Permit tp I,
SEE
CITY TIGARD PLUMBING PERMIT
�I DEVELOPMENT SERVICES PERMIT #: PLM2000 -00003
` VI I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/06/2000
SITE ADDRESS: 10530 SW JOHNSON ST PARCEL: 2S103AA 01915
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 014 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1st 100' of sewer line
FEES
Owner:
Type By Date Amount Receipt
LAMBERT, ROBERT A PRMT BON 01/06/200C $50.00 00- 320951
10530 SW JOHNSON ST 5PCT BON 01/06/200C $4.00 00- 320951
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone 1: 939 -5246 Sewer Inspection
Reg #: LIC 110314
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: , V " V�L Permittee Signature: t
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Chec #
131'2 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd i - 10 - 1000
(503) 639 -4171 Date to P.E.
Print or Type • Date to DST
Incomplete or illegible applications will not be accepted Permit# 04112412
Related SWR #
Called
Name of Development/Project 1 FIXTURES= (individual) " * -' , " "" ;-CM.,;::;; PRICER AMT:4,i
e..a.�;� :n+n"xa ,.,xr.:...x, „ . w_ . �, i"5 -r % ... .... ..,, „ s ue: .zw ;�- , >r+:�r,,
JOI) Sink 11.50
Address Street Address Suite Lavatory 11.50
453o o -, i • ttstiv Tub or Tub /Shower Comb. 11.50
Bldg # City /Sta Zip Shower Only 11.50
'� ' ' �' Water Closet 11.50
Nam ( /�
S * \7Se1. t 42,c-•A‘yAk- Urinal 11.50
Owner Mailing Address Si Suite Dishwasher 11.50
1057;1) W Aointhst 4 Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Na 7 � r Washing Machine 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.
1 Yb MG )3Yi $)R.‘AQC IA XCtIAL MFG Home New Water Service 32.00
Contractor Mailing Address 7 Suite L MFG Home New San /Storm Sewer 32.00
W-12%* Na 5 C i9*AL Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy \) t
Drinking Fountain 11.50
of all licenses are Oregon Conet. Cont. Board Lic.# Exp. Date
required if '1\0 , V 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' 9 32.00
C ity /State Zip Phone Water Service - 1st 100' 38.00_
Engineer Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New ' Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Resid ntial tX Commercial 0 Commercial Back Flow Prevention Device 32.00
Additional description of work:
Residential Backflow Prevention Device* 19.00
C r) tMAc C C 7 Af qjc. axen l e__ Catch Basin 11.50
Are you 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 ` ''" °:'
,.
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 %; -; '= „R.' <' ° ° ' ' %F %-i'
., � .>
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 „ ;. ; ; _1k ° 5 , a'
Si of Owner /A9g Date o . .`'"' „, `3'
V ` MC-6P �� 8 /o SURCHARGE °
erson Name Phone "`
Con
eHO C tCr$ 939 s i4 r * *PLAN REVIEW 25% OF SUBTOTAL 3 ; a;;�; - '
g r ,. Required only if fixture qty. total is > 9
9 Mr4 HOt35E.S,178 00 r r TOTAL
.A o>iw �z -Li t o
4 'HaI1S 285 A
s fee odes atI plumbing fixtures in the elltng and a flt8t�. *Minimum permit fee is $50 +8% surcharge, except Residential Backflow Prevention
. 7 _04 6 464a S8 @ StOtYrt 8eSN8 altif Wd� i On.6 B} . Device, which is $25 + 8% surcharge
**All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:\dsts\forms\plumapp.doc 12/17/99
PLEASE COMPLETE:
14, c2-Nti; I'1 wi
, 21,29,04 e
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 \forms \ptumapp.doc 12/17/99
i
CITY OF TIGARD BUILDING INSPECTION. DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
,, / BUP
Date Requested t ! C AM x PM BLD
Location t' 2C) 5d 1 S V �.. sT Suite _ MEC
Contact Person Ss-LeA1-•--. Ph 9''7 -s 4 ,0 ppi/21=esi,
Contractor Ph SWR ii CX
BUILDING, r ; , '',, Tenant/Owner ELC lq 1 l ,,,x/13
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 •. / 1.----
Fire Alarm 4 `4/ / r Susp'd Ceiling WW..- �_ �
Roof
Misc: - � r
Final /L .d // fi l�Af/ /, Al , ,
PASS PART FAIL
ett1MBTRF3h
Post & Beam d /„ J i ,,,,, /7
Under Slab r e L' Ataid`'l tii�/ x� .�
Top Out k � $ f /—
Water Service f—'
+a Sew / fr
R. Drains �� �/
PART FAIL I
HANICAL
Post & Beam
Rough In
Gas Line Smoke Dampers ` J &o �9 /7 L
PASS PART FAIL
()"(
ELECTRICAL
Service
Rough In
, ((...
L V b
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 6 Inspector �/
' j� Ext ,?'
Other
Final
PASS PART FAIL DO OT REMOVE this inspection record from the job site.