Permit C ITY OF TIGARD PLUMBING PERMIT
'" DEVELOPMENT SERVICES PERMIT #: PLM2000 -00343
1 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/15/00
SITE ADDRESS: 15465 SW ROYALTY PKWY PARCEL: 2S110CD -05200
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: 021 JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacing like kind: two sinks, one lavatory, one shower, one garbage disposal •
FEES
Owner:
Type By Date Amount Receipt
FELBICK, HELEN M TRUSTEE PRMT CTR 9/15/00 $83.00 27200000000
15465 SW ROYALTY PARKWAY 5PCT CTR 9/15/00 $6.64 27200000000
KING CITY, OR 97224
Total $89.64
Phone 1:
Contractor:
PARAMOUNT PLUMBING COMPANY
6019 SE 23RD AVE
PORTLAND, OR 97202 -0000 REQUIRED INSPECTIONS
Phone 1: 239 -7516 • Rough -in Insp
Top -out Insp
Reg #: LIC 00125438
PLM 26 -627PB 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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: / Permittee Signature: a
Call (5 3) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
C. Plan Check #
..ITY OF T IGARD Plumbing P erm it A pp li ca ti on '---. 13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec' - /S'dv
Date to P.E.
:503) 639 -4171 Date to DSTyy111� 0 '/
Permit et /21X00
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Deev , FIXTURES (individual) Qty Price Total
Job W -l- ! . r P e /O-( Sink 16.60 33, Z 0
Address /StAd Lavatory j 16.60 6 G0
!" / /WW__ I? Tub or Tub /Shower Comb. 16.60
Bldg # City/ to Zip v Shower Only 16.60 /e ( v
Name Water Closet 16.60
Urinal 16.60
Owner Mailing Address Suite Dishwasher 16.60
Garbage Disposal / 16.60 /6 (o�
City /State Zip Phone
Laundry Tray 16.60
Name Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60
Occupant Mailing Address Suite 3" 16.60
4" 16.60
City /State Zip Phone
Water Heater 0 conversion 0 like kind 16.60
N 1 t! Gas piping requires a separate mechanical permit.
�' L�%V I i n X J MFG Home New Water Service 46.40
Contractor ailing A dress , Suite MFG Home New San/Storm Sewer 46.40
?„!, a/9 .5 e .2 .3 / t , Hose Bibs 16.60
Prior to permit City /State Zip P�ione Roof Drains 16.60
issuance, a copy 3? 756
Drinking Fountain 16.60
of all licenses are O�ego ors . Cont. YJ Board Lic.# Exp. gate
r
required if / �.J 3 . gyp // Other Fixtures (Specify) 21.75
expired in COT Ruin Lic. x . E pat
. database 7 P.6
Name
Architect Sewer - 1st 100' 55.00
or Mailing Address Suite Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00
Engineer City/State Zip Phone
Water Service - each additional 200' 46.40
Describe work to be done: Storm & Rain Drain - 1st 100' 55.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 46.40
Residential 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Are you capping, moying or rr ecin fixtures? Insp. of Existing Plumbing or Specially Requested 72.50
Yes No 0 Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 65.25
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 16.60
WORK COULD RESULT IN INCREASED SEWER FEES.
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL •
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if t]ua *S Total is > s
that plans submitted are in compliance with Oregon State Laws. SUBTOTAL 83,00
Signature of Owner /Agent Date u
8/oSURCHARGE
6.4
Contact Person Name Phone **PLAN REVIEW 25% OF SUBTOTAL
• x _BATH HOUSES249.20P, t r:, . t^'- 30 -; 4.7•+'Lbw Required only if fixture qty. total is > 9 TOTAL q
B• HOUSE t, e * r` �x, .;. . .„ . ` ,1 6l f • 4 3 . OUS 0 r . . � e c . M� r. �r�
4! . u al plumbin tlxtu 6 r e dwel n id the • rS r ' 'Minimum permit fee is $72.50 + 8% surcharge, except Residential BacMlow Prevention
y: ', ` te, tie . I t, 1�. E Device, which Is $36.25 + 8% surcharge.
�1.91b .S8tN • 5' ,h' r .
"All New Commercial Buildings require plans with isometric or riser diagram and plan review.
wslsVormslplu mapp_rev.doc 9/8/00
PLEASE COMPLETE:
Fixture Type Quantity by Performed
New Moved 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:tdsts'ormstplumapp_rev.doc 9/8/00
KING CITY
)1
15300 S.W. 116th Avenue, King City. Oregon 97224-2693
NIMINININIMIN Phone: (503) 639.4082 • FAX (503) 639-3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd. Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: ^e- K.Je-1 err iSLArooi+,, .
located at: 15 46 5 Sw K. ya /47 Pikkw -7
/ —Lf/
Kin Ci� ' � Representative
I DSTS.XCNNST DOC
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / AM PM BLD
Location /5 S G✓ 2 7f 7 & / pec�. Suite MEC
Contact Person " G lrs _ / Ph 2f(/ 3 �iX) PLM jive &
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 eleC
Roof
Misc:
Final
PASS PART FAIL
PLUMBIN
Post & Beam
Under Slab
o 0
eater Service
Sanitary Sewer
Drains
PART FAIL
HANICAL
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 Date Inspector Ext
Other
Final
PASS PART FAIL DO NOT EMOVE this inspection record from the job site.