Permit T CITY OF TIGARD PLUMBING PERMIT
{ i; DEVELOPMENT SERVICES PERMIT #: PLM2000 -00289
f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/3/00
SITE ADDRESS: 16350 SW KING CHARLES AVE PARCEL: 2S115B6 06200
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: OTR 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: Installation of gas water heater.
FEES
Owner:
Type By Date Amount Receipt
WARREN, ROSS W + SHIRLEY. C PRMT DEB 8/3/00 $50.00 KING CITY
16350 SW KING CHARLES AVE 5PCT DEB 8/3/00 $4.00 KING CITY
KING CITY, OR 97224
Total $54.00
Phone 1:
Contractor:
T & K MECHANICAL
20565 SW TV HWY #346
ALOHA, OR 97006 REQUIRED INSPECTIONS
Phone 1: 09/30/00 Top -out Insp
Reg #: LIC 121165 Final Inspection
PLM 34 -319PB •
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may ht ,in copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued y: _ —I !i�� -� �� Permittee Signature:
-- Call (503) 639 -4175 by 7 :00 P.M. for an inspection needed the • • usiness day
•
AUG -03 -00 THU 11:34 AM City of King City FAX:503 639 3771 PAGE 3
CITY OF TIGARD Plumbing Permit Application . Check#
13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Reed b - 3 -CO
(503) 639 -4171 Date to P.E.
Print or Type Date to DST S- 3 -0a
Incomplete or illegible applications will not be accepted Permits Ptf1 09o�
Related SWR #
Called.
Name of Development/Project i d )`'� ; , Q RICE;1
1 ua �..;<. ;�? ,, AMT:
Job ; Sink 11.50
Address Street Address Suite Lavatory 11.50
t ro SO 5J Ke? c-HeNr E S A ye Tub or Tub /Shower Comb. 11.50
1 Bldg # ,, City /Stf[e Zip Shower Only 11.50
Y - ��" rit>P 7 water Closet 11.50
Name
12 Q$. We. rre."l Urinal , 11.50
Owner Malting Address Suite • Dishwasher 11.50 •
(6357." t.../ co G�r co �vr Garbage Disposal 11.50
City/State _ i Zi z. y 9G � Z # Laundry Tray 11.50 ^��
Name 2 Washing Machine /Lau Tray 11.50
sal Floor Drain/Floor Sink 2" 11,50
Occupant Mailing Address Suite 3' 11.50 '
4" 11.50
City /State Zip Phone
Water Heater- 'conversion 0 like kind ) 11.50
Nam _ Gas piping requires a separate mechanical permit. 1 J
T ' J rn � e . MFG Home New Wafet Service 32.00
Contractor . Malting Address Suite MFG Home New San/Storm Sewer 32.00 •
7 706 5 Lf 7// W >d fr79 . Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
Issuance, a copy r <9 . /' 9�Oe9� 3 yL /�
< b Drinking Fountain 11.50
of all licenses are regon Coset. Cont. Board Licit Exp. Date
required if 12 116.,,5 f0 ( Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp Date
database , y 3 � - - 00 .
Name q.3v -0°
V
Arc hitect Sewer - 1st 100' 3$M0
- 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 �No 0 Storm & Rain Drain - each additional 100' 32.00
Residential Commercial 0
Additional description of work; "-'- Commercial Sack Flow Prevention Device 32.00
1-1.C--/ • Residential Backflow Prevention Device' 19.00
� i J. ... r &'AS �i2 / f J .-►� Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No / 1*-- 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 s
given is correct, that l am the owner or authorized agent of the owner, and *SUBTOTAL ..;
that plans submitted are in compliance with Oregon State Laws.
Signature of Owner /Agent Date .
SURCHARGE . •
,«'-:c =arson fi9Filo Phono "'PLAN REVIEW 25% OF SUBTOTAL ''
M d aw �' 'x ".' ^ . s - ; �
t *xur... "r, Required only If fixture qty. total Is a 0
1 R 9 ? 7
'1c0:,',.j;. ,p ;air , t?%',r ,ya, Y� " /. d:_,`'d ^ph;.:a',' i P =
. -•.��' ;! ,i,!,. �'�il.,l ",��.., .w.. .,(�3:p`�'r. )40,4:'
•:.I�,��, a � 9: � ' .b� i�+' ..� . �. #..��.'ti r,.rrt• , ::5 , ,:7�,. ?� �r:t':'.c!t:,.�<, TOTAL
�y �y (j�11, C .y`�f t .n i 'AXE. , {ii . {;.�.:; d s , : , , J.,:. ;: P„ r.,!+'„5''!;i;�'� �. . ?.� M
� :.A7't:lt 143 i 1 0 {']_G� � i 1. r.N..�. ..:p.t�.. ::,�::� �1 .)_ ,.Mr: .i .. ��1- �'��''.x A!
:: . ti t l,`y1 v Y „!N_'! � a.. ,.��,h i�.'ir.nf; ?;V' �t4 yAr „.,� J
;.Q BA `�e , 0,0S ob„ :'tl,(F'.F`S M y.M i. .d { R 7 °�� rl.1 .. . 4 ' h:., ,";�9- h+yf��' .
�.- � .�,��l ,1. ( 'd V .4 ., "�:1:1 �. �Yrl , - J'. .': ? .:. ; :� �';;, ;., ■'�
ii jj rl: oxhide iiil(j; . 1.Ttt . iieo , liti yYAli l 1; O; fffi(t tz- 0 ,, 'Minimum - permit fee.e $50_r_8%. surcharge, - except Residential .Backflow_P_re_vention
'160` 'f 11 Ptr t' 5,.� r an t ..40,tPF�, &. rit li u'vet Oovice, which Is $25 Ai 8% surcharge •
"All New Commercial Buildings require plans with isometric or riser diagram and
_ • plan review,
ccst,vor o piumapp.doc 1 1n599 •
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 8 14-1 6o AM PM BLD
Location 1(035 e. 42C6s Suite MEC
Contact Person Ph PLM 2e — (
Contractor Ph SWR
BUILDING - . ° 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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
•A PART FAIL
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 V / Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.