Permit C ITY OF TIGARD PLUMBING PERMIT
Ylk DEVELOPMENT SERVICES PERMIT #: PLM1999 -00320
� - II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 `DATE ISSUED: 10/1/99
SITE ADDRESS: 12055 SW ROSE VISTA DR �
G � PARCEL: 2S103CC -00800
SUBDIVISION: COLONIAL VIEW , ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: URB
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: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacement of less than 100' of water line.
FEES
Owner:
Type By Date Amount Receipt
MCPHERSON, LORIN F /LAURA N PRMT DEB 10/1/99 $50.00 99- 318785
12055 SW ROSE VISTA DR 5PCT DEB 10/1/99 $3.50 99- 318785
TIGARD, OR 97223
Total $53.50
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: Water Line Insp
Reg #: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 -0001 -0010 through OAR 952 - 0001 -0080.
You - o • ai : • • ies of thes- rules or direct questions to OUNC by calling (503) 246 -1987.
Is ed By: � i _ , �% ' l 4iL Permittee Signature:
Call (503) 63' -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Chec ---
13125 SW HALL BLVD. Commercial and Residential Rec'd B
TIGARD; OR 97223 Date Rec'd t4 / - 9?
(503) 639 -4171 Date to P.E. '-�' -
Print or Type Date to DS
Incomplete or illegible applications will not be accepted Permit # � 2p9pP, -to.
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job toys t� t L ie- 12FPLIAcbs Sink 11.50
Address Street Address Suite Lavatory 11.50
1 zoSS 9W 12 V 1 srA.P.( Tub or Tub /Shower Comb. 11.50
Bldg # City/State Zip Shower Only 11.50
T f emit() 0 tc- R122 Water Closet/Urinal (Specify)
11.50
Name AM-P1/16400A1 Dishwasher 11.50
•
Owner Mailing Address Suite Urinal 11.50
I ZOO SW Io$a Vr 5774 PR Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
- 1 - 1 (o A+i 0 � 9 7223 Syo - 5/f 3 Washing Machine/Laundry Tray (Specify) 11.50
Name
N A S AhO1/ c_ 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
Name Gas piping requires a separate mechanical permit.
O w o ) e _ MFG Home New Water Service 28.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 28.00
Hose Bibs 11.50
Prior to permit City/State Zip Phone Roof Drains 11.50
issuance, a copy Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Other Fixtures (Specify) 15.00
expired in COT Plumbing Uc. # Exp. Date
database
Name
Architect Sewer -1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Engineer City/State Zip Phone ., Water Service - 1st 100' 38.00 3$00
g Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes -No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 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 O No Inspections per/hr
If yes, see back of form to indicI 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
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL �G ��
that plans submitted . • in compliance with Oregon State Laws. cr
SI t l.ff Owne , ( oi l I g Q S URCHARGE �f
Contact Person Name Phone
LVA-1 A yL t 2 - SK) ¶-9 .3 "PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total Is > 9 el
2 BATH HOUSE $250.00 TOTAL y/' 8
3 BATH HOUSE $285.00
(This tee includes all plumbing fixtures in the dwelling and the first *Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) _ Device, which is $25 + 7% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
• plan review.
Mists \formstplumapp.doc 9/20/99 • - - -
•
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray --
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:Wsts\forms\plumapp.doc 9/20/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested ith ? J' / / q AM PM BLD
Location / 51,0 Re• (�r�.
SR- L2, Suite MEC
/
Contact Person �K c PkaLKS6k Ph 5 3?” PLM ? 3?`O
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: FPS
Foundation r _
Ftg Drain
Crawl Drain Inspection o es: GU Cc7`'e, L ,, . SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
' Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Final Final
PASS PART FAIL
PLUMBING
Post & Beam -
Under Slab •
To. •
San! ary Sewer
R.'s Drains
1�, 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date ((4 r 13 Inspector r Ext 2—
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.