Permit r.-_)
A CITY OF TIGARD PLUMBING PERMIT
j" DEVELOPMENT SERVICES PERMIT #: PLM2000 -00229
� - 13125 SW Hall Blvd., Tigard, O 97223 (503) 639 -4171 DATE ISSUED: 06/20/2000
SITE ADDRESS: 12125 SW SUMMER ST PARCEL: 1S134CB-00300
SUBDIVISION: SUMMER HILLS PARK ZONING: R -4.5 ,
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: OTR 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: ft
WATER CLOSETS: WATER LINE: 98 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 98' of water service.
FEES
Owner:
Type By Date Amount Receipt
ZUFFREA, GREGORY J + MICHELLE PRMT DST 06/20/200C $50.00 0003123
12125 SW SUMMER ST 5PCT DST 06/20/200C $4.00 0003123
PORTLAND, OR 97223
Total $54.00
Phone 1:
Contractor: •
•
AMERICAN STAR PLUMBING
CHARLES ANDREW BUXTON .
PO BOX 66183 REQUIRED INSPECTIONS
PORTLAND, OR 97290
Phone 1: 238 -1919 Water Line Insp
Reg #: LIC 131403 Final Inspection ___
PLM 26 -652PB
ORIGiNA •
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 ma obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issu . • = �,�!/ ,,�� ,� - Permittee Signature: -- •
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed he next business day __._
,
1
CITY OF TIGARD • Plumbing Permit Application Plan p ec � `�
13125 SW HALL BLVD. Commercial and Residential Rec'd`By r�m�9
TIGARD, OR 97223 Date Rec'd 6 7 too
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # � ctr -cog99
Related SWR #
Called
/ Nam n eof / D � e � velopment/Project FIXTURES (individual) QTY PRICE AMT
Job ( AO r// A- Sink 11.50
Address Street Address 5. Suite Lavatory 11.50
J 2} 75 ,c .rj Si,.v►nA02 Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip Shower Only 11.50
7 4:-.4.Q2) ' rZ
Water Closet 11.50
Name
(r , f2 nc:-- Urinal . 11.50
Owner Mailing Address Suite Dishwasher 11.50
sA-.A// f' 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
Gas piping requires a separate mechanical permit.
Name e[4,12,.45 At...p)21c.J -- 6c,kx7-0 t l MFG Home New Water Service 32.00
AM rTr ' r Q -.-' S T.4 R, P./ r),v1 771'G
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00
An Rn x ‘G i , Hose Bibs 11.50
Prior to permit City /State - Zip Phone Roof Drains 11.50
issuance, a copy y ' 7 0 Q es !Z 9 ,.., 2 9r� 2 . ' - / Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Ex Date
required if / 3 /4"? -// -00 Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # N _6 F6 Exp. Date g /5 0 •
database 3 9 '/ p 9
ame
Architect Sewer- 1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
En ineer City /State Zip Phone Water Service - 1st 100' / 38.00 s�'.au
9 Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 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 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
98 , Residential Backflow Prevention Device' 19.00
/ e/, - . 5 ft /e.-It a iz. re; T�L Catch Basin 11.50
Are you 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. QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information
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 Oregon State Laws. *SUBTOTAL 6b .e..50
`�L
Signature of Owner /Agent Date 8% SURCHARGE
jOd
Contact Person Name Phone ((
L uT//l{- 5' i , -TON G ri � 2,>` **PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00 I TOTAL i / 4�
3 BATH HOUSE $285.00 i 7
(This fee includes all plumbing fixtures in the dwelling and the first (
100 feet of sanitary sewer storm sewer and water service) 'Minimum permit fee is $50 + 8 % surcharge, except Residential Backflow Prevention
i Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I: \dsts \forms\piumapp.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"
3f
4 "
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I: \dsls \formsVplumapp.doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 6 °' / 2 cr AM PM BLD
Location / 2 / 2— 4 2 — t'/ c9 vv4 . — Suite MEC
Contact Person 6 1)'T (/ S e CC (i Ph 5 7 q / PLM 2a2CO - 002.2
Contractor 4 r1 44 t Cl h F ( tom Ph 23 q) -/c/9 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 C /r
Fire Sprinkler
Fire Alarm ..
Susp'd Ceiling
Roof f
Misc:
Final
PASS PART FAIL
UMBING
Beam
Under Slab
Top Out
(WMer Swiss
Sanitary Sewer
Rain Drains 1
� Fi
,.. r FAIL
H•V AL
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 Inspector h Ext
Other
Final
PASS PART FAIL D • NO REMOVE this inspection record from the job site.