Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2000 -00125
A j DEVELOPMENT H BMEN9 Tigard, SERVICES 639 -4171 DATE ISSUED: 4/25/00
SITE ADDRESS: 07230 SW SHADY CT PARCEL: 1S125DB -08300
SUBDIVISION: SHADY DELL NO.2 ZONING: R -4.5
BLOCK: LOT: 056 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 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: Replace existing gas water heater with like kind.
FEES
Owner:
Type By Date Amount Receipt
DAN BURLEIGH
7230 SW SHADY COURT PRMT GEO 4/25/00 $50.00 0001694
TIGARD, OR 97223 5PCT GEO 4/25/00 $4.00 0001694
Total $54.00
Phone 1: 503 - 768 -9066
Contractor:
JACOBS HEATING +A/C INC
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 234 -7331 Final Inspection
Reg #: LIC 1441
PLM 26 -548PB
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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 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:
Call (503 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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CITY OV-I.IGARD Plumbing Permit Applicatip0-® Plan Check#
13125 SW HALL BLVD. Commercial and Residential ,�� ®� Recd By
TIGARD, OR 97223 Date Recd
Q►Q
(503) 639 -4171 S 0.\‘‘'‘. Date D Date to DST
Print or Type `( ate to S
Incomplete or illegible applications will no acc Permit #p��o�00 - O O/ '
Related SWR #
N--- Called
Name of Development/Project FIXTURES (individua l) QTY PRICE AMT
Job D at, u - L e t c k.. Sink 11.50
Address Street Address V Suite Lavatory 11.50
'? a 3 O S 41 S knout C-7" Tub or Tub /Shower Comb. 11.50
Bldg # I /State Zip Shower Only 11.50
t 3a ec1 O le- 97072:3 Water Closet 11.50
Name
, iv i Ll P ` . t 5l.. Urinal , 11.50
Owner Mailing Address Suite Dishwasher 11.50
3 d S W S'Ah`(C.r Garbage Disposal 11.50
'7
City/State Zip Phone
-T Il arch Q 97.7A3 '74e9-90626 Laundry Tray 11.50
Ngale Washing Machine /Laundry Tray 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone
ater Heat conversion .‹iklkind 11.50 `, 50
Name Gas piping requires a separate mechanical permit. 1
MFG Home New Water Service 32.00
as, MFG Home New San /Storm Sewer 32.00
Contractor Mailing Address 1 Suite
y` /7�/ Se. ►'►'1tiw4wk,te rive . Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy P I cv .te) OW_ ? lac 073 - 733 I Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if ) N '- / Other Fixtures (Specify) 15.00
-
expired in COT Plumbing Lic. # Exp. Date
database L.- 5-tiA P
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 b done: j Storm & Rain Drain - 1st 100' 38.00
New 0 Re r O Replace with like kind: Yes No O Storm & Rain Drain - each additional 100' 32.00
Residential - Commercial 0
Additional de ption of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are y u capping, moving or replacing any fixtures? 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.
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 Quantity Total is > 9
that plans submitted are in compliance with O 'regon State Laws. *SUBTOTAL
Sign ore of Owner /Agent Da e °
/ i4 Q 1 la J A. � _ / . 8% SURCHARGE
.t Jll 14
n c / t� Person Name Phone *PLAN REVIEW 25% OF SUBTOTAL
S1 1Vi'� � ) a3v- 735/
1 BATH HOUSE $178100 Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00 TOTAL
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 sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I: tdstsVormstplumapp.doc 11 /18/99
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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
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: ldstsVormstplumapp.doc 11/18/99
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
\ / BUP
Date Requested 1 .S / ° / °° AM PM n BLD
Location — 213 Suite MEC ?:od "Qn1 3l
Contact Person � ' � , 1 Ph 2 37' l R PLM 2 O 001 ZS
Contractor �!e(4.,v Ph 7 D C 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
(PLUMBING}
Post & Beam
• Under Slab
Top Out
Water Service
Sanitary Sewer
Drains
FAIL
Post & Beam
Rough In
Gas Line
Smoke Dampers
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 ���r� /j
Other D >� Inspecto Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.