Permit 4 C ITY OF TIGARD PLUMBING PERMIT
4, DEVELOPMENT SERVICES PERMIT #: PLM1999 -00446
f l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/29/1999
awl w W
SITE ADDRESS: 13265 SW HOWARD DR PARCEL: 2S103CA -00700
SUBDIVISION: WOODCREST ZONING: R -4.5
BLOCK: LOT: 014 JURISDICTION: URB
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: 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: Water heater conversion
FEES
Owner:
Type By Date Amount Receipt
ROSE, DAVID & CHRISTIE PRM4 BON 12/29/199 $50.00 99- 320741
13265 SW HOWARD DR 5PC2 BON 12/29/199 $4.00 99- 320741
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
JACOBS HEATING +A/C INC
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 234 -7331 Misc. Inspection
Reg #: LIC 1441 Final Inspection
PLM 26 -548PB
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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: 6, Permittee Signature: 0017 Q lu7d1ll7A - Wdri
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
131,25.SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 RECF "4ED Date Rec'd lL Z ' `l- 1
(503) 639 -4171 Date to P.E.
qqqqqq Print or Type Date to DS
Ihdo ileWor illegible applications will not be accepted Permit# t M( 1 `f`fCP
Related SWR #
-inmUNITY DEVELOPMEIN Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Street Address D Site Lavatory 11.50
1 . tc'3 StSt.) V 3 o , ' k Tub or Tub /Shower Comb. 11.50
Bldg # City /State -� � pp Zip Shower Only - 11.50
Name Water Closet 11.50
C,t0 ■ 3 q, ckil ri5ih 42_ e_C._ Dishwasher 11.50
Owner Mailing Address p Suite Garbage Disposal 11.50
13, "C)L � IC9 Washing Machine 11.50
. 2 r/State P Zip Phone
t t C,eGV1C k. (2)(4- c 'I 7 .3 579 -OYSI Floor Drain /Floor Sink 2" 11.50
Name 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater Si-conversion 0 like kind 11.50 , I
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 11.50
Urinal 11.50
Name Other Fixtures (Specify) 15.00
Contractor Mailing Address - St
- 4 / 4- 17ki, .St_rn,1wc.LAA.c
Prior to permit ty /St e Zip P��iione , Sewer - 1st 100' 38.00
issuance, a copy U (L- CI 1 .0 ? a?3H -1
Sewer - each additional 100' 32.00
of all licenses are Oreg�Cop j. Cont. Board Lic.# Exp. Date
required if 1J I Water Service - 1st 100' 38.00
expired in COT Plumbing Lic. # ,v P3 Exp. Date Water Service - each additional 200' 32.00
database alC - "4 D ( 3 Storm & Rain Drain - 1st 100' 38.00
Name Storm & Rain Drain - each additional 100' 32.00
Architect Mobile Home Space 32.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 32.00
Pollution Device
Engineer City/State Zip Phone Residential Backflow Prevention Device* 19.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes Q No 0 Any Trap or Waste Not Connected to a Fixture 11.50
Residential ' Commercial 0 Catch Basin 11.50
Additional description �ofwork:
��_� 4 t � � eJ-Qi \ Insp. of Existing Plumbing 50.00
t per /hr
Are you capping, moving or replacing any fixtures? Specially Requested Inspections 50.00 r
r
Yes 0 No CiC Rain Drain, single family dwelling 45.00
If yes, see back of form to indicate work performed by Grease Traps 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 - 5
given is correct, that I am the owner or authorized agent of the owner, and
that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL 2
Signature nOwner/Agent
( Ct p tp�e ! -5% SURCHARGE " c
Coont t rl r t w Name LP hh on ne * *PLAN REVIEW 25% OF SUBTOTAL
t' Y Q_ VG .,,Q c ( l Vt ‘,.__,,./_--/..s...5) Required only if fixture qty. total is > 9
;BATH:HOI $8117800 ,a : s'- TOTAL
°BATH HOUSE $250.00 ,. 1'
'BATH HOUSE $285.00 , : g ., * * Minimum permit fee is $50 + 5% surcharge, except Residential Backflow
, , his fee includes all plumbing fixtures in the dwelling and "1, 8fi : ,, Prevention Device, which is $25 + 5% surcharge
p0 feet of sanitary sewer storm sewer and water service) '- * *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I: \dsts \form s\plumapp.doc 6/2/99
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:\dsts \forth s\plumapp. doc 6/2/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Requested / / AM PM 1-3 BLD
Location /,3 Z (' Suite t / 9 9 - 5 7 3
Contact Person Ph LM
Contractor Ph SWR
BUILDING T•magtiatiar &CJ - art �� ` L �G0 - 660 0
Retaining Wall 0q,-2 — 3 7 ,'/ i 64! ,c7 1 - 6 ?S /) ELR
Footing
Foundation Qacc Z / 2 n2. FPS
Ftg Drain
Crawl Drain Inspection Notes: ,�_ t
SGN
Slab tJJ SIT
Post & Beam /
Ext Sheath /Shear 72i- ) ,�, !1./l. -DYVt
Int Sheath /Shear
Framing ! 3
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS P RT FAIL
cLUMBIN
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
• I rains
1 P • r FAIL
!T HANICALJ
Post & Beam
Rough In
Gas Line
Smoke Dampers
arxn.
• • zT FAIL
ECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
lY 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 7, Inspector j C� r Ext
Final l
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.