Permit •
A CITY TIGARD PLUMBING PERMIT
11 DEVELOPMENT SERVICES PERMIT #: PLM2000 -00145
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 ----- DATE ISSUED: 5/8/00
SITE ADDRESS: 15478 SW 114TH CT 77 PARCEL: 2S110DB 90772
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDO ZONING: R -25
BLOCK: LOT: 077 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 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: Replace gas water with like kind.
FEES
Owner:
Type By Date Amount Receipt
NICHOLS, WILLIAM D + HEIDI L PRMT DEB 5/8/00 $50.00 HAND RCPT
15478 SW 114TH CT #77 5PCT DEB 5/8/00 $4.00 HAND RCPT
TIGARD, OR 97224
Total $54.00
Phone 1:
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD •
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone 1: 643 -5535 Top -out Insp
Reg #: LIC 001009 (CORRECT #10967) Final Inspection
PLM 34 -42PB
0iGk'4M-
This permit is issued subject to the regulations contained in t•- Tigard Municipal Code, State of On .
Specialty Codes and all other applicable laws. All work be done in accordance with approved • lans.
This permit will expire if work is not started within 180 Gays of issuance, or if work is suspended •r more
than 180 days. ATTENTION: Oregon law requires , ou to follow rules adopted by the Orego tility
Notification Center. Those rules are set forth in 0 R 952 - 0001 -0010 throu• • OAR 952-1111-0080.
You may i b of these rules or direct qu-stions to OUNC by calling ( 03) • •-1987.
I ct
Issu d By: / a.-6 4 4 PKrnittee Signature: , _ y'_�
Call (503) 9 -4175 by 7:00 P.M. for an insp- ion neede• the next b. rn- -yam
CITY OF TIGARD Plumbing Permit Application Plan c ��-
j31'25'SW HALL BLVD. Commercial and Residential Rec'd Ii j,
E IGARD, OR 97223 Date Rec'd 5--1-6240 (503) 639 -4171 Date to P.E.
Print Or Type Date to DV '--
Incomplete or illegible applications will not be Krited Permit # /!B -00 /4/5
Related SWR #
j ( A
Called •
Name of Development/Project FIXTURES: =.(i "' "'' °"'"
�,� , .. �. , ndividualh ° ' " "`` ° ;,, -:i ND 'S .: -, ,RICE-, .:AMT °::‘
Job Sink 11.50
Address Street Address Suite Lavatory 11.50
1 Jr`'I - 1 3 So `I M U rt* # ' Tub or Tub /Shower Comb. 11.50
Bldg # City/State I Zip Shower Only
1 \ Ct a (OA Y 11.50
Name Water Closet/Urinal (Specify) 11.50
k leyfvnC f, n\LholS Dishwasher 11.50
Owner Mailing Address 1 � Suite • Garbage Disposal . 11.50
t 5% 1 R s 114 Li - 1 -1 Washing Machine /Laundry Tray (Specify) 11.50
City /State Zi _ Phone
(' � )
Cte 0 • l l 3 9 3 7a I Floor Drain /Floor Sink 2" 11.50
Name l 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater 0 conversion EKTike kind / 11.50 11 57)
Gas piping requires a separate mechanical permit.
City /State Zip Phone MFG Home New Water Service 28.00
MFG Home New San /Storm Sewer 28.00
Name, q
Id,t �Dtf` l
Hose Bibs 11.50
�P�11�t��
Contractor Mailing p Ad res Suite - Rain Drains 11.50
19 O S� � - ( a (m nC n Drinking Fountain 11.50
Prior to permit Cit /State Zip Ph Other (Specify) one Oth Fixtures (Sify) 15.00
issuance, a copy . 4- 04 �1 c0 5 ,�/�-3 , 5 5 3 r5
of all licenses are Oregon Const. Cont. oard Lic.# p. Date
required if d CA,413 ' j 48 , 0 3
expired in COT Plumbing Lic. # Exp. Date
database 3t --L\- Po 6,3 ,OCR , .
Name Sewer- 1st 100' 38.00
Architect Sewer - each additional 100' 32.00
or Mailing Address Suite Water Service - 1st 100' 38.00
Engineer City/State Zip Phone Water Service - each additional 200' 32.00
Storm & Rain Drain - 1st 100' 38.00
Describe work to be done: � Storm & Rain Drain - each additional 100' 32.00
`
New 0 Repair 0 Replace with like kind: Yes C No 0 Commercial Back Flow Prevention Device 32.00
Residential 0 Commercial 0 Residential Backflow Prevention Device` 19.00
Additional description of work:
i Cl-L.0-_, CO \ / fry Catch of Existing 50.00
V Q f
1 f `� Insp. of Existing Plumbing 50.00
Are you capping, moving or replacing any fixtures? per/hr
Yes 0 No 0 Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by per /hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL }•; , e ='"
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 �,;�,°�*. -< '�i:;ta;:H;t
that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL `'± '° 1'
• Signature of Owner /Agent Date `°,;= -- R, _ _=
7% SURCHARGE , Fm!.;„ ; : " 4 DC
Contact Pe on Name I( ` Phone - == . F °' w
re(i P- ek ,5 * *PLAN REVIEW 25% OF SUBTOTAL £ %' 4 "'. ==^V`i
_ R' - ,�; ; : - c; Required only if fixture qty. total is > 9 : `
1'E "Bi4TH,H0tJ E�=� T ,,'� °�`�;�
5....1 $, c" 9 Y qY
ax:�
2'i3AT1iHOUSE$250. - , .,;: T OTAL ; ` , s . ,•
1S ,7"H HOUSE = 5285.00'" '` _ . ,, � �' =-
IjThis<fe I ncludes II Plan fix *4 in t dwelling and =the4iirst, C
" - Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
IOD,feet ofssanita :sewer=stia sewer and?;wafsr <service ;, e - p s
`' " Device, which is $25 + 7 % surcharge
"`All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I: \d st s \forms \p l u m a p p. d oc 7/19/99
PLEASE COMPLETE:
T1 by WF afrdT
ricopwii '!IVOteelr 601001 6dielii Oa:
2
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:
1:1dsts Vorms1plumapp doc 7/19/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Requested l, � / I I fir ) AM PM !� BLD
Location J L.7 11 X8'1 ( 64' Suite T T MEC
Contact Person C )It ( ,AA/ Ph /Ai 2 — ciRr PLM 1O (Y"? �Od
Contractor /� __ Ph SWR
BUILDING Tenant /Owner ( 1 if�,e.,{�1A,..., -- ELC
Retaining Wall `� f _ ELR
Footing • ^:,?"'.�(- �i ;v l ra`` � ( ` Z f 2'�L 1� �'i�3.'� -'i`' ' i.-.. .o..c� -
Foundation Rit;''�.� =� ^
.�� � FPS
Ftg Drain r_ �b l A l �cs>..Q•�c:*�' :. - � y ;S�w` ° :" ` `t`zL ! =�t t�' %.
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing •
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof •
Misc: ^ D
Final / M/0-77
PASS
PASS PART FAIL
LU /
BING (�G
Post & Beam / !
Under Slab
Top Out
Water Service
Sanitary Sewer
RaiQ Drains
Fin
C —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
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk �� � � 1 n/Y)
Other Date, 1 1 / 6 t' Inspector ' /1 Ext Fial �:
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.