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Permit CITY TI A D PLUMBING PERMIT karotiI DEVELOPMENT SERVICES PERMIT #: PLM2000 -00279 „�� 13125 SW Hall Blvd., Tigard, O 97223 (503) 639 -4171 DATE ISSUED: 7/31/00 SITE ADDRESS: 08347 SW LANGTREE ST PARCEL: 2S112CC -10600 SUBDIVISION: LANGTREE ESTATES ZONING: R -12 BLOCK: LOT: 038 JURISDICTION: TIG CLASS OF WORK: OTR 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: Installation of backflow prevention device for irrigation system. FEES Owner: Type By Date Amount Receipt MUSSLER, LOREN B + CAROL B PRMT DEB 7/31/00 $25.00 0004106 8347 SW LANGTREE ST SPOT DEB 7/31/00 $2.00 0004106 TIGARD, OR 97224 Total $27.00 Phone 1: Contractor: OWNER REQUIRED INSPECTIONS Phone 1: RP /Backflow Preventer Final Inspection Reg #: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You ay obtain •pies of these rules or direct questions to OUNC by calling (503) 246 -1987. - f . ( / mil' J Permittee Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day , CITY OF TIGARD Plumbing Permit Application Plan c c # 13125 SW HALL BLVD. ��orr�r and Residential Recd r� J . TIGARD, OR 97223 Date Rec'd 7f-o0 (503) 639 -4171 - • Date to P.E. - -' Print or Type Date to DST) r --- Incomplete or illegible applications will not be accepted Permit # cy -©O.219 Related SWR # Called Name of Development/Project 1 'F.IXTURESy individual ,`� ) , .. �;;= �.,.. ` e,��., aTY; :. PRICE- 'AMTV Job Sink 11.50 Address Street Address `,, `,° y " Suite Lavatory 11.50 &N dr T 44 'Qw e,ev 7Q Tub or Tub /Shower Comb. 11.50 Bldg # City/State Zip Shower Only • 11.50 ` 4 �. Water Closet Name � f 11.50 Ga ,l y (L _j$ fed Urinal , 11.50 Owner Mailing Address Suite Dishwasher 11.50 Garbage Disposal 11.50 City /State Zip Phone Laundry Tray 11.50 Name Washing Machine /Laundry Tray 11.50 Floor Drain /Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11.50 City /State Zip Phone 4" 11.50 Water Heater 0 conversion 0 like kind 11.50 Name Gas piping requires a separate mechanical permit. -K 0 10 kJ1-441 MFG Home New Water Service 32.00 Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00 Hose Bibs 11.50 Prior to permit City /State Zip "Phone Roof Drains 11.50 issuance, a copy Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date database � Pjo /d f eie 1 - ,( t 2 Name �/ Architect /c-- Sewer - 1st 100' 38.00 Or Mailing Address Suite Sewer - each additional 100' 32.00 Engineer City /State Zip Phone Water Service - 1st 100' 38.00 Water Service - each additional 200' 32.00 Descr" p 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 Residential 0 Commercial 0 Additional description of work: Commercial Back Flow Prevention Device 32.00 .5 A� /� t � -�/ \ Residential Backflow Prevention Device* / 19.00 / � � l J iii , Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 -- Yes 0 No Inspections per /hr If yes, see back of form to indicate ork 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 ,. . • -r; 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 '`'',•:' _„ %• that plans submitted are in compliance with Oregon State Laws. * - : - %''l ' _,�* I ` T 9)1 8% SURCHARGE ° " �' ';, r S' ature of Own : d nt Date Q i q ' at. ' & � , 1 r.,' ga . �, ontact Perso ame Phone �<a. '`, ��,.�` _ * *PLAN REVIEW 25% OF SUBTOTAL ':!5,,j s ';a114:." � ,_> Required only if fixture qty: total is > 9 ` < : f % 1 : BATH HOUW 178:Q0 „ " . .,,,,k- ....., i . <,a.� :2BATN`HOU 250:0 _ TOTAL rs a 5 . 3<BATHHOUSEr 28:0:..: ° . � �, , f includes 0 1 %I mb fl ttie. the *Minimum permit fee + 8 � %z •+ � ,a - � �,w� a,� � . a p is $50 /o surcharge, except Residential Backflow Prevention 0 10�fee 0 f sanita - s ewer152 sewer and)water�servi ' 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 11/18/99 !e . PLEASE COMPLETE: Wir:LANitturelkiierial::- Quantity by Work Performed New Moved * R ep laced 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: ejlariMan V__MWA FM I NM IMKOF tr-iz 410 o l'"=" • I:\dsts\forms\plumapp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 ,;..Business Line: 639 -4171 MST BUP Date Requested AM PM BLD Location 33 (7 54, Lam^fOyu Suite MEC '` e,u -G u � Contact Person Ph PLM .7orvv -, B® *-7 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 1 PASS PART FAIL I tiMe1Dl Post & Beam Under Slab Top Out Water Service Sanitary Sew - Rain Drains 40.1 ; \ i PASS ART 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 - Other Date �' �� I nspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.