, / as ra _ /Q , FPS
Ftg Drain '/ /�{ da SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing a / } /diJ
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PAS T FAIL
C t UMBIN
& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rai Drains
Odel` PART 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 / o/ UU / i2 ' pproach /Sidewalk / h Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.