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Permit C ITY OF TIGARD PLUMBING PERMIT Yl DEVELOPMENT SERVICES PERMIT #: PLM2000 -00078 ,� I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 03/13/2000 SITE ADDRESS: 09120 SW LOCUST ST PARCEL: 1S135AB-00203 SUBDIVISION: TOWN OF METZGER ZONING: R -4.5 BLOCK: LOT: 005 JURISDICTION: TIG CLASS OF WORK: ALT 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: ft WATER CLOSETS: WATER LINE: 40 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of 40' water line. FEES Owner: Type By Date Amount Receipt DAVID ADDERLY,SHARON PRMT GEO 03/13/200C $50.00 0000610 9120 SW LOCUST 5PCT GEO 03/13/200C $4.00 0000610 TIGARD, OR 97223 Total . $54.00 Phone 1: 503 -452 -3987 Contractor: ACTION PLUMBING & HEATING 19587 SW RED OAK LN ALOHA, OR 97007 REQUIRED INSPECTIONS Phone 1: 503 - 356 -9630 Water Line Insp Reg #: LIC 138159 Final Inspection PLM 34 -369PB 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: /J 4 Permittee Signature. Call (503) 63 -4175 by 7:00 P.M. for an inspection nee ed the next business day cfr, OF TIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIGARD, OR 97223 Date Rec'd (503) 639 -4171 Date to P.E. Print or Type Date to D • Incomplete or illegible applications will not be accepted Permit Glf4R - At,O , Related SWR # Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job Sink 11.50 Address Street Address - - Suite Lavatory 11.50 C\\ �0 -° C� J ' Tub or Tub /Shower Comb. 11.50 Bldg # /State Zi Ilti Shower Only 11.50 VI 4 Name Water Closet 11.50 Mailing ` a a � � t o \.y Owner D Urinal . 11.50 ishwasher 11.50 M - \ \ -`. 4 ‘v Garbage Disposal 11.50 City /State Zi hone a \-\ mho Zits �� Laundry Tray 11.50 O Name `? J d Washing Machine /Laundry Tray 11.50 e-, ∎, _.. ‹.... Floor Drain/Floor Sink 2° 11.50 Occupant Mailing Address Suite 3" 11.50 4" 11.50 City/State Zip Phone Water Heater 0 conversion 0 like kind 11.50 Gas piping requires a separate mechanical permit. ` �A� � �` � MFG Home New Water Service 32.00 • Name�� \-`, o �R \ Contractor Mailing K � g Address f �.�,�(�_ Suite MFG Home New San/Storm Sewer 32.00 1°t 0 SW�� t Hose Bibs 11.50 • Prior to permit City/State Zip Phone Roof Drains 11.50 issuance, a copy INp \eA ° CI ©& Drinking Fountain 11.50 of all licenses are Oregon Const. Con Board Licit Exp. ate required if V� \ S \ O 2 \ /C) \ Other Fixtures (Specify) 15.00 expired database OT •Plumbi =g Li S. A- --sr. t o \ a me Architect Sewer -1st 100' 38.00 or • Mailing Address / -Suite Sewer - each additional 100' 32.00 C ity /State Zip Phone Water Service - 1st 100' �� 38.00 - Engineer Water Service - each additional 200' ' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New 0 Repair Qy Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential (V Commercial 0 Additional description of work: Commercial Back Flow Prevention Device 32.00 Residential Backflow Prevention Device' 19.00 Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No 9 - 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 > 9 56 given is correct, that I am the owner or authorized agent of the owner, and that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL a 1 ...-/ -- Sign ofv r /Agent ( Q o D t ° `T // 3�` l C: 0 / 10/2-°0-0 8% SURCHARGE Contact Person Na 1gn ; ,�„ ` � to � J b b "` PLAN REVIEW 25% OF SUBTOTAL 1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9 2 BATH HOUSE $250.00 TOTAL 5 [� 3 BATH HOUSE $285.00 f (This fee Includes all plumbing fixtures in the dwelling and the first . *Minimum permit fee Is $50 + 8% surcharge, except Residential Backflow Prevention r 100 feet of sanitary sewer storm sewer and water service) Device, which Is $25 + 8% surcharge "AII New Commercial Buildings require plans with isometric or riser diagram and plan review. I:\dstsVormstplumapp.doc 11/18/99 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved J Replaced Removed /Capped 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: • I: ldstsVormsAplumspp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION - " 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested n I AM PM BLD Location q 2 W Suite MEC Contact Person J1 V\A_ Ph 3Slp 30 4 e�» Contractor Ph 4 t' 00 () 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 kL1A1 ,hj / / •� Post &Weam Under Slab Top Out Water Service Sanitary Sewer Rain Drains - Fi PART FAIL ECHANICAL 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 0 O Other Date , J f . V Inspector Kd Ext /� Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.