Permit CITY TIGARD PLUMBING PERMIT
• I;A DEVELOPMENT SERVICES PERMIT #: PLM2000 -00059
�'I I - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/28/2000
SITE ADDRESS: 15683 SW SUMMERFIELD LN PARCEL: 2S111 DC -05100
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 351 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 1 sink, 1 tub /shower, 1 washing machine and 1 gas water heater conversion in single family dwelling.
FEES
Owner:
Type By Date Amount Receipt
LAMAE BATES PRMT KJP 02/28/200C $50.00 00- 321864
15683 SW SUMMERFIELD LANE SPOT KJP 02/28/200C $4.00 00- 321864
TIGARD, OR 97224
Total $54.00
Phone 1:
Contractor:
CROUCHLEY PLUMBING
• 8717 N LOMBARD ST
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone 1: 503 - 286 -4431 Top -out Insp
Reg #: LIC 00001184 Final Inspection
PLM 26-21PB
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 co ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: /1• \ Permittee Sign • . _
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY O€sTIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Recd
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# FI.M - u0os2
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job i u m .a . 2 J -+L 0 Sink / 11.50 / /,f0
Address Street Address S v ,..--.. , uitte Lavratory 11.50
6
/ ,f if Sw L fu L Tub or Tub /Shower Comb. 11.50 I /
Bldg # City/State Zip Shower Only 11.50
Name
G� 7.--i, �� ,, 7 s Lf- Water Closet 11.50
/ -? o .� / --- 2a •G1 /3o 77...r. Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
e . - +-- - -� Garbage Disposal 11.50
City/S Zip Phone Laundry Tray 11.50
Name Washing Machine / 11.50 it 50
----- Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Addit�s 4 Suite 3" 11.50
City/State Zip Phone 4" 11.50
Water Heater i1i( conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit. / a 3
N me
ad c/ C k (✓ y/ pe (T- er) MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00
2.7 / 7 ,t/ le y v „ y Hose Bibs 11.50
Prior to.permit City/State Zip Phone Ecq Roof Drains 11.50
issuance, a copy Pr' /> P cJ AI-6 -0 ?/
Drinking Fountain 11.50
of all licenses are Oregon Const. ' / Cont. Board Lic.# Exp. Date
required if / / � Y ,•' 7-6- Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database "- T / ✓ ' /'' 010 07
Name
Architect Sewer -1st 100' 38.00
•
or Mailing Address Suite Sewer - each additional 100' 32.00
C ity /State Zip Phone Water Service - 1st 100' 38.00_
Engineer 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: YesV No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0 Commercial Back Flow Prevention Device 32.00
Additional description of work:
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 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 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. f /o d o ,
re of Owner /Agent Date, o
., �/ :Z ( / O O 8 /o SURCHARGE
C ct Person Name - Phone 3. 6F
Contact
r1. ?PG - V-V1/ "PLAN REVIEW 25% OF SUBTOTAL
1- BATH HOUSE $178.00 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 Preventi CF '
100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
• "A11 New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:IdstsVornstplumapp.doc 12/17/99
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:
I:tdstsVo ms\plumapp.doc 12/17/99
r
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / 0 8 AM PM BLD
Location / S ( g ?, .- i i4/v,irrt.e/L,j.r;'i Suite GPA , MEC
Contact Person rv/ Ph PLM L D O r � OOO j
Contractor Ph --R' &/4,3/ SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing T7 /
Foundation CCeS 144 � ` D , ,j9 � (/� � °QO1C r FPS
Ftg Drain LA lel'' SGN
Crawl Drain Inspection otes: �
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm / ../..-/V;
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING `
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
PAS PART FAIL
1VIECHANICAL
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 l 1 o
Approach /Sidewalk Date ( 7 In spector � f 1 I (,Q_- J pV Ext
Other liD i
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 • Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location I 560g 3 311 ft A C%Ljite MEC 2 - OW S /
Contact Person (Y1 b1") / Ph Zga --6/q3/ PLM 2 ��
Contractor Ph 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 ' L _ ,' y
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
P�uMBING j
Post
Under Slab
p Out
Wa er Service
Sanitary Sewer
Rain Drains
Fin.
- -11LT EARL FAIL
ECHANIC
Post & Beam
Smoke Dampers
Fi..
rte,, 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 ?i /lJ 0 Inspector ( Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.