Permit "IV
C ITY OF TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2000 -00144
'f ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/04/2000
SITE ADDRESS: 09630 SW O'MARA ST PARCEL: 2S102CD -02001
SUBDIVISION: EDGEWOOD ZONING: R -4.5
BLOCK: LOT: 020 JURISDICTION: TIG
CLASS OF WORK: ALT 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: Residential backflow prevention device
FEES
Owner:
Type By Date Amount Receipt
MCDILL, STEVEN J + KIMBERLY C PRMT DST 05/04/200C $25.00 0001932
9630 SW O'MARA ST 5PCT DST 05/04/200C $2.00 0001932
TIGARD, OR 97223
Total $27.00
Phone 1:
Contractor:
INNOVATIVE LANDSCAPING
9630 SW OMARA ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone 1: 503 - 670 -7832 RP /Backflow Preventer
Reg #: LIC 12424 PLUS BACKFLOW Final Inspection
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 thro •h OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calli/g (503) 241-19: .
Issued By: f Jt �/� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t' next busin day
IPR TIGARD Plumbing Permit Application Plan Check
'3125 SW HALL BLVD. Commercial and Residential Rec'd By
"IGARD, OR 97223 Date Rec'd "4-
.503) 639 -4171 Date to P.E.
Print or Type Date to DS
Permit* 1 - 700 ct FM'
Incomplete or illegible applications will not be accepted Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
•
l
Job o ') �.l t,
C O A ST Sink 11.50
Address Street Address Suite Lavatory 11.50
Tub or Tub /Shower Comb. 11.50
Bldg # C I /Sta tt;, _) ��1 Z e criz i Shower Only 11.50
� },( l �� Water Closet 11.50
Name - ` KCO; n Urinal , 11.50
Owner _Mailing Address lxJ Suite / e Dishwasher 11.50
0 6 ) 54.0 . O d+tZP ' " Garbage Disposal 11.50
City/State Zi Phone Laundry Tray 11.50
Na me ' " j � 22� C°�0� 32 Washing Machine/Laundry Tray 11.50
Na = � 3 Pi"f \ \& "5
Floor Drain/Floor Sink 2' 11.50
Occupant - MailingAddreslq,�, t � Suite 3' 11.50
V � 4• 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
Ni
1 m� Li o ov r �� t` � r ,,� J o ( MFG Home New Water Service 32.00
i ling Address ►T 1 v Levu MFG Home New San/Storm Sewer 32.00
Contractor 4 30 C �M�lAZ u7 9 c�r Hose Bibs 11.50
Prior to permit rate Zip l _Phone Roof Drains 11.50
Issuance, a copy "1122 3 (10r--iE32- Drinking Fountain 11.50
of all r licenses are Oregoq Cons. ;/ Cont. Board Lic.# Fx 3 ` lJ D�t / O' Other Fixtures (Specify) 15.00
required if (� d
expired in COT Plumbing Li o. ft Exp• ale
database k, 2, c.D 3D
"1,Z l tx
Name
Architect Sewer -1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00 -
C ity/State Zip Phone 32.00
Engineer Water Service - each additional 200'
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Rep it 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential Commercial 0 Commercial Back Flow Prevention Device , 32.00
Additional description of work: Residential Backflow Prevention Device' 1 19.00
Catch Basin 11.50
Are you capping, moving or re lacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No Inspections per/hr
If yes, see back of form to ind' ate work performed by Rain Drain, single family dwelling 45.00
fixture. FAIL � - E TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COU RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby earl' edge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total Is > 9
given Is come , that I am the ow er o authorized agent of the owner, and *SUBTOTAL 7
that glans ,-, bmitted .' 4 • -, a . ith Oregon State Laws. GC
Slgnatu -> ; • ' /�� D5 , O v 8% SURCHARGE ate
`; 2 .00
Con c, ° e rtp r .ca cc „�/- PLAN REVIEW 25% OF SUBTOTAL
E $ [ s L 'Co�'I Required only if fixture qty. total Is > 9
g � OtJSE 4 " i +,k F ' : TOTAL 71d) .
+ ' J ate, 0 SE 50 ?. , , , t i • �. > u-4 1 � . �
OUS � 28.5.00 : a.
41, A c( es 1 • U . bing res` n • e Iin� a rst ,_a f *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
:,, , , W K5. Ba .. '.-...4.. r n ' to Service ? , } , _. , .. • Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
I: dstsVOrmslpiumapp.doc 11/18/99
PLEASE COMPLETE:
Fixture Type • Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Onl
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: ldatsVormApk+mepp.dm 11/18199
r+- -CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
/ BUP
Date Requested / d AM PM BLD
n
Location 1'(00 '- £ ',i7 A Suite MEC
Contact Person Ph PLM _2 0 Q'0/ /
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 r � YlSV l? ` l %7 4, S l /vr f � '
Insulation // / /
Drywall Nailing ■ TrYIUi ci c0 fef � 4 `� c/e ydLA,
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab /jj
Top Out ``
Water Service P4vic .
Sanitary Sewer
Rain Drains
`AS PART FAIL
CHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service -
Rough In P,
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL .4001111111/
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 /
Otheoach /Sidewalk Date / � � Inspect /�' / / L e - �I/ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.