Permit C 1TY OF TI GARD PLUMBING PERMIT
PERMIT #: PLM2000 -00127
- 13125 ;jl1 DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 04/20/2000
" SITE ADDRESS: 14800 SW SEQUOIA KWY PARCEL: 2S112AD -00900
A
SUBDIVISION: ZONING: I -P
BLOCK: LOT: • JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: • BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Install a commercial back flow prevention device.
FEES
Owner:
Type By Date Amount Receipt
HOME DEPOT USA INC PRMT GEO 04/20/200C $50.00 0001577
BY MARSHALL + STEVENS INC SPOT GEO 04/20/200C $4.00 0001577
ATTN: MELISSA SHAPIRO
PHILADELPHIA, PA 19103 Total $54.00
Phone 1:
Contractor:
RESCUE ROOTER
PO BOX 1728
WILSONVILLE, OR 97070 REQUIRED. INSPECTIONS
Phone 1: 243 -1172 RP /Backflow Preventer
Reg #: . LIC 127325 Final Inspection
PLM 34 -168PB
o:RrGrAL
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: `1, /
Call (51- 639 -4175 by 7:00 P.M. for an inspection neede s next busi ess day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125'BW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# R# ao�o oo /,�
Related SW #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job A Cu 4'8 Vg Sink 11.50
Address Street Address Suite Lavatory 11.50
/ y froo sw sE4' u 4 PiKY Tub or Tub /Shower Comb. 11.50
Bldg # City/State Zip Shower Only 11.50
T /64,go e� C17ZZ5� '/ Water Closet 11.50
Name
HO ----17-/ E a Q S'/ /x./ c Urinal . 11.50
Owner M "ling � Address Suite Dishwasher 11.50
15 y / 1 #4046 SVE-() /US //t/__ Garbage Disposal 11.50
C" /State Zip
71 /L /9 P E � /9/ V / / C / Laundry Tray 11.50
Name Washing Machine /Laundry Tray 11.50
()'u (' / c I z)- Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite (� 3" 11.50
/�f SGt� 6ac /,y- ��� 4" 11.50
City/S ''!
te 7, ip Phone Water Heater 0 conversion 0 like kind 11.50
Y �`'V" 17/ Gas piping requires a separate mechanical permit.
72 6 - cog Boo r¢ MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00
PO 13'/ / 7Z - Hose Bibs 11.50
Prior to permit City/State Zip Phone Roof Drains 11.50
issuance, a copy ft/d y / //E D2 9707 5-63- 24/3-//72
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
L
required if / 27 3 Z 5-- /R-g, t7 -OQ _ Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database 34/ _ /4g p� 3-3 0/
Name
Architect Sewer - 1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City/State Zip Phone
Water Service - each additional 200'_ 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair 61' Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial g(
Additional description of work: Commercial Back Flow Prevention Device / 32.00 - 5 , ,2
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 0 No % Inspections per /hr
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. 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 l
that plans submitted are in compliance with Oregon State Laws. TO
Si n e of Owner/ ent Date
9 ei 4/-zD ea 8% SURCHARGE
1
Contact Pers Name Phone
**PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if facture qty. total is > 9
2 BATH HOUSE $250.00 TOTAL 5-ti
3 BATH HOUSE $285.00
(This fee includes all plumbing fixtures In the dwelling and the first 'Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
' 100 feet of sanitay sewer storm sewer and water service) _ i Device, which is $25 + 8% surcharge
T - J ^ "All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:tdstsVormstplumapp.doc 11/18/99
r .
PLEASE COMPLETE:
Fixture Type Quantity by Work 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:
1:ldstsforms1plumapp.doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 .
BUP
Date Requested ZI /00 AM PM _ BLD
Location I ( 4 g 0 cse u1.toI1 (__, Suite MEC
Contact Person (5,XV2-• Ph PLM ' 00)
Contractor Ph SWR
BUILDING Tenant/Owner f'D1— CL ( /✓1 ELC
Retaining Wall 0OY1/l.L- 04R
•
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab - SIT
Post & Beam- •
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation - - - - - r- . -
Drywall Nailing 7
Firewall
Fire Sprinkler � /
Fire Alarm
Susp'd Ceiling ./�
Roof -
Misc:
Final
PASS PART FAIL
�LUMBIN
Post & Beam
= Under Slab e
Top Out •
Water Service
Sanitary Sewer
•
Rain Drains
AS PART FAIL
CHANICAL
Post & Beam 7),)
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 )/
Other Date q(9./ 161 Inspector Ext;
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.