Permit CITY OF TIGARD PLUMBING PERMIT
. ce DEVELOPMENT SERVICES PERMIT #: PLM2000 -00254
.411-1J, 13125 SW Hall Bl vd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/06/2000
PARCEL: 2S105DD -01300
SITE ADDRESS: 14885 SW SUNRISE LN
SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: URB
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: Water Heater Conversion
FEES
Owner:
Type By Date Amount Receipt
CASH, DWIGHT C PAULA L 5PC2 JMT 07/06/200C $4.00 0003504
14885 SW SUNRISE LN PRM4 JMT 07/06/200C $50.00 0003504
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
GL HEINTZ HEATING & COOLING
20871 SW 216TH PLACE
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 625 -6798 Rough -in Insp
Reg #: PLM 34 -309PB
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.
i
Issued By: T Q Permi t tee Signature: �/ . A • /:�
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the nex , • I siness d-
,
CITY 14TIGARD Plumbing Permit Application Plan Check#
13125 MV HALL BLVD. Commercial and Residential Cp± Rec
TIGARD, OR 97223 Date d Rec '�J 7� 7 - 00
(503) 639 -4171 / Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be a ccep ed Permit # P!_/1? 7,k 90
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Street Address , Suite Lavatory 11.50
/MI ,SjjJ lie Z.4 e- Tub or Tub /Shower Comb. 11.50
Bldg # Sill/State Zip Shower Only 11.50 SI �/ f�ity� �� - Water Closet
V) /s 11 7 11.50
` l Urinal 11.50
Owner M Address Suite Dishwasher 11.50
// W ✓ C � fJh71 SC tt G Garbage Disposal 11.50
_gay /State Zip dY Phone
/,,.4na ( 9 .S16- 2 n Laundry Tray 11.50
Naaarr Washing Machine /Laundry Tray 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
City /State Zip Phone -
4" 11.50
Water Heater conversion 0 like kind 11.50
Narne
Gas piping requires a separate mechanical permit.
61. Ilei* le 14-0- e ao/ 4 f MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00
�7 ( ,5I) ,,2/61/11 /t Hose Bibs 11.50
Prior to permit CU /State Zi �j �/ Phho / Roof Drains 11.50
issuance, a copy t/I(,.JQ#Q' t' 7/7 u ( S / 71(
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if /02 g3 r /I -4- 0 v Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database 3(/_ 309//,8 /0-3/ -00
Name
Architect Sewer - 1st 100' . 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Engineer City /State Zip Phone Water Service - 1st 100' 38.00
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 "Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
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.
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 compl'. nce with Oregon State Laws. *SUBTOTAL Ov
Signatu of O .• ne Dat- '
- s� /AM OS 8% SURCHARGE 41 6°
Contact. Person P on• I
6M41 . • LL 7 - jW * *PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOU$ $ 178:00 , „ " fit rr " ' Lt _' Required only if fixture qty. total is > 9
r� f ,: =_
E t2ATH ' B HO O0 ,' " :4 -0 4 . , r a 1� '.4: i l TOTAL 54 1 01)
:3 BATHHOUSE $285 00 • 't : ; *3F °'`' "
(This fee lnc lu all'plu b ixtures; in y theo dwelling and the first , permit tee is $50 + 8% surcharge, except Residential Backflow Prevention
100 0 feet,of�se ltary; sevverstormsew _er. „waterservlce) i ; 4, Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometnc or riser diagram and
plan review.
I \dsts \lorms\plumapp doc 11/18/99
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Remove d /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
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
'' 24 -Hour Inspection Line: 639 -4175 - Business Line: 639 -4171
f 42 W Date Requested DD AM PM BLD
Location 5 14.1 ttoi i -e Li., Suite MEC ✓. M i 0 21/
Contact Person / / ' ' DGJ Lq t 4 Ph () PLM 24120_612
Contractor Ph SWR
BUILDING Tenant/Owner ELC ZOO X034
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ���� yy
Slab (/t/�. i( /*/
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
LUM
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
u se , - • - ♦
41.c % PART FAIL
` IPAL
Po :eam
Ro In
Smoke Dampers
JYlo
4211 PART FAIL -
M , L r �
Service
Rough In 1�
UG /Slab � Q
Low Voltage vN
Fire Alarm
PART FAIL
SITE \ ��
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 7// 3 / � �) CJ(/ Inspector / c ?- 7 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.