Permit - ., CITY OF TIGARD
PLUMBING PERMIT
X01 DEVELOPMENT SERVICES PERMIT #: PLM2000 - 00004
{ 13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/06/2000
SITE ADDRESS: 12975 SW BULL MOUNTAIN RD PARCEL: 2S109AA - 01100
SUBDIVISION: ZONING: R -
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 300 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace existing water service - 1st 100 ft + additional 200 ft as needed.
FEES
Owner:
Type By Date Amount Receipt
CHI DA NG PRMT KJP 01/06/200C $70.00 00- 320977
11006 SW 81ST
TIGARD, OR 97223 5PCT KJP 01/06/200C $5.60 00- 320977
Total $75.60
•
Phone 1: 503 - 539 -3208
Contractor:
KJ'S PLUMBING
PO BOX 230925
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone 1: 503-684-4431 Water Service Insp
Final Inspection
Reg #:
ORIGINAL
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 co ' s of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ext business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 � Date to P.E.
- ��'
Print or Type ' ` 5 Date to DST
Incom Incomplete or illegible applications will not be accepted Permit# 1�1-M 20cap -0000�
p 9 pp Related SWR #
Called
Name of Development/Project YFIXRURES (indiv dii I) ' ' >` ' QTY : :PRICE LO
Job Sink 11.50
Address Street Address �7 /i i y�� f . l Suite Lavatory 11.50
/297s 1 0// �RI Tub or Tub /Shower Comb. 11.50
Bld g # Ci tate Zip Shower Only 11.50
A g Ll OR " 9r 22 " Water Closet 11.50
Name h i J�j
14 Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50 it
1/ 00 to S, `✓ 8'/ Garbage Disposal 11.50
� j tiState Zip Phone Laundry Tray 11.50
/ 4 -.ems/ aR 9 7Z ZY 5-3c,....3 Zo F.
Washing Machine 11.50
6 C i - �1.7.), /Z-e Floor Drain /Floor Sink 2" 11.50
Occupant Mailing Address ( Suite 3" 11.50
`Z. 9 s ) 5 flu l If l/ 4" 11.50
• _ciiy/State Zip Phone Water Heater 0 conversion 0 like kind 11.50
//fao &/C 9 ZZ y Gas piping requires a separate mechanical permit.
e K / 1:2/0.4 I_ p ,t MFG Home New Water Service 32.00
Contractor Mailing d ess ' ude MFG Home New San/Storm Sewer 32:00
P clJ a g , k 4 _. Hose Bibs 11.50
Prior to permit City /State 4 Zip Phone Roof Drains 11.50
-'/ A
issuance, a copy ! r '7 7, 0 �✓ i 6 "q_ 7 / � 93, g
Drinkin Fountain 11.50
of all licenses are Qoegg n Con . Cont. Board Lic.# Exp. Date
required if / 33tz y' - /S°15"/ Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # - Z3 NL Exp. Date//-30
database _ 7g r� 4
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' No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
I � , t� rk f lam_
Residential Backflow Prevention Device* 19.00
1 CO L'L Q. )Li w e Catch Basin 11.50
Are ybu capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 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.
QUANTITY TOTAL ti
I .;
hereby acknowledge that I have read this application, that the information ,° - „;, •-
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required f Quantity Total is > 9 '
that plans submitted are in compli with Oregon State Laws. *SUBTOTAL h ; " ; °.; , ,', 4
Si /r of Owner /A en Date " � � ` , ,. E v �
/ - G -en 8% SURCHARGE .:`
Co - 'erson Na Phone .,,
**PLAN REVIEW 25% OF SUBTOTAL • -' ~ `;
q y qty. v:.,' '
Required only if fixture t total is > 9 1 = "3
' :`BATH HoWill 783PA .. TOTAL � /
BA- kt6 #k 2 00 ` k 1 / 0
� 3ATH HO F
°: h fee ittcludessatt.piumbing thCtures En th e wei and 0 *Minimum permit fee is $50 + 8% surcharge, except Residential Prevention
9� of S a111fAr jf 1 @wer " , wor and W�l rv . : ,, Device, which is $25 + 8°7° surcharge
,n,:a. ...M. r
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I: \dsts\forms\plumapp.doc 12/17/99
PLEASE COMPLETE:
;41
totw:: 4 4 RIced t 'J'Sgt"09"PdiCAPO-04'
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:\dstsforms\pJumappdoc 12/17/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 1 /l Q � AM x PM BLD
Location I �q S I1,t,f 7 tee ( Suite p MEC �1,,, 04
Contact Person ( _ Ph qK (�SZ,�(n �� co0
)
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
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Fi.
'd PART FAIL
HANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final J
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
Approach /Sidewalk _
Other Date _ ` - Inspector )7A Ext
Final
PASS PART FAIL D NOT REMOVE this inspection record from the job site.
•12/10/98 THU 16:57 FAX 503 681 3993 WASH CO. BLDG SERVICES l ]001
WASHINGTON COUNTY
`�; = :-,' =',,'1
_ _ _�� Building Services
t r FAX TRANSMITTAL
Send Fax To: _ _ _ _. _ f / 1 Fax # P 7 loe
r '
A ftn: dir .....,, -An... - /
Fax Transmitte • From:
Name: I 01]
4
Phone: i i - , r, / Ext:
Total number of pages (including cover) I / Date: ////0/91
91
Notes or Comments:
4 ,, L X4,30,(Z&L
„.... "Lu
/ 4.,z.)140
i c vi L id/ y
.s. ,bd" - } \A6-
Washington County
Land Use and Transportation
Building Services
155 N. 1st Av. 350 -12
Hillsboro, OR 97124
Fax Number 1- 503 -681 -3993
Note:. To avoid loss or misplacement, the Project number must be included on all
additional information sent to us for plan review.
If we have sent a fax and all pages do not arrive in legible form, please contact our
staff at (503) 640 -3470.
•
- 12/10/98 THU 16:57 FAX 503 681 3993 WASH CO. BLDG SERVICES 1 002
eermits Live ab Id: ACTP150 Keyword: UACT User; JENNIF 12/10/98
.Activity Maintenance - Inspection Processing Add. /Alter. Combination
Permit #: 05072772 Applicant: JURHS, THOMAS & JILL
Status: EXPIRED Address: 12975 SW BULL MT RD TI
Item Description Item Description
199 Final Building 405 Service
299 Final Plumbing 205 A Rough -In Plumbing
4.99 Final Electrical 201 Water Service
399 Final Mechanical 212 Storm Sewer
401 Temporary Service 203 Storm Drain Line
125 Set Backs 107 A Framing
105 A Footing 108 A Insulation
106 Foundation 111 A Wallboard Nailing
204 Plumbing Post & Beam 408 Hot Tub /Spa
109 A Structural Post & Beam 302 Gas Line
402 Underground Electric 304 Heating Appliance
207 Ground Work /Underground 307 Wood Stove /Fireplace
403 Cover & Service 208 Shower Pan
Select Inspection Item: 199
(E= Entries A r= Required Inspection n= ,Additional Notations recorded)
F1 =Add item F2 =Next F3 =First F5= Requests F6-Notations ENTER= Select ESC =Exit
'12/10/98 THU 16:58 FAX 503 681 3993 WASH CO. BLDG SERVICES Z003
Permits Live db Id: ACTP150 Keyword: UACT User: JENNIF 12/10/98
`At Maintenance - Inspection Processing Add. /Alter. Combination
Permit #: 05072772 Applicant: JURHS, THOMAS & JILL
Status: EXPIRED Address: 12975 SW BULL MT RD TI
Item Description Item Description
'208 'Shower Pan 411 Low Voltage Final
126 Special Inspection 137 Basement Slab
306 Rough -In Mechanical 138 Garage Slab
305 Mechanical Post & Beam 214 Backflow
116 Fire Wall 404 Cover
127 Shearwall Nailing 142 Rebar
128 Vapor Barrier 133 Roofing
135 A Exterior Sheathing
136 Waterproofing
206 Top Out
213 A Rain Drains
409 Low Voltage Cover
410 Low Voltage Underground
Select Inspection Item: 208
(E= Entries A= Approved r= Required Inspection n= Additional Notations recorded)
F1 =Add item F2-Next F3 =First F5= Requests F6= Notations ENTER - Select ESC =Exit
** End of list **