Permit CITY TIGARD PLUMBING PERMIT
4'"1 ft DEVELOPMENT SERVICES PERMIT #: PLM2001 -00153
' 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/13/01
PARCEL: 2S104DA -03100
SITE ADDRESS: 13350 SW 129TH AVE
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 017 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Backflow preventor
FEES
Owner:
Type By Date Amount Receipt
KORNERSTONE CONSTRUCTION PRMT CTR 4/13/01 $36.25 27200100000
14247 NW SPRUCERIDGE LN
5PCT CTR 4/13/01 $2.90 27200100000
PORTLAND, OR 97229
Total $39.15
Phone 1: 260 -8918
Contractor:
DMS PLUMBING INC
12602 NE 28TH STREET
VANCOUVER, WA 98682 REQUIRED INSPECTIONS
Phone 1: 360 - 254 -4539 RP /Backflow Preventer
Reg #: LIC 80744
PLM 37 -271 PB
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: I Permittee Signature: �t161
Call (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
` Date received: 1— — 13 —O ( Permit no.: PC./l1 a c49 -00 / 53
""'4111';' - City o Tigard
}, ( `J Sewer permit no.: Building permit no.:
' - " Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: , By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ — 1 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
l�d'New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 1_ SC l" -Ct - t - Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: ' New I- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (( (Block: I Subdivision:(p1 KA„" (41;FR (2) bath .
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities: ,
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: Nstl S p 0L , 1 , - 0.• Manholes
Address: to 6,- RE_ �(3 _ k Rain drain connector
City: Or).(‘-C, V-i.ir -. State:CJN ZIP: Qg4Q2_ Sanitary sewer (no. lin. ft.)
Phone:? , _( I E -mail: Storm sewer (no. lin. ft.)
CCB no.: g o / { I Plumb. bus. reg. no: '11—'X( pB Water service (no. lin. ft.)
Z._ 5 Fixture or item:
City /metro lic. no.:
Absorption valve
Contractor's representative signature:
Back flow preventer ✓ '1
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: .
Ejectors /sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): �tkto�� � -p-tc> C S k-- Floor drains/floor sinks/hub
Garbage disposal
Mailing address: Kas. ( t, S }-t. r-2d
Hose bibb
City: by � -1 ar�,-K. I Stat . b tz, ZIP: 9 Ice maker
Phone: 'Z 6.., _ 8 I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primers)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property n as per OR,S Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: IS ( � Date: c'() — . \ Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at _ %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / i within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount - 440 -4616 (6/00/COM)
PLUMBING PERMIT FEES
.
• ..-:_ ," '.,..?„,:, :•. -,,...,,,,,, PRIC ,,TOTAL,- ','t•te1a,21.401::i!i(dTwepitig*Onik: ,..-, , - ••
' FIXTURES (individual) 'k - 1 ..4e-, ... QTY ., ':(6A) .`:., 'AMOUNT : !'(inpli.tdes14!1$4MbiOtifiiilurei.:.in . - .. PRICE ,,,g' - .j . 0 . *
Sink 16.60 Alie!dWillirig iiidtke4TritlOCi ft. ' QTY :' (ea) * - i :
iiii'eactvutiliticcoiiiiection) ` .
Lavatory 16.60
One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60
SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL .. . ,
•. . .
Garbage Disposal 16.60 TOTAL ..
Laundry Tray 16.60 _.
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 • v ...• • Quart* by,Wo'rk Performed . -
Gas piping requires a separate mechanical Fixture Type; - ,.. . NeW' ,Moved.. . iReptaced„ Removed! .. ,
permit. . , ' 'Capped
MFG Home New Water Service 46.40 Sink •
MFG Home New San/Storm Sewer 46.40 Lavatory ..
•
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device" 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL , • :i -::, , ' - •
Isometric or riser diagram is required if
Quantity Total is >9
*SUBTOTAL '" , ', , ,'s , ' - ''' :,,-, ---)r .."---
8% STATE SURCHARGE
:
'PLAN REVIEW 25% OF SUBTOTAL . •
Required only if fixture qty. total is >9 ,
TOTAL ' :-,!.,' ; ,- - • $ i c
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device: which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:\dsts\forms\plm-fees.doc 10/10/00
_ J
cITY'OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 4171
BUP
Date Requested 4-- 27 - d / AM PM BLD
Location / 3 3. 1 ?-5 '' Suite MEC
Contact Person Ph c2.w- — gq/k 40 ,0 — 00 ig
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
0 4 ; -
Post & Beam a y /
Under Slab n
Top Out `�
Water Service (%V
Sanitary Sewer
Rain Drain § ,
1 . C.
PART FAIL
. ANICAL
Post & Beam • •
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL •
EL ECTRICAL ,- ',. ,
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 4( 1 2)')/6 Inspector Ex
Other
Final
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF.TIGARD BUILDING INSPECTION•DIVISION :-: = - 2,; _Ii)
:J'�3„'
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 -
// / BUP
y`
Date Requested '114 - AM', PM BLD
Location / 3 3 5 '5(...) / 2 f / 4 Suite MEC. . ...,,,,// _
Contact Person • • • . . , 14a 8. /' • PL Y' OO !S 3
Contractor. • . ph SWR 4 Tenant/Owner ELC
Retaining Wall ELR
Foot g Access: C�c /C 6
Foun• :tion _ FPS
tg.Dr- •n .1 • 4' �)
yawl D -in - Inspection Notes:
Slab . _ _ . .. . SIT - -
Post 8.
Ext_ Sheat_ ar Y --z,...,0 _661 S�
l
Irit Sheath/S ar & - / _ � 1 1 -�- ' d,
Framing C�''L�- ( ,� J
=iling � ` � J . .. eS�`-
D
Firewall �}�, ,�
Fire. Sp nkler "`--� ' S. `'O S
Fire • - Ceiling r / _
Sus• d Ce . . -- _ �- cf
Ro• S L_ LS - 2, 1 / l
Mi•.c:
PASS PART FAIL S ��' 1 .
PLUMB' tit: 1,1 6' v z`� 2lf 1f
k " - Post & Beam `=\� d
Under-Sleb
1t/Top Out - ,(://, -
}- Water Service
,�3 Sanitary Sewer ' `� . ` Q
�" Rain Drains �cl es.... �,.c�t/l�. �j -- � � •,r
FI A PART ... U I� �� --,---,/ L s
.u' -
Gas Line
Smoke D • • pers
(Tm
'''''PAS: PART • FAIL
E . C,TTRICAL t • -
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 Date Z11. (p ( \ `. Inspector �� Ext
Final !
PASS - PART FAIL - DO NOT REMOVE this inspection record from the job site.
Z. z y y
CITY OrfIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 ST 2.e6
BUP
Date Requested `t -' z 7 AM PM BLD
Location / 3 7 }Z S C- /2 f' �i Altdi Suite
MEC Pi"; (-Ai"
Contact Person Ph Z e- ,n ?-6 06 l Si
Contractor Ph �� I 00 d-e
BUILDING" Tenant/Owner ELC
Retaining Wall -- ELR /047o6 (ma)
Footing Acces •
Foundation r co /e FPS
Ftg Drain
O4-Crawl Drain Inspection • = _ • SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing eLH2,,c, / v 1 l 5
Insulation
Drywall Nailing etc —rx
Fire wall k ( -1-r) / d
Fire Sprinkler
Fire Alarm
. Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
FV Post & Beam
�der�ab -
0 Out
Water Service
it/Sanitary Sewer
�ain Drain
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
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 �i / 2�
Approach /Sidewalk Date (C) -- E.; LC) other Inspector
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site
• • CITY OF BUILDING INSPECTION DIVISION a yP .. : - •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171'
ST ct! C fr . 3 6
Date Requested q--2-40 AM / - AM BLD
Location / 7 3 5 se.) /21 �A1ue Suite MEC
Contact Person Ph o26 -Try J8• ► 6 ,Q0D (" 0C1 s 3
Contractor Ph 427, — 0 0 - 1e7
BUILDING ' . : Tenant/Owner ELC - ktS
Retaining Wall ELR tO e 60 ✓Y1 es
Footing Access:
Foundation (-NA / , ) FPS
Ftg Drain
8u SGN
/Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
kit Sheath/Shear J . , e _ s z � ^ �, ; ` ; `�
Framing `�
Insulation
Drywall Nailing
Firewall (A-41,e_
Fire Sprinkler 6 "P U
9 � �.
Fire Alarm -11-2.) v "'�--& \� . S p
Susp'd Ceiling
Roof
Misc:
Final ; � 4'\i/LW t---\ PASS PART FAIL
X81 /.- O Le." ` r- -0--( S --,,,
Post & Bea ,
tea , 0: — w. R-I c - .
00/top Out
6am Water Service 4
1)il1/Sanitary Sewer Q �- e
,✓Rain D_ r„ai_ns - WI $ A.a.41./ (....4.. kAi ' 0/ i A C.-
SS PART rn-'D 1 5 o kA.d k S
MECHANICAL 4� \' ...1 1 �--Q
Post & Beam -
Rough In b O y .,,r1
Gas Line
Smoke Dampers
Final
PASS PART FAIL l f • l _s L. X. q
ELECTRICAL , •_ (/. - . - v ,,
'\
Service • S . °
•
Rough In
UG /Slab
Low Voltage °� 1F - !
Fire Alarm �� -. - "__ • S
Final L -�S r
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 c
Approach /Sidewalk Date ® \ [
Othe Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
3z /,
CITY OF rIGARD '3U'ILDING INSPECTION DIVISION. ` . boa -acv �/3�
24 - Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 4 --/ 7 AM PM BLD
Location /33) .51.-.1 /&9 r' ,&' Suite MEC
Contact Person Ph 266 VV / g LM 0 2/MU— 0a I.-3
Contractor Ph R 600 -6d;--/ 2
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation 1 „I " 4e1-f' ' " FPS
Ftg Drain / SGN
OZ(,-Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Ina Sheath /Shear yo -� j 0 -k — 00 a s �, _ , r . L
Framing (i® dam/ `�
Insulation _
Drywall Nailing -e ,
Firewall
Fire Sprinkler _
Fire Alarm /� _
. Susp'd Ceiling AS � � - Z • (�
Roof C -P/ -% /D A110” g C.‘_ . C.. —
Final \ _ �` c �Z q
�ASC -ART FAIL °
p ,F Pte , .
Post & Beam
.:e1,___30...,22_,....
ttli, Top Out
IN Water Service
ex,-..-4--4R•D, /
.UJ Sanitary Sewer
0,2.(Aain Dr jgs,"
anal 111•
ASS PART (f;
MECHANICAL y : j N , c — -- f t - d �C�� �ce
Post &Beam
Rough In C - -
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL` ; y:
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm � 1 _
Final
PART FAIL ��- � •
SITE'S.... ' ' lir I -
Backfill/Grading
Sanitary Sewer - _ 6:P'-' Storm Drain Reinspection fee •' $ 'P required next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call ft rei -- - ° . [ ] Unable to inspect - no access
ADA
Approach/Sidewalk /i A
Other Date [ / Inspector Ext t9
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
4 Inspection Description Date Passed By I Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing
4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing
MFG- Structure set -up MEC - Mechanical Permit
Insulation
4 Inspection Description Date Passed By
Drywall nailing Post/beam mechanical
Suspended ceiling Gas line
Engineered soils _ Mechanical rough -in
Welding Lab Final _ Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final Mechanical final
Structural observation
Final inspection Wove- -
Plumbing Permit
4 Inspection Description Date Passed I By
BUP — Fire Protection System Permit ' Plumbing underslab
Inspection Description _ Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out ,r
Sprinkler fmal RP /backflow preventer 4/ L o I
Fire alarm fmal Rain drain
_ Storm drain
Water service
SIT - Site Permit ` Sanitary sewer
J Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final 4 (2 7/U ,
Sprinkler supply lines •
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils Inspection Description Date Passed By
Engineering acceptance Sanitary sewer _
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM SWR, ELC ELR MEC SIT PERMITS
CIT OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2001 00153
41I DATE ISSUED: 4/13/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 104DA -03100
SITE ADDRESS: 13350 SW 129TH AVE
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 017 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Backflow preventor
FEES
Owner:
Type By Date Amount Receipt
KORNERSTONE CONSTRUCTION PRMT CTR 4/13/01 $36.25 27200100000
14247 NW SPRUCERIDGE LN
5PCT CTR 4/13/01 $2.90 27200100000
PORTLAND, OR 97229
Total $39.15
Phone 1: 260 -8918
Contractor:
DMS PLUMBING INC
12602 NE 28TH STREET
VANCOUVER, WA 98682 REQUIRED INSPECTIONS
Phone 1: 360 - 254 -4539 RP /Backflow Preventer
Reg #: LIC . 80744
PLM 37 -271 PB
th
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Q
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 O
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. O
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: / Permittee Signature: ,
y'
Call (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day