Permit A CITY
OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES
PERMIT #: 0 -00291
818100
DATE ISSUED: 8/8100
- '' J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11330 SW IRONWOOD LP PARCEL: 1S134AB-01000
SUBDIVISION: ENGLEWOOD ZONING: R -4.5
BLOCK: LOT: 009 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: Installation of backflow prevention device. No electrical permit required for controller.
FEES
Owner:
Type By Date Amount Receipt
SIMNITT, N KNOL + ANGELA S J PRMT RCP 8/8/00 $25.00
11330 SW IRONWOOD LOOP 5PCT RCP 8/8/00 $2.00
TIGARD, OR 97223
Total $27.00
Phone 1:
Contractor:
REQUIRED INSPECTIONS
Phone 1: RP /Backflow Preventer
Reg #:
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
// • � '
Issued By: / /L.� Permittee Signature: p
Call (5' 3) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
,
CITYOIrr'TIGARD Plumbing Permit Application Plan Check
13125 SW HALL BLVD. Commercial and Residential . /'/ Recd By
TIGARD, OR 97223 \ l� Date Rec'd
(503) 639 -4171 / Date to P.E.
- Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit#
Related SWR #
Called
Name of Development/Project !FIXTURE$ individual 5 %-, R "° ``r' �;QTYY�^ "PRICE:° ; AMT„
�
Job Sink 11.50
Address Street Address Suite Lavatory 11.50
Tub or Tub /Shower Comb. 11.50
Bldg # City/State Zip Shower Only 11.50
Water Closet 11.50
�Na
v \ i \cNO, c)\ �Y> At Urinal 11.50
Owner Mailing Addre s Suite Dishwasher 11.50
t(330 SIA) Zr0hW000,
l,� •
City /State 1 Phone Garbage Disposal 11.50
N am d - 5 - l q q l ^o15 Laundry Tray 11.50
� Washing Machine /Laundry Tray 11.50
Floor Drain /Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00
Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database '
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 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential X Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* f 19.00 / :,.;7)
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No O 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
I hereby acknowledge that I have read this application, that the information' " " `x y > <`.
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 r ,
that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL '- ;.q ?.` °°°
Signature of Owner /Agent Date u 1
8/o SURCHARGE .<<,; ,, os 0-7
Contact Person Name Phone .,,.,;.
* *PLAN REVIEW 25% OF SUBTOTAL " � "cx,'•,4 ,°;'
if d only R
„ equrey fixture qty. ,', = ,.
1 BATH>HOUSE`s178 OU ;: 'r,;i t total is > 9 ' x ; r ., ,, ,
Z BATH HOUSE x $250 OD - n TOTAL f ' 03 )
BATH HOUSE s285.O :-
t (This fee IaClttdesx l' iumbrng iy u i' etiing the fitat� : 5 *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
.:d � Vi a, :
$1t10 #@Praf BIlit8 / iegeikS#ACnt 8 :- 8t S „ Device, which is $25 + 8% surcharge
"'All New Commercial Buildings require plans with isometric or riser diagram and
- plan review.
l: \dsts \forms\plumapp.doc 11/18/99
J
4 . 1;
•
PLEASE COMPLETE:
j. ' vr7 ," ;a:4W 1 !- - ZCS6 ;,SIC7r; ."&" , • „C1
V,Z-P4 . AirjiCtLi re
ITARNiiiiik: IrMtive-ori
: ' 1 4e ,54 4
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: \ dsts\forrnskplumapp doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP
�l! P Date Requested _ AM /�PM BLD
Location // . 3 0 'mot/ --/ 1' c Suite ME
Contact Person Ph LM e-6 40 q /
Contractor Ph SWR
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
P PART FAIL
LGMBIN
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rai Drain ,
PART FAIL
M_CHANICAL
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 Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA 0961a
Approach /Sidewalk Date Inspector \✓ ( -/�'�— Ex
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
"l4 3Z- -' Date Requested 532 AM PM BLD
Location / X33 0 5 w yr u)O /d (43ety) Suite MEC
Contact Person Ph PLM o7 ' - 0oc f
Contractor Ph SWR
BUILDING ' -_ ; `.: /! 1 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 ! ✓ . ! �� _AA/
Fire Alarm
Susp'd Ceiling 1. - _ j 1 _
Roof /
Misc:
Final
PASS PART FAIL
cG G
Post & Beam
Under Slab /77zel je
Top Out
Water Service
Sanitary Sewer
Rain Drains. fi
PASS PART
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 Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date r! d Inspector /�� , Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.