Permit A ,. CITY OF TIGARD PLUMBING PERMIT
w DEVELOPMENT SERVICES PERMIT #: PLM2000 -00212
�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/13/2000
SITE ADDRESS: 08048 SW SHAFFER LN NEW DURHAM PARCEL: 2S113B0 -00300
SUBDIVISION: &OR(9MM ELEMENTARY SCHOOL ZONING: R -12
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 commercial backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
SCHOOL DISTRICT NO 23J PRMT KJP 06/13/200C $50.00 0002923
13137 SW PACIFIC HWY 5PCT KJP 06/13/200C $4.00 0002923
TIGARD, OR 97123
Total $54.00
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
1: RP /Backflow Preventer
Phone
Reg 1 . 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 t • e - . u OA • , 2-0001-0080.
You may obtain co • f these rules or direct questions to OUNC calling (51 ) ■ -1987.
Issued By: Permittee Si natur-
p
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
06/12/00 MON 10:03 FAX 503 598 1960 CITY OF TIGARD IN O2
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Redd 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 #�LMz.�f, -ot)--
Related SWR #
Called
•
Name of =
Developm 1 :;f_l ICI RES�r�i hCliyfd�i . °���s � �:;4: .:�- ; =��� -� ' �� �10 a.i��.��i�r . •L:::..,.,.�:;
JOJob b;3dh�w1 �G�''�,Y1�' Sranr ( Sink _ '' 11.50
•Address Street Address. -- 11 r £ u ite Lavatory 11.50
g0i' '2 \�.. 7 hc_ � Tub or Tub /Shower Comb. 11.50
Bldg # ity /Stale 'q Zlp Shower Only 11.50
J Z `��� t v . 1 l 2 Water Closet 11.50
Nam
• tt )„,-,-A � LYA 7l(DI d1`,� Urinal , 11.50
Owner i�Jl � Sulle Dishwasher 11
�� JJ ll ✓, V Garbage Disposal 11.50
�
itylSlale Zi a P Laundry Tray 11.50
11,-(4 L . 1 122,_ 51 Je Washing Machine /Laundry Tray 11.50
Nam ,,,,5
(ult., 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.
l MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00
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 tic. # Exp. Date .
database
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 - let 100' 38.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 19. Commercial Back Flow Prevention Device 1 32.00
Additional description ofwork:,(C..b lM 4- X1S�n` V•1t41.2 ( (Int., ��'
r Residential Backftow Prevention Device' 19.00
0 44„1_ b.a -klf:v i C l �c. l t - -6 r • y )rd i a.-\ '7 Y Y Catch Basin 11.50
Are you capping, moving or replacing any fix ures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 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 hay- • • this application, that the information I .� r' '=' `i=° ='� ;�
Isometric or riser diagram Is required if Quantity Total Is > 9 ;
give. ' correct, that I - m the • , -r or : uthorized agent of the owner, and *SUBTOTAL ;, y ,,,.. - - .i , : .x ;
at •tans • •mitt:Ijalc•,1 'ion - with Oregon State Laws. - .. .._:; _•: e
Si
lilt. ( Y ? ^ui � z:; �:.'
not • e o • �� 1 YV1v r'1'� iL4iy.F• z;j. : �' ti=
g �'� E' G ! z Zo 8% SURCHARGE - �::i; ati : ;:? I t:.,_; _
Co ct Person :hone -' _ _ ; ` ; ;: , '
Con VA ty am CA (7t) 1� b 1 • yi)l e) "PLAN REVIEW 25% OF SUBTOTAL " F_ , p�yy__ , ::• •..
1
ri? :•
_ . __ „.•, .,� Required only f/ facture qty. total Is > 9 Mad {: ��.,: .,. :
€ . =H E ` 17'0` kw � TOTAL :':
v4�i f � / � . s . • ' ? } . .r .. i � j _� ' � ' ' :gip,;. _ ..
ti 1 .-- 'Yl' Y i � �^t � i•: ` �- S!-ee�� Ll"n-' u 'iitiI�L�� - •. W
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4
01.-.8.: is udeS all' _
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l : 'f' Grela=d -� , - •r 9' ia .� n
{ � , , ! • ,J, _ �, . A �� , ` , _ � ; � L 'Minimum permit fee Is $50 + 8°6 surcharge, except Residential 6ackllow Prevention
E 100f t "_ n i : iiii_O irit - d .I0Ae F@ , s " R . y =; Device, which Is 525 + 8% surcharge
"Ail New Commercial Buildings require plans with isometric or riser diagram and
plan review.
1•tdslvyormstplumapp.doc 11/18/99
8/21/00 Activities for Case #: PLM2000 -00212
3:43:55 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 6/13/00 KJP RECD No Hold KJP 6/13/00
PLMC005 Permit Created 6/13/00 KJP DONE No Hold KJP 6/13/00
PLMC750 RP /Backflow Preventer No Hold KJP 6/13/00
PLMC799 Final Inspection
No Hold KJP 6/13/00
PLMCO50 (F) Issue permit 6/13/00 KJP DONE No Hold KJP 6/13/00
PLMA055 (F) Reprint Permit 8/15/00 ZZZ DONE No Hold ZZZ 8/15/00
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Flour Inspection Line: 639 -4175 Business Line: 639 -4171 -
BUP
-
Date Requested / 2 - / LI AM PM BLD
Location go k 5 w S Ct r L el Suite MEC
Contact Person Ph 'Y 3/ - c/6 / $ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes() � �, ��� SIT
Slab /`. ,
Post & Beam
Ext Sheath /Shear D e v [G
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling I
Roof
M i c:
Final
PASS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer d / „„
Rain Drains rl
g 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 y � j
Other Date t 66 Inspector Ext 7/✓
Final
PASS PART FAIL D NOT REMOVE this inspection record from the job site.
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