Permit •
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW 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 # "i1twoo -ooIN6
Related SWR #
Called
Name of Develo FIXTURES (individual) QTY PRICE AMT
1
Job Ze -v °J\ t.2.., Sink 11.50
Address Street Address Suite Lavatory 11.50
l�(oq 5 Sf>n>tij t Q Tub or Tub /Shower Comb. 11.50
Bldg # city/State Zip
rd2 OF qua Shower Only 11.50
Name Water Closet 11.50
JU Urinal , 11.50
Owner Mailin Addres Suite Dishwasher 11.50
I2.1. gtv 5pdk rL
Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Name 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
Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
`1Vlit,.. g t qe, MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00
r:LtAA .e_ 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 Lic. # 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 - 1st 100' 38.00
New 0 Re air 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential Commercial 0
Additional description of work: ?1 w Commercial Back Flow Prevention Device 32.00
n p ry 7-1549341.
Residential Backflow Prevention Device* 19.00
Li 9 Catch Basin 11.50
Are you capping, moving or reel cing 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 -
that plans submitted are in compliance with Oregon State Laws.
Signature of Owner/ ent 6l 1 8% SURCHARGE
,l t7"l.. !� �I lvC�
Contact Person Name Phone
**PLAN REVIEW 25% OF SUBTOTAL
'1'1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9
!' 2 BATH HOUSE $250.00 :: e , TOTAL 3-)
';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
P1,00 feet of sanitary sewer stand sewer and water service) Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
ltdstsVorms\plumapp.doc 11/18/99
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: ldstsVormslplumapp.doc 11/18/99
CI'Y OF TIGARD BUILDING INSPECTION DIVISION Q,/M
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested -6 7 0 d AM PM BLD
Location t 2-LA A � , d Suite MEC
Contact Person Ph (0C1— 1— 31 L3 ` ?000
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR I A
Footing Access:
Foundation FPS it 1 . �1
Ftg Drain
Crawl Drain Inspection Notes: SGN
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
PAS RT FAIL
UMBI G )
Post & Beam '
Under Slab ��
Top Out
Water Service
Sanitary Sewer
Rain Drains
4 PART FAIL
ANICAL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk `n 1
Other Date /3 v Inspector
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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AUG 29'00 14:27 FR TVBS CORPORATE TO 6243981 P.01/03
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BuP
Date Requested i - f k AM. I 8 06 PM BLD
Location / 2 61 1 4 Su, se, ; 1 G. , 1 c+ a . Suite ME •
Contact Person Ph 7-3763. LM 4 2 &co. - Gv r c/ G
Contractor Ph SWR
Tenant/Owner ELC
Retaining Wall ELR
Footing - ; .--. -• ., r ;...£; __ -... 1 "' - `'1 �,. `'Z FPS •
Foundation ..; „ �- ' , (. t ., �? '; ' r_`t r •' ,ti , d .'a..
Ftg Drain ;, r L T.:-,. _ - SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Fact Sheath /Shear
Framing Shear — � E L � - 0 rte . f
n9
Insulation r+ ,,� f� �o t t Qf � . C�� .
Drywall Nailing �+ v� V
Firewall
Fire Sprinkler �^
Fire Alarm 1 �. Y ( r
Susp'd Ceiling � - 1 X-1/1 fA•' /'�
c"....)
Roof tn �---• 1 - -' C. --� C,... 1 'R (�
Misc: Y �G` ��` -
Final U C `+- 0--'' r v \(�..Z...v'∎; - C
P $g,� •.PA . FAIL ` \ A I a J`�
-rte t C G- -
Post 8 Beam
Under Slab g p .. Nu 0 _ - 17: , k.
Top Out / - J
Water Service LO 2--4 7-, C.��cy i - ,
Sanitary Sewer ,
- Drains it) , A iv."
F- S PAR FAi
! g0.1ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELR RiGA1. -
Service
Rough In
UGISlab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SffE `":::.,-J ... ... .
Backfill/Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line i Please call for reinspection RE: [ ] Unable to inspect - no access
Fire
ADA ..3\c)
Approach/Sldewalk Date g) 1 V 0 v Inspector v V Other «!
Final
PASS PART FAIL • DO NOT. REMOVE this Inspection record, from the • job site...
•