Permit CITY TIGARD PLUMBING PERMIT
44 . DEVELOPMENT SERVICES PERMIT #: PLM2000 -00029
c4ll DATE ISSUED:
13125 SW Hal Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09415 SW LEHMAN ST PARCEL: 1 S126DC 01003
SUBDIVISION: LEHMANN ACRE TRACT ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: REP 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: 140 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacing 140' of sewer line
FEES
Owner:
Type By Date Amount Receipt
LAYMAN, DEBORAH J S TRUSTEE PRMT BON 2/3/00 $70.00 00- 321580
3216 SW SCROLLS FERRY CT SPOT BON 2/3/00 $5.60 00- 321580
PORTLAND, OR 97221
Total $75.60
Phone 1:
Contractor:
MICHAEL + CO PLUMBING
P 0 BOX 23008
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone 1: 639 -3189 Sewer Inspection
Reg #: LIC 000678 Final Inspection
PLM 26 -333PB
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: , G--
i
Permittee Signature: o--- P /G--d
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By t■
TIGARD, OR 97223 Date Rec'd 2. •
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit #PAM °ti°Z-1
Related SWR #
Called
Name of Development/Project 'iFIXTtJRES:"(individual) '" v i:VI,Mg3,47 L TYF'° ' PRICE '
Q °14M7'.
Job Sink 11.50
Address Street Address 1 i Suite Lavatory 11.50
9 Lt is .S L,,) "e- lnivta'n Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip Shower Only - 11.50
- 1 - ic,4eL o-r - 57 223
Na a Water Closet 11.50
'e 66. E 1,c, 1 irKaleN Dishwasher 11.50
Owner Mailing Address r , Suite Garbage Disposal 11.50
3af (4 s� Sc I,eils iigT: Washing Machine 11.50
Oity /State Zip Phone .
pt p q 722. / 91A 0.s ,p Floor Drain/Floor Sink 2" 11.50
Name. 3" 11.50
CAPS Cv iddg-n y 4" 11.50
Occupant Mailing Address r Suite Water Heater 0 conversion 0 like kind 11.50
5tirss/.4) 4 P fim4A) Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 11.50
77 I" I p 9 77-23 Urinal 11.50
Name
iZ'►ichGe1 de Ru hilt N q Other Fixtures (Specify) 15.00
Contractor Mailiug Address Suite
P° IS p A a31,t0S'
Prior to permit City /State Zip Phone Sewer - 1st 100' I 38.00 3
issuance, a copy t l •p-c4 o.r g 72-$) 1,3 ?-3 /f ,' , •"' Sewer - each additional 100' / 32.00 3 3
of all licenses are Or gon Const. Cont. Board Lic.# Exp. Date
required if 4;7 P 7'7 Water Service - 1st 100' 38.00
expired in COT Plumbing Lic. # Service - each additional 200' 32.00
database d` & - 333 Exp. Date 3 PQ Storm & Rain Drain - 1st 100' 38.00
Name Storm & Rain Drain - each additional 100' 32.00
Architect Mobile Home Space 32.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 32.00
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device* 19.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes A No 0 Any Trap or Waste Not Connected a Fixture 11.50
Residential it Commercial 0 Catch Basin 11.50
Additional description of work:
!�
11 Insp. of Existing Plumbing 50.00
2,epleee.. /'iv' Je,L -r L, -P per/hr
Are you capping, moving or replacing any fixtures? Specially Requested Inspections per/hr
Yes 0 No 0 45.00
Rain Drain, single family dwelling 45.00
If yes, see back of form to indicate -work performed by - Grease Traps 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL 'r`' ;"
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 :: ,,, _°
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL fir'° ) 00
:;, :, �,:,, 7o
that plans submitted are in compliance with Oregon State Laws. !�,, ; m ,>� P �� a •,
Signature er /A ent s/o s r; .
p D ate SURCHARGE = >;- `4(
&Person Name Phone ** 25% " i
Cont `- t
� �� �� g d / � 5 Required only if PLAN REVIEW 25 /o OF SUBTOTAL , , f�� ���'
��-
tf e 'JQ fixture qty. total is > 9 g ', „i, a� r<"
, ',1 ' BH H BATFI H UPE 1gi90 x, TOTAL = ' :' ' s tc% •
ATt'?tJSE 325,0 D0 " .:` 7
BA ouSE 6 * Minimum permit fee is $50 + 5% surcharge, except Residential Backflow
{;this inciudesoall plu mbing fixtures4n theadwellin and the firs - - _ Prevention Device, which is $25 + 5% surcharge
100tfe of sa, tta '
ry se se e,r l nd wa i i,rM4) - All New Commercial Buildings require plans with isometric or riser diagram
a ,
and plan review
I:ldstslformslplumapp.doc 6/2/99
PLEASE COMPLETE:
'''' . <' . ':::: >. ' ' > : < < ° ; >
ti . b Work Performed . ::. .
Mo:v::ed '.. ''Re laced Removed /Ga e:
New:.:.:.....
. ... ..... ..........
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:
1:ldsts\ forms tplumapp.doc 6/2/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
lJ BUP
Date Requested / 00 AM e � PM BLD
Location 1 S Let) 6'� Suite MEC
Contact Person Ottie. Ph U39 3/ � p PLM - Q")40 a '
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain 11-7
SGN
Crawl Drain Inspecti n otes:
Slab SIT
Post & Beam /4 Ext Sheath /Shear ` Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling r / l
7 �
Roof
Final
PASS PART FAIL
OMBI U3
Post & Beam (��
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS 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
Other Date Inspector I2 , M /, Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.