Permit CITY OF TIGARD
,
�,y� 0'NI' ��; , DEVELOPMENT SERVICES PLUMBING PERMIT
lf PERMIT # - PLM98 -0128
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/08/98
PARCEL: 2S111DA -01400
SITE ADDRESS...: 08736 SW LODI LN
SUBDIVISION....: APPLEWOOD PARK NO. 1 ZONING: R -7 PD
BLOCK - LOT :010 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:R3 FLOOR DRAINS......: 0 TRAPS - 0
STORIES - 0 WATER HEATERS - 0 CATCH BASINS - 0
FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS - 0
SINKS ° 0 URINALS 0 GREASE TRAPS : 0
LAVATORIES....: 0 OTHER FIXTURES - 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0
Remarks: Installing residential backflow prevention device
Owner: FEES
JERROLD D HIGGINBOTHAM type amount by date recpt
8736 SW LODI LN PRMT $ 15.00 B 05/08/98 98- 305614
TIGARD OR 97224 SPCT $ 0.75 B 05/08/98 98- 305614
Phone #:
Contractor
OWNER _
Phone #: $ 15.75 TOTAL
Reg #..: 000000
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Back f low Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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.
____
e ,,
Issued By: ftAaa..A/ ` 1 -- Permi ttee Signature:,_ . 40 .;ir / / . ,,' 0:
++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + ++
Call 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 TI _ _
TIGARD, OR 97223 Date Recd 5 '`6 I
(503) 639 -4171 Date to P.E.
Print or Type Date to D
Incomplete or illegible applications will not be accepted Permit# (-1 9b- /`y Z-S
Related SWR #
Called
Name of Development/Project On back indicate Work Performed by fixture.
Job A Oil wood ��FIXTU�RES� g.. �,. i:1974 4 rPRI CE �.
Address Str Address Suite Sink 9.00
8L13 c, stA) Lodi L. z. Lavatory 9.00
Bldg # .g /State. Zip , / Tub or Tub /Shower Comb. 9.0
LO} ) 0 - J el sog. 972 Shower On '
6 et 9.00
J, b
(11 / Water Closet 9.00
•
Owner Mailing Addrete Suite Dishwasher 9.00
?3 sf.J€ ka,,,,,✓ Garbage Disposal 9.00
/State
n p � /' /
9 CUr��P an `77, . 4/ Phone
59Y- 373 {, Washing Machine 9.00
i Floor Drain 2" 9.00
J k kart 04..61 3" 9.00
an
p
OccU t Mailing Add ,/ Lodi ite
� L
310 Sw d L.
i Water Heater 0 conversion 0 like kind 9.00
y /State / Zip • Phone
l a afie e ( ,z 9722-V V L s' .3 y, - 6 Laundry Room Tray 9:00
N Urinal 9.00
() (A ) - Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
Prior to permit City /State Zip Phone 9.00
issuance, a copy Sewer - 1st 100' 30.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date Sewer - each additional 100' 25.00
required if Water Service - 1st 100' 30.00
expired in COT Plumbing Lie. # Exp. Date Water Service - each additional 200' 25.00
database
Name Storm & Rain Drain - 1st 100' 30.00
Architect Storm & Rain Drain - each additional 100' - 25.00
Or Mailing Address Suite Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Engineer City /State Zip Phone Pollution Device
Residential Backflow Prevention Device* 1 trj o
Describe work New 0 Addition 0 Alteration 0 Repair 0 Any Trap or Waste Not Connected to a Fixture 9.00
to be done: Residential Non - residential 0 Catch Basin 9.00
Additional description of work:
S ca ft . ng a 4 Sys-1 1 Insp. of Existing Plumbing per h
Specially Requested Inspections 40.00
per /hr
Rain Drain, single family dwelling 30.00
Existing use of
building or property Grease Traps 9.00
Proposed use of • QUANTITY TOTAL ; r A0
building or property Isometric or riser diagram is required if Quanity Total is > 9 > '- 114 4,4
*SUBTOTAL 4 , , ' a .(�
I hereby acknowledge that I have read this application, that the information
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE ; ' � "17, `.. .
Z.
that plans submitted are in compliance with Oregon State Laws.
at ._:, 7 4 v ne Date *'PLAN REVIEW 25% OF SUBTOTAL = E
Q Required only if fixture qty. total is > 9 , , � ,,,
i /yYt_ 0 �g TOTAL t-' "° µ " 7 x
4ontact Pe ' ame Phone * ,
` � ` J,, 'Minimum permit.fee is $25 + 5% surcharge, except Residential Backflow
`J • r 1151 1 i nt o 0 w\-- -3 13.E Prevention Device,'which is $15 + 5% surcharge
�:J
**Ail New Commercial Buildings require plans with isometric or riser diagram
and plan review /`
1:ldsts,plum bapp. doc 5/5/98
PLEASE COMPLETE:
New Moved Replaced .................................
::::
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal •
Washing Machine
Floor Drain 2"
3 "
..„
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
•
Mts1plumbapp.doc 5/5/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 -
1 r BUP Date Requested 3/ �d /9 AM PM BLD '
,
Location 1 /4, i� • _ �.�ri : t " Suite MEC �,/
Contact Person Ph PLM ? ,)I ?
Contractor Ph SWR
BUILDING1 a; ::- .,::,:. 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 ___
Fire wall � /
Fire Sprinkler
Fire Alarm k N
Susp'd Ceiling
Roof "
Misc: •
_ _ Final
PASS PART FAIL
__ PLUMBING.:
?.L - Post & Beam
Under Slab / �
"`" " Top Out ' I
Water Service
Sanitary Sewer
.R- - inspi
4 0FIV_I -4 1 Li
- ART FAIL
;7471*-;' ICAL` ''' et
eam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL .
ELECTRICAL; ,..., a -;` * °
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE: 41w
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 o ��1�T �
Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .