Permit CITY TIGARD r PLUMBING PERMIT
' DEVELOPMENT SERVICES PERMIT #: PLM2000 -00320
�'�' `� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/29/00
SITE ADDRESS: 15245 SW 116TH AVE PARCEL: 2S110CA -01600
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: DEM GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: UNK FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 1 GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Capping one toilet and one urinal.
FEES
Owner:
Type By Date Amount Receipt
KING CITY CIVIC ASSOCIATION PRMT DEB 8/29/00 $50.00 KING CITY
15245 SW 116TH 5PCT DEB 8/29/00 $4.00 KING CITY
KING CITY, OR 97223
Total $54.00
Phone 1:
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503 - 692 -4139 Insp existing /capped fixtures
Reg #: LIC 00087852 Final Inspection
PLM 34 -166PB
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 n copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
/ Permittee Signature: /, ' 4
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi ess day
AUG - 29 - 00 TUE 11:15 AM City of King City FAX:503 639 3771 PAGE 2
CITY OF TIGARD Plumbing Permit Application Plan Check*
13125 SW HALL BLVD. Commercial and R Recd By : ll f..
TIGARD, OR 97223 Date Recd :. i�sri
(503) 639 -4171 Date to P.E. �1
Print or Type Date to $.-2 e G0
Incomplete or illegible applications will not be accepted Pen"` '"```
Related SWR *
Called •
Name of Development/Project " 1RES ft divldiia g'; = ` `; < -� :; ,'°" %P ": -. 'Q'F(t ` = { 19E <4
-', .X
,.� . ���-. i . l /� ,�,iyy.,. : •` x,. i , ;AMT
Job + rt1 G C• ,i G. 45Art --ft • Sink 11.50
Address Street Address Suite Lavatory 11.50
/5.2 54141, //6 r'lt • Rec . Rao .-1 Tub or Tub/Shower Comb_ 11.50
Bldg S City/Stale Zip Shower Only 11.50
KIN" ce74 . 97221/ •
Name Water CloseWrinal (Specify) , 11.50
Dishwasher 11.50
Owner Mailing Address ' Suite Urinal 11.50
Garbage Disposal 11.50
City/State Zip Phone Laundry Tray 11.50
Name Washing Machine/Laundry Tray (Specify) 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Malting 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.
fee., 6,s era ''5 / h mkr'ra y ..,4_fic • MFG Home New Water Service 28.00
Contractor
mailing Address Suite MFG Home New San/Storm Sewer 28.00
r ya . ,eD,c 6 _ Hose Sibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
Issuance. a copy Tt,mt/te .a, 00 I ,. 9 704,
of all licenses are Oregon Const. Cont. Board Uc Other .0 Exp. Date Fixtures (Specify) 15.00
expired in COT Plumbing Uc. t Exp_ 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 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Commercial Back Flow Prevention Device 32.00
Additional description of wo :: - •-N .
/' / - , , n n ' �1 - Residential Baekflow Prevention Device" 19,00
�' Catch Basin 11.50
Are • u ca • • •, m;Zn 9 or replacing any fixtures?
y Insp. of Existing Plumbing or Specially Requested 50.00
Yes to 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. ' ,,, .
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL
Isometric or riser diagram is required. 1(Quantiry Total Is 9 4
given Is correct, that I am the owner or authorized agent of the owner, and "SUBTOTAL ".` '$ ;'' t5 (
that • tans sub ,
• fitted are in corn •liance with Ore. on State Laws. _, , ` L. i 11 : i
-- . • I er /� e t Date -, :
1�:r 8-'.29, --.7 eeo 8% SURCHARGE t .,, .
Contact Per • n Nam ' Phone X ` ,••∎., 4 • r r '; J' . " '
GAR . , 07!11' "PLAN REVIEW 2,5°/a OF SUBTOTAL;' ;"rr X47,
fi7 r� . r � w , lr � t5 Required only if li nure qty. total Is v 9 "5; . .;'",..:,a4 -, , , A ( ..1
o , r z • F a ; gip ,, " . y am „ C C,C
a . )r
i"
} t y'1 < y , Msix �$ r � 4' TOTAL : y r ` "g`
t r+„
"tf ,- b , ' {Idn i p t t G ' + , - t � * *NI KO 4
�Rn ' � ., ,JrtJrt , � ( � ,� .((;, - Miniimum permit fee Is 350 * a% surcharge, except Residercrtlal Bacidlow Prevention
r,. •, • . •••tv. ,,ZIt I r4: Mh. a f:ll.i(-.7w'r 0.0ce, W,,,cn 1 q a2Y * 8% surcharge
'Ail New Commercial Buildings require plans with isometric or riser diagram and
plan review.
1' Watslrormalpianapp.doc 1W1/96 - -.
AUG - 28 - 00 MON 03:10 PM City of King City FAX:503 639 3771 PAGE 3
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Sink
Lavatory •
Tub or Tub /Shower Combination ,
Shower Only
Water Closet 1
D
Urinal Yes
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2" 11111111111111 :
3"
4 ,. , -
Water Heater ,
Other Fixtures (Specify) -
,_
•
COMMENTS REGARDING ABOVE:
is k. S - 5 gelr.9-we d r!iif 0ik7ef 1 QJ ro,`.ts / s', eIe a .
•
I:vaalavortnarp•'mapp,dac 10/1199 _ __
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
f BUP
Date Requested ' s 0 AM PM
BLD
Location / 2 � / g S hie; 6 /'f C • Suite MEC
Contact Person Ph ' 9? - W 3 7 PLM i+- G' D 2
•
Contractor Ph SWR •
BUILDING Tenant/Owner ELC •
Retaining Wall ELR
y [ �a } 1
Footing ., o r ` ..2 (= biJ Y.,, LC`l L� Si ���+2 ��>i{!g '� °;, o ' b• -W " as -v---1,--,-.. °
Foundation '" .�+�,�;, �^' � Q � ; � "` �s' �" ^` `, y °s ° ` F
Ftg Drain ��s>:. ►T #' �_ wr
Crawl Drain • Inspection Notes: ' SGN
Slab SIT
Post & Beam
Ext Sheath /Shear -
Int Sheath /Shear
Framing
Insulation _
Drywall Nailing
0 CI:
Firewall
< Fire Sprinkler ,
Fire Alarm
' f
Susp'd Ceiling & '-
- A
Roof
• 4 1jr . \
Misc: -
Final
PASS PART FAIL
FLUMBIN t/"
i ,
1 &'Beam \
Under Slab , G N ,'- ` - t
Top Out - -' ro 4 / ejejAl
(..toi .,,.
Water Service '..: \:' 'k
. Sanitary Sewer i, 'i.: Vti .
Rain Drains
i ,, `` 1,
Final \.
/PASS 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 e
. Sanitary Sewer - -
Storm Drain [ ] Reinspection fee of $, required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin s`
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA �
Approach /Sidewalk D 11 -' - 0 ` 0 b Inspector ( - . i 1 Ext
Other
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
Date Requested g ' 3 v AM ! PM BLD
Location /5 y 3 S / /4' 15 k e Suite MEC
Contact Person Ph 3 y 41, tJe' °a 3 Z U
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
PASS PART FAIL
�LUMBIIJ3>
'Beam •
Under Sla
Top Out
Water Service
Sanitary Sewer
\
Rain Drains
Fi
PASS ,PART FAIL
)QIEC 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
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 �- 1
Approach /Sidewalk Inspector Ext i -- t� t�
Other Date v. 0
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site