Permit CITY TIGARD PLUMBING PERMIT
t DEVELOPMENT SERVICES PERMIT #: PLM1999 - 00168
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 13543 SW LAUREN LN PARCEL: 2S104CA 02700
SUBDIVISION: HILLSHIRE ZONING: R -
BLOCK: LOT: 027 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Residential backflow prevention device
FEES
Owner:
Type By Date Amount Receipt
MOHSEN TORABI PRMT BON 5/25/99 $15.00 99- 315650
13543 SW LAUREN LN MISC ' BON 5/25/99 $0.75 99- 315650
TIGARD, OR 97223
Total $15.75
Phone 1: 524 - 5698
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: RP /Backflow Preventer
Reg #: Final Inspection
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: Permittee Signature:
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 SW,HALL BLVD. Commercial and Residential Rec'd By _
TIGARD, oh 97223 • Date Recd 5-2.5 i
(503) 6394171 Date to P.E.
Print or Type Date to D
Incomplete or illegible applications will not be accepted Permit#
Related SWR V - 090,61 #
Called
Name of Dev pmenUProje ' b °g"°" z'', - °
� � � <:F: > individual wR�, =�4TY -`�- ��PRICE
Job (3 5 - 3 3 tA1- L le_k `-' G Sink :v - 9.00 3.
Address Street Address - Suite Lavatory 9.00
Tub or Tub /Shower Comb. 9.00
-- Bldg # City /State Zip Shower Only 9.00
h A-1 Water Clos 9.00
Nary e
1 "`'� 4j", (1.( ---6 O t ' Dishwasher 9.00
Owner . dress_ / Suite / Garbage Disposal 9.00
c � ...SW '-A Aie r `� L " Washing Machine , - -9,11g. ,
Cit /State Zip Pon '
'T A� p \n 6\4 Floor Drain /Floor Sink 2" 9.00
Name J 3" 9.00
4" 9.00
Occupant Mailing Address - Suite Water Heater - 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray • 9.00
Urinal 9.00
Name
Other Fixtures (Specify) 9.00
Contractor Mat Ad ress Suite 9:00
9.00
Prior to permit City /State Zip Phone • • Sewer - 1st 100' 30.00
issuance, a copy • - - -
Sewer - - each additional 100' 25.00 -
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date --
required if Water Service - 1st 100' 30.00
expired -in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database Storm & Rain Drain - 1st-100' 30.00
_ Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
or Mailing Address Suite - Commercial Back Flow Prevention Device or Anti- _ 25.00
Pollution Device
Engineer City/State Zip _ Phone Residential Backflow Prevention Device* 15.00
(Irrigation timing devices require a separate ( / 5
Describe work to be done: - restricted_energy permit.) - -
z- -• r
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture - - 9.00
Residential 0 Commercial O Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
per/hr
Are you capping, moving or repll cing any fixtures? Rain Drain, single family dwelling 30.00
Yes 0 No : Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9 ' _ ' R F %
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL R;' °y--- - ; „' ,: :`` '` ` °'
I hereby acknowledge that I have read this application, that the information '1: L - 2-
given'is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE '`' _° 1s :f:" - r
that plans submitted are in compliance with Oregon State Laws. !NW1 4 „in ,(5
Si, nature of Owner /Agent Dat / f **PLAN REVIEW 25% OF SUBTOTAL :mss:' "4``° n='
, - j � �� I rl Required only if fixture qty. total is > 9 ray N, z
!! 1 TOTAL mss-°.
-, /t 7
Contact Person Name Phone • , � . %n % _ ,z ; t� �-- 1 '
__ _ ______ __ ___ __ - __ -_ _ _ __ ____ ___,__ *Minimum permitfee_is_$25 ±5 %surcharg except Residential_Backflow ___
Prevention Device, which is $15 + 5% surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
•
is dsts forms\plumapp.doc 11/30/98
PLEASE COMPLETE:
New Moved Replaced Removed/Capped
_ Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2"
3 „
. 4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
•
COMMENTS REGARDING ABOVE:
•
lAdsts forms1plumapp.doc 11/30/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
--,, 00 ��,, BUP
II
Date Requested 5 — (e — ! G / AM PM BLD
1
Location 3S4 3 LcuiltDA, Suite MEC
Contact Person 1 1OCecei Ph to 2P Z0 PLM 1 q (p 0
Contractor Ph 1 0 7-- (Sri SWR
pp! LD,IN,G = Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
r SGN
Crawl Drain Inspection Notes:
Slab S � � �
�lrl/U L 5 SIT
Post & Beam
Ext Sheath /Shear a t / 1211 T) +1) I n
Int Sheath /Shear a
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler il�i� :11c--&-,
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
• -- - PASS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Fin
A PART FAIL
MECHANICAL "r.= x,P ;- A
.A\
• Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
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
Approach /Sidewalk Date Other D ° 9, Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•