Permit A CITY OF TIGARD
��i� DEVELOPMENT SERVICES
PE RM I PLUMP
T # ING PERMIT
(dpi I • PLM98 -0363
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/05/98
1 30\ PARCEL: 2S 1 O3CC--OO5OO
SITE ADDRESS...: 15 SW 121ST AVE
SUBDIVISION • ZONING: R -4.5
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:OTR GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:R3 FLOOR DRAINS • 0 TRAPS : 0
STORIES 0 WATER HEATERS 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS • 0
SINKS • 0 URINALS 0 GREASE TRAPS : 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 299
WATER CLOSETS.: 0 WATER LINE (ft)...: 380
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Installation of sewer line and water line to connect existing house.
Owner: FEES
FRED PASSMORE type amount by date recpt
7501 SW 195TH PLACE PRMT $ 160.00 DST 10/05/98 98- 309714
ALOHA OR 97007 SPCT $ 8.00 DST 10/05/98 98- 309714
Phone #:
Contractor
SUNRISE EXCAVATING INC
3351 SW WEST SHORE DR
GASTON OR 97119
Phone #: 357 -3576 $ 168.00 TOTAL
Reg #..: 90426
REQU INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Line Insp
applicable laws. All work will be done in accordance with Misc. Inspection
approved plans. This permit will expire if work is not started Final Inspection
within 1:. days of issuance, or if work is suspended for more
than 186 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952- 8001-8010 through OAR 952 -0081 -9888. You may
obtain copies of these rules or direct questions to OUNC by calling
(593)246 -1987.
s of t • Permittee Si gnat ar
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan c
13125 SW HALL BLVD. Commercial and Residential Recd t ').
TIGARD, OR 97223 Date Rec'd f 2 "5" Ju
(503) 639 -4171 Date to P.E.
Print or Type Date to D T
Incomplete or illegible applications will not be accepted Permit# Li /t 3& -
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT 1
Job / -1)0■i7 Sink 9.00
Address Street Address 1 .y- Suit Lavatory 9.00
3r W � 1). 5 Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
11 GAD q 7,3,2 3
Name Water Closet 9
Ft,H Dishwasher 9.00
Owner Mailing Address ---T“ n Suite Garbage Disposal 9.00
75 SIN i 9 5 f i L Washing Machine
City /State Zi Phone 9.00
r� + ct 7 cc.7 6 4 1 , cj/ Floor Drain /Floor Sink 2" 9.00
Name / 7 3" 9.00
V ) rr • 4" 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
me E l(e- n 1 " le-9- Other Fixtures (Specify) 9.00
Contractor Mailing Address _ /' 1 ' Suite 9.00
,535 7 ,..0..) Gv�%�3//J U . 9.00
Prior to permit ity /State Ip Phone
Sewer - 1st 100' ��� 30.00
issuance, a copy 1�% Q/i C/ 7//9 35 7- 7 c s"i 25.00 S �o
Sewer - each additional 100'
of all licenses are Or on Cost. Cont. Board Lic.# Exp. Date
required if y , /,9,6, 4 / - / � , - 7 q Water Service - 1st 100' 'r ; / 30.00 30 . co
expired in COT Plumbing Lic. # Exp. Date / Water Service - each additional 200' Z 25.00 co. 00
database Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City /S Zip Phone Residential Backflow Prevention Device* 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work: _
dc,)N E i Ex/fi -n ti a. /�LC S /
� o Sgi-o e- Insp. of Existing Plumbing 40.00
per /hr
p- it>/' -7"f. 1)_._ g kV/ el__ , Specially Requested Inspections 40.00
per /hr
Rain Drain, single family dwelling 30.00
Are you capping, moving or replacing any fixtures? Grease Traps 9.00
Yes O No O
If yes, see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9 Get.
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL Q
I hereby acknowledge that I have read this application, that the information ; 'C '
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE p
that plans submitte are in compliance with Oregon State Laws.
Signal / rier /Agent Date * *PLAN REVIEW 25% OF SUBTOTAL
.02.4-0--*--- Je Required only if fixture qty. total is> 9
/ ` TOTAL A6
Contact Person me Phone 4j
fi g -p r S /`7 C Q Z .-(S f *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
* *AII New Commercial Buildings require plans with isometric or riser diagram
( " 1 ''' and plan review �j
1:ldststplumapp.doc 7 /2/98 ^ 3 7
PLEASE COMPLETE:
.................... .
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped'
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I: Wstskplumapp.doc 777/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
al - --
24 -Hour Inspectio Line: 639 -4175 i E3usiness Line: 639 -4171 BUP
) � te - quested AM PM [ _2 l � BLD
Location t {i: 4 1.8 S 1 \. 0 Suite MEC
Contact Pera 0 • - ' / Ph 3_57- R (i/6 - q O 6 3
Contractor &SS on 0.1-Q-/ Ph ,2 -- / 5 / 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 JGL 1. ) `'t'C, �� '° „` n � /� 1� ��%i'J 1
Framing r- - (✓
Insulation rr /�_ �, 1� , /
Drywall Nailing J I �_ [
Fire wall 1 Yil ' / Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof � ,Q, \ r
Misc:
Final ` A S T�ii J ' t ! ��� v-1-L____e_7
PASS PART FAIL ( -
,.�U�
Post & Beam
Under Slab / �� .� UV ( ,�`�/ Q �j� \.L.-e S -1/('\/ VV\
Top Out
QNater Se vic `�L 0 \ S
Sanitary Sewer /
Rain Drains 1 1. {- ,(� ` (flA., Q 9.- / le c._.,
PASS PART FAIL L. At _ AL■L —• AN:
N M P1 8,11[3 NICAL 1 MIL .., _. k - - • • - - Y - 0 • - - - ‘ - 1 -
eam e ' 1L
R In �J .r AL A. �t I _ ` l_, -
Smoke Dampers C AAr1. `„ D - •
Final Y �J�
PASS PART FAIL
ELECTRICAL -,
Service
Rough In
UG/Slab e (-)` t"` 5 5 QM
Low Voltage \A AS (n ` /1 ,...., e s Fire Alarm 1, �J (1L/ FPal It PASS PART FAIL - i r I
SITE - I OM tu_1(\ 1 / � rr IO _ •�
• „e l
Backfill /Grading
U ./IA.3, "
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before ne • : section. 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 D 1 ` v - ` c( Inspector `\ 1 CY— Ext
Final
PASS PART FAIL 0 N T REMOVE this inspection record from the job site.
5/10/00 Activities for Case #: PLM98 -00363
2:31:35 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 10/5/98 DEB RECD DST 10/5/98
PLMA005 Create Permit 10/5/98 DEB DONE DST 10/5/98
PLMA799 Final Inspection DST 10/5/98
PLMA705 Sewer Inspection 1015/98 10/26/98 RB FAIL RB 10/26/98 0937 am Septic tank pump
ticket and fill ticket req'd. No
test on sewer. 3034 (green)
piping prohibited w /in 5 -feet of
building. Maintain proper depth
of sanitary line & 30 gpm
flow /slope capacity.
PLMA710 Water Line Insp 10/5/98 11/2/98 RB PASS RB 11/2/98 1 -1/2" SERVICE MAINTAIN
DEPTH OF TRENCH FOR
• WATER LINE.
PLMA740 Misc. Inspection 10/5/98 DST 10/5/98
PLMA050 (F) Issue permit 10/5/98 DEB MEMO DST 10/5/98 Per instructions of Jill A. okay to
issue this plumbing without
issueing the sewer permit at
this time. The sewer permit is
to be issued at the same time
as the SOP permit.
PLMA705 Sewer Inspection 12/29/98 RB PASS J *H 10/30/98 See SWR98 -0274
PLMA800 Case Finaled 12/11/98 JT 12/11/98
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