Permit . 1 -
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A CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2000 -00293
A!I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 10135 SW INEZ ST PARCEL: 2S111BC -00700
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: U GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 100' OF SEWER LINE
FEES
Owner:
Type By Date Amount Receipt
HALL, JANET M PRMT RCP 8/9/00 $50.00 0004373
10135 SW INEZ 5PCT RCP 8/9/00 $4.00 0004373
TIGARD, OR 97224
Total $54.00
Phone 1:
Contractor:
MICHAEL + CO PLUMBING
P O BOX 23008
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone 1: 639 -3189 Sewer Inspection
Reg #: LIC 000678
PLM 26 -333PB
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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 callin (503) 246 -1987.
Issued By: T p Permittee Signature: G
Call (5 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing .Permit Application Plan Check#
131' 5':SW HALL BLVD. Commercial and Residential Rec'd By 9772
TIGARD, OR 97223 Date Rec'd 91
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
- Incomplete or illegible applications will not be accepted Permit /'��I . G y 2ro��D°�`f?
Related SWR # 0 � 000).
- Called
Name of Development/Project 'FIXTURES, (individual)' ` M'' I :, Ami Itt9,9P, AMT ;
Job Sink 11.50
Address Street Address Suite Lavatory 11.50
j 3 13" S A e _ Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip Shower Only 11.50
Name Water Closet 11.50
JO" ( ( %c, t(... Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
10134" Sus Xne 2.. Garbage Disposal 11.50
City /State Zip Phone
' Laundry Tray 11.50
T creel t t)'r Gi 1 1-1-4 to3 - 403 t�
Name Washing Machine 11.50
AG'-e 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.
te. f e 1 d '0V4.0%.60- et MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00
VID CIO% 0300 P Hose Bibs 11.50
Prior to permit - City /State Zip Phone (; Roof Drains 11.50
issuance, a copy 1 c�jo+� t r C, Zf I 631-316# 1
e " Drinking Fountain 11.50
of all licenses are Or gon Const. Cont. Board Lic.# Exp. Date
required if tr. -')& 7 Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database '''. (o - 333 " 1
Name
Architect Sewer - 1st 100' I 38.00 q g e_
O 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 et Replace with like kind: Yes ® No 0 Storm & Rain Drain - each additional 100' • 32.00
Residential <,_ Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* 19.00
Catch Basin 11.50
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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. e.
I hereby acknowledge that I have read this application, that the information q Quantity QUANTITY TOTAL s ; ;, ;
Isometric or riser diagram is required if Quantit Total is > 9 t y' "
given is correct, that I am the owner or authorized agent of the owner, and - *SUBTOTAL �" ` -;' ' ^' '� "
, `.` 00 that plans submitted are in compliance with Oregon State Laws. ;, . _ ° , F
S i re f Owner /A 9 en . gate/ t,„
,
u..-{ 4 � -4 . y (3 8% SURCHARGE , a te _ � '- �� C ` I
r , e , , %
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Co i Name Phone i F'
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„� tie �o,r\e'S La 31 F9 'PLAN REVIEW 25% F SUBTOTAL
.. v , . ,.. , 7 :-!.; Required red o y fixture qty. total is 9 P
r� �� 31 a ui only if a t > O : :-� ` "� u �.:
1 B FIt3tlSE1:.:.00 ` Mil;;,: TOTAL � .. , . �,�;,:,,
BA'ri�IiOtl56 5250 s � � � f `' � -�
It{ Thy U a I: ; Ium to =th6 ,,_ lItng'an 1IIB mo % surcharge, except Residential Backflow Prevention
av "CI ,�a ?� �° . � .. . dew c�, y,: =� � ^- i�r'"� � � s , `Minimum permit fee is $50 + 8
0007:- � l3Att4 . M B 0 tQ 8,9W8�di1t 1N,040r1f�C0 . s ;: Device, which is $25 + 8 / surcharge
**All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I: \dsts \forms\plumapp.doc 12/17/99
PLEASE COMPLETE:
r;
anti � b Wor
k 111,'
f
laced;: ed
sNew' � Moved .`Re " Re moved /Ca
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
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s
I:\dsts \forms\plumapp.doc 12/17/99
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NO CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 m�
/ BUP •
Date Requested d' 9 AM PM / f BLD
Location / G / 3 J s4, -1 r P 7- Suite MEC
Contact Person Ph &3 % ) / PLM
Contractor Ph SWR
BUILDINGP° u$.0 : ff .. Tenant/Owner P7,OG,k' O&% - 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 { �� f � I �/
Susp'd Ceiling 51(') b ' " `� .n actEa t
Roof
Misc:
Final
pASS PART FAIL
PLUMB 6
Pro & Beam
Under Slab
Top Out
Water Service
amanita Sewer
Rain Drains
Final
PASS O FAIL
MECHA
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 - 0 d
Other Date / U Inspector - aril •/ Ext
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
/
Date Requested r' ( AM PM BLD
i
Location /0( -, 5 'V ( �7 .P - Suite ME
Contact Person Ph ' 93 - • LM Anvv -4/0 93
Contractor Ph 42D1,2-000 — 0C
BUILDING, 3 ,. ° ' `3q' # ` , Tenant/Owner ELC
Retaining Wall ELR •
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain InspAg @t']/Notes: /j c Q
Slab /'� �
SIT
Post & Beam
Ext Sheath /Shear
•
Int Sheath /Shear
Framing ! _ r A — , • `
■ Insulation •
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _,
Roof I
Misc:
Final
PASS PART FAIL
MBING r\15$177
Puat eam
Under Slab
Top Out
Water Service •
(Sanitary Sew
Rain Drains
Fin.
PART FAIL
HANICAL
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
Other Date a t> Inspector Ex;
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.