Permit " CITY OF TIGARD PLUMBING PERMIT
�I DEVELOPMENT SERVICES PERMIT #: PLM1999 -00420
§ - I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 10490 SW JOHNSON ST PARCEL: 2S103AA -01914
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 015 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: Sewer line to connect
FEES
Owner:
Type By Date Amount Receipt
BADGER, QUENTIN J EUNICE PRMT BON 12/10/199. $50.00 99- 320338
10490 SW JOHNSON ST 5PCT BON 12/10/199 $4.00 99- 320338
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone t 939-5246 Sewer Inspection
Reg #: LIC 110314 Final Inspection
ORIGINAL
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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.
`
B A�'' s
Issued By: . f � �•CL�' � Permittee Signature: 1 �
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��
13125 ,W I1,iALL BLVD. Commercial and Residential Rec'd By tJ
TIGARD, OR 97223 Date Rec'd ll
(503) 639 -4171 Date to P.E.
Print or Type Date to DST �""���
Incomplete or illegible applications will not be accepted Permit# �t (�t� 1
Related SWR #
`X0 q -D2-0(.. r Called
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{
Name of Development/Project ._ <;;;,w,: .PRICE ; ; AMT„
Job _ Sink 11.50 UPro ect FIXTURES >(itidividu `M•, ,. ;, , . QTY
; ".., . .
Address Street Address Suite Lavatory 11.50
I 6 w 90 SUL) cy6srti, Tub or Tub /Shower Comb. 11.50
Bldg • City /State ,
` ' ,` r Zip Shower Only 11.50 NreljOt•-k Name '� C� U Water Closet/Urinal (Specify) 11.50
C_ ;
\ S Dishwasher 11.50
Owner Mailin g Address Suite Urinal • 11.50
• S -V•-tic Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Name Washing Machine /Laundry Tray (Specify) 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.
�iD isK-t) f OR 1 N CT ° I" bX C- IN C..-
MFG Home New Water Service 28.00
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 28.00
1 t, 7 $ N. 5C-4-0/1:1`t_ Hose Bibs 11.50
Prior to permit City/ State Zip Phone Roof Drains 11.50 '
issuance, a copy 0 R G' rmo Drinking Fountain 11.50
of all licenses are Oregon Coast. Cont. Board Lic.# Exp. Date -
required if t l O 3+
Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database
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Name
Architect Sewer- 1st 100' I 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
Describ work to be done: Storm & Rain Drain - 1st 100' 38.00
New Re air 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Res' ential Commercial 0
Additional d scription of work: Commercial Back Flow Prevention Device 32.00
` Residential Backflow Prevention Device* 19.00
v.v\� ,_, li c mes -V7 5 -- D et --\-y 5'r tA)4IZ Catch Basin 11.50
Are you capping, moving or replacing any fi»((tures? 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•
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 rti ' :
that plans submitted are in compliance with Oregon State Laws. SUBTOTAL :,: ., ,' $ - `,-` a0
Signature of Owner /Agent Date '' l % N ig: , v '
8% SURCHARGE : Viif3!'A ` e
Con _c Person Name Phone I , 4: r
�/ * *PLAN REVIEW 25% OF SUBTOTAL ! ; \; `��':a
�" SATI y � ; . Required only if qty. total is > 9 Via,; : : :' ;:
=1 zl VE: 17800" ° T -; �: g. -A ' : .. =t M•
�..,,.
,,�. � � <:, �° ��';;�� °� s;'> - i �° Qi TOTAL ', y(�
'' E �$250 :00 =- = -.. si
a� > '� � x �'.z, �a < „ ° .,.. ,.,,.yµ��
Th a 5�
RArH�MOUSE 285A0 -4 ,rti =; - ail-'`.''
r,,t inciudes tutnbi'n '*tures;.ln;the dwel a nd the r
fi _-, . o
„ y ,,,,,� ",,y , . ",�(>' .. , k F• 9: ,..;,.�,• ' , , r . *Minimum penult fee is $50 + 8 /o surcharge, except Residential Backflow Prevention
100 feetflo# sanitary s6wer 500.1, :0 a ii Wd 58NICe) , 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 10/1/99 • - • -
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PLEASE COMPLETE:
1:411'
' W?:ciNeriv1M, TO164-6 ROTiql*ji Ilkftli0,$0
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Floor Sink 2"
3 „
4 "
Water'Heater .
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1:1cIsts \forms \plumapp.doc 10/1/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24- Houlnspection Line: 639 -4175 Business Line: 639 -4171
/ I
if BUP
(d7
Date Requested (`ft q9 AM /d'-PM BLD
Location /0 $9v ( U l u ► �S s� S Suite >14 1 q 'iq- 00 q,
Contact Person /''r Q- b. / Ph 3 •"‘S --L1 . ,( °
Contractor Ph SWR I49 — O 00 /
BUILDING: ".` - Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation nieseCiai I FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear V/ �, _ ( L c
Framing Y(_,,I(,��1�) �Jl/v� '"C�� /V `l
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
LUMBING n.rsaK % ,•.:
Est & Be� 644/
Under Slab ry
Top Out -4'+ r>>���QQ
Water Service k,�..vyt..''
anitary ill 5 _ _ L e
Rain Drains ��T�
PAR FAIL
CHANICAL: a,,ro,
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
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 C,
Approach /Sidewalk (, l
Other Date l Insp ector �� `--- Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.. •