Permit PLUMBING PERMIT
PERMIT #: PLiUI 1 - 1
DATE ISSUED: 1I -
SITE ADDRESS: Irma 1 Lt VYAI N PARCEL:
SUBDIVISION: ZONING: R
BLOCK: LOT: JURISDICTION:11 6
CLASS OF WORK: NT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: fir% WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: lZ,3 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: 200 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks:
Owner: FEES
Type By Date Amount Receipt
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Phone 1: 1 ei
Contractor:
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JI �� REQUIRED INSPECTIONS
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Phone 1: �PZS Ho, I 6442r ( 11: 6 ��^
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 may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -1987.
• 1
:is
ssued By: Permittee Signature:. 41 ,- tk\k/
Call (503) 639-4175 by 7:00 P.M. for an inspection needed th a 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
(503) 639 -4171 Date to P.E.
- Print or Type Date to DST
COS
Incomplete or illegible applications will not be accepted Permit # PLN
Related SWR it
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 9.00
Address Street Address , Lavatory 9.00
I i 1 1 q 0 5j t'^ G L rt sr-- Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
9 , k) - z Z'
Name Water Closet 9.00
5T7 1 )e rve.--- Dishwasher 9.00
Owner Mailingtadress Suite Garbage Disposal ' 9.00
) t yat> S`') 1 -4 0 14 7 1- / Du ✓'79 67-- Washing Machine 9.00
City /State Zip Phone
7i OR g)zz3 G3y -6q,y Floor Drain/Floor Sink 2° 9.00
Name 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
vY7 A 11 6 WaJaTt r.) Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
9.00
Prior to permit C' /State Zip Phone Sewer - 1st 100' , 30.00 3
issuance, a copy l } q 1 4 p 6'7 16 I I Sewer - each additional 100' I 25.00 ZS=
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
Describe work to be done: restricted energy permit.)
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 0 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 replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes O NO O 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 H Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER. FEES. *SUBTOTAL
I hereby acknowledge that I have read this application, that the information 5c.e
given is correct, that I am the owner or authorized agent of the owner, and 6% SURCHARGE r
that plans submitted are in compliance with Oregon State Laws. Z • 7C
ature of Owner /Agent MB "'PLAN REVIEW 25% OF SUBTOTAL
uJ
D` -- - v�n v ( Q / (9 Required only it fixture qty. total is > 9
V TOTAL 5 1 7
Co Person Name Phone
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
and plan review
l dststplumapp.doc 7/2/98
. . .
PLEASE COMPLETE:
New Moved J Replaced Removed/Capped
tit).
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:IdstAplumapp.doc 717198
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639- 4175 Business Line: 639 -4171
/ / l / �9 BUP
1 Date Reque i te ,, d , BLD
Location 1(1 7 0 1 11 2. _ �I AM PM L`e/ Suite MEC
Contact Person Ph PLM f 9-' ?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 / / - 3–e 5 •� / p V _
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
-. Post & Beam
_ Under Slab
Top Out
*Off Sentine
CanitaryeS ewer
Rain Drains
F'
PASS ART FAIL
ANICAL
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 V Inspector Ext
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.