Permit ..s.A- CITY OF TIGARD PLUMBING PERMIT
d�c�lij DEVE H B rd SERVICES PERMIT #: PLM2000 -00104
� 1 1 DATE ISSUED: 4/4/00
SITE ADDRESS: 15855 SW ROYALTY PKWY \ „ Al . /IN ` PARCEL: 2S110CD -02900
SUBDIVISION: KING CITY NO. 2 ' . ZONING: •
BLOCK: LOT: 006
JURISDICTION: KIN
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Replace less than 100' of sewer line.
FEES
Owner:
Type By Date Amount Receipt
RICK JILLAIN PRMT DEB 4/4/00 $50.00 KING CITY
15855 SW ROYALTY PKWY SPOT DEB 4/4/00 $4.00 KING CITY
KING CITY, OR 97224
Total $54.00
Phone 1: 968 -2400 •
Contractor:
OWNER
REQUIRED INSPECTIONS
1: Sewer Inspection
Phone
Reg 1: Top -out Insp
g : 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.
Y may obtain copies of t. -se rules or direct questions to OUNC by calling (503) 246 -1987. il
Is e d By: 1 i i . / �� # Permittee Signature: ,,1Ajj4 ie, -,/,e -rte.
Call (503) • 9-4175 by 7:00 P.M. for an inspection needed the next bu iness day
APR - 03-00 MON 02:12 PM City of King City FAX:503 639 3771 PAGE 2
C11 TIGARD Plumbing Permit Application Plan Checks
13125 SW HALL BLVD. Commercial and Residential Reed By ' ..__
TIGARD, OR 97223 Date Rec'd . eMI56,Y •
Date to P.E. •
(503) 639 -4171 Date to D ►� �'OD '
Print or Type Permit* poi9eoo -00 /o 5/ •
Incomplete or illegible applications will not be accepted Related SWR
• Called •
•
Name of pevelopmenHProject / O / • �; •' .. „RE.•0 S�!ric�6,i +x.;. : �•+ii,.,..... i..a War � .�`.,�; �.._ .. _
Job /oy esi BA` Sink 1 11.50
Address Street Address Suite Lavatory 11.50 • •
Tub or Tub/Shower Comb. 11.50 •
•
Bldg # C 3 Cry ,. Zip , Shower Only 11.50 •
• & . /A ! 7 � Water Closet/Urinal (Specify) 11.50 •
Na me., � / / 11.50 Aso
(C << �1 L 4.14//t. Dishwasher
Owner Mailing Address Q j ( Urina 11.50 •
/ S T Sa � JO •i d w ry A Garbage Disposal 11.60
• � p laun Tray
Washing Machine/Laundry Tray .(Specify) . . 11.50
' Name ' 11.50 •
•
Floor Drain/Floor Sink 2"
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.
Name _ ) E /� MFG Home New Water Service _ 28.00 •
•
•
Meiling Address Suite MFG Home New San/Storm Sewer 28.00
Contractor Hose Bibs • 11 .E
Prior to permit City /State Zip Phone Roof Drains 11.50 •
issuance. a copy . ' Drinking Fountain 11.50
•
•
of an licenses are Oregon Const. Cont. Board Llc.g Exp. Date Other Palates (Specify) 15
•
required it •
_;,peed ii n Co I riurnbing Lie. # Exp. Date
database
•
Name
Architect Sewer - 1st 100' 1 38.00
Or Mailing Address Suite ' Sewer - each additional 100' • 32.00
Water Service - let 100' .. • 38.00
Engineer City /State • Zip Phone
Water Service - each additional 200' 32.00
Describe work to be one: Storm & Rain Drain - 1st 100' • . 38.00
New 0 Repair Replace with like kind: Yes 0 NoAt Sloan & Rain Drain - each additional 100' 32.00
•
Residential 0 Commercial O Commercial Back Flow Prevention Device • 32.00 •
Ad Itlonal description of work: •
Residential Backflow Prevention Device" 19.00
(� '�'�� C Catch Basin 11.50
•
Are you capping, moving or re ing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
•
Yes 0 No Inspections _ t perlhr •
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 QUANTI Y TOTAL x r;,.'? "i`''ce 3•;,
j) ;M
I hereby acknowledge Mal I have read this application, that the information isometric or riser diagr I requtredif Quanti Tatar is > 9 ` ? E$i Ii /oi' •• ,,..r'.: .`: :
given is correct, that I am the owner or authorized agent of the owner, and SUBTOTAL T " " } I' } " ''' •
that plans submitted are In compliance with Oregon State Laws. ' " `•' i '-`( -"
Sig . +'><IL'r> o • t D te -Dt� 8% SURCHARGE " "n / ,�' ` ' " '7:;ll di p
o r i:,.i:!'fi':.`isw' zc::
Con on amo_� Phone
"PLAN REVIEW 25 °16 OF SUBTOTAL + "'''I "�'Y' i ``" "''
! A ,. �� A � � Required only tr (hdura qty. total is > e �:" • ::.. 't "�.. .
; ft'
F � s•� ' �y�� � ^w' ;•' , . �;,?� TOTAL � 0. 4 ., Q;i'x . . ' ■ f118 ; Irid( ' Ip 1 ` • J i . ` ' ; 0?1. ..• ,: , g:� 44 _1ts ) ..�" �•
J if . y�y�[ .. rf ....., l w .4 Eli 2 O; >: x` -Minimum permit fee is 550 .8% surcharge, except Residential Beddow Prevention
Device, etid, is 525+ 84 rairrhargo
"Vdl New Commercial BulldtrtgL require plans with Isometric or riser diagram and
plan review.
I:Wsttermskeaseepp.doe 1011199 - - -
5/24/00 Activities' for Case #: PLM20O0 -00104
3:02:20 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 4/3/00 DEB FAXD No Hold DEB .4/4/00
PLMA005 Create Permit 4/4/00 DEB DONE No Hold DEB 4/4/00
PLMA705 Sewer Inspection 4/25/00 MRS FAIL No Hold AKJ 4/25/00 1) hub needs to be cut off and
• proper adapter used from
concrete to ABS
PLMA725 Top -out Insp No Hold DEB 4/4/00 •
PLMA799 Final Inspection 4/28/00 MRS PASS No Hold AKJ 4/30/00
PLMA050 (F) Issue permit 4/4/00 DEB DONE No Hold DEB 4/4/00
PLMA800 Case Finaled 4/30/00 AKJ DONE No Hold AKJ 4/30/00
•
•
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
(47U/456 BUP
Date Requested AM PM BLD
Location 41 ES gS nn ,, • / , [J / Ite MEC •
Contact Person I Ph C IA - V-100 PLM "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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
�C I�MBIN /
Post & Beam
Under Slab
Top Out
Water Service
Rain Drains
Fi I
400- PART FAIL
HANICAL n
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 �11
Approach /Sidewalk
Other Date Z Inspector /`�, EXt7
Final
PASS PART FAIL D NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
\ / BUP
Date Requested ZS 00 AM X PM BLD
Location : S S � �t ' , C. 1_ Suite MEC
Contact Person 4 h clb g ' 2 Lino PLM 7. -0016 y
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 /� /l '' I,�
Framing I a� f i ,�,� AI* � b ( , 1 -7'Q0 f VA. 1' WJ et-f∎
Ins I ( J ^ � �
Drywall Nailing 10Spf (y � � ` )J ) `j `�L
Firewall cJ
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof ifff!M , AMY - Misc:
Final %!j
PASS RT FAIL ��
AAIMIVA..2.il&Liff../ � WAIF'
Post & Beam / -
Under Slab
Top Out
Water Service
i ary Se
Rain Drains
Final
PASS PART AI
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA , (
Approach /Sidewalk Date i 2) U Ins )2/7„/
. 7 } Ext
Other l
Final
PASS PART FAIL 0 NOT REMOVE this inspection record from the job site.