Permit CITY TIGARD PLUMBING PERMIT
A. DEVELOPMENT SERVICES PERMIT #: PLM2000-00147
'�' '��I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/16/2000
SITE ADDRESS: 16160 SW UPPER BOONES FERRYRD PARCEL: 2S113A6 -00600
SUBDIVISION: BAISII O CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 2 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install two (2) commercial sinks, two (2) water heaters, and a 3" floor sink. See SWR2000- 00098.
• FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT GEO 05/16/200C $57.50 0002214
15350 SW SEQUOIA PKWY #300 -WMI 5PCT GEO 05/16/200C $4.60 0002214
PORTLAND, OR 97224
Total $62.10
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Rough -in Insp
Reg Underfloor /Underslab
eg #: LIC 00000172
PLM 26 -83P6 Final Inspection
•
OR ° A � -
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: .lj�,� / Permittee Signature:
Call (50,39 -4175 by 7 :00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check 4
13126 HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd 1 7 - .'" 26619
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit W R #2 O - V9
Related SW #2 DOD - ccO y8'
Called
Name of Development/Project FIXTURES (individual) /� � QTY PRICE AMT
Job A �T� �
0 - Sink 11.50 a3
Address Street Address ` Suite Lavatory 11.50
/ fc 1(0 S ui imPPe4 13ooi6i as F y. Tub or Tub /Shower Comb. 11.50
Bldg #_ City /State Zip Shower Only 11.50
T 6-AI Water Closet/Urinal (Specify) 11.50
lipme
Aerie. v..51-- Dishwasher 11.50
Owner Mailing Address 5 eAst%Ao► Suite Urinal 11.50
! 33 co se.) P K y 300 Garbage Disposal 11.50
City/State /State Zip Phone
7 6-h ►A ‘R gi "' 4e 3oo Laundry Tray 11.50
Name Washing Machine /Laundry Tray (Specify) 11.50
642. Suite 3" � 11.50 I I p� Floor Drain/Floor ' 2" 11.50
Occupant Maili Add `' _ , /� C
J
% ____'" 4" 11.50
City /Stat / Zip Phone
Water Heater 0 conversion 0 like kind 11.50 pp
Name Gas piping requires a separate mechanical permit. a3
t EA A.J 14)A. 4 a Cr. i 6 V MFG Home New Water Service 28.00
Mailing Address Suite MFG Home New San/Storm Sewer 28.00
Contractor 3u% S E ! 3 Hose Bibs 11.50
Prior to permit Ci /State Zip erla �a Phone Roof Drains 11.50
issuance, a copy oet,rLR
�d1 a3/9 1 -1/5 R Drinking Fountain 11.50
ill licenses are Oregon Const. Cont. Board Lic.# Exp. ate
required if d t ? � 1A 23`0 0
Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # /� Exp. Date
database a (.43 Pe & 3o f o0 g
Name
A rchitect 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
NewX Repair 0 Replace with like kind: Yes 0 No g Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 1 4 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 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 - �O
that plans submitted are in compliance with Oregon State Laws. 5-7 �-
Sig wnef(Agen Date 8% SURCHARGE 60 Contact Person Name Phone
L i
&L. E Aet✓ 234-4 sa **PLAN REVIEW 25% OF SUBTOTAL
HODS ti 78x00 ,.: if z :!1`.! Required only if fixture qty. total is > 9 TOTAL
- Y � iela,C 2- ' 0 ti Ai
uNiiJ. G O 3 00 t
. u b ti res e dwelling and a fr *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
'_ CiT s . nn, sewer a id wa , service) b Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
l' .--) n c L(.) 41S4- plan review.
I ldstsformstplumapp doc 10/1/99 O / cX)C7 , _ _ - _
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
Sink a
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
R-o00- SINK 3"
4"
Water Heater ( p . T'kt 4. TYPt) vl
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
p_ l c--
/ 0
,,/
0009 -4 q �--
I.Wsts formstplumepp doc 10/1/99 - -
CITY OF TIGARD BUILDING INSPECTION DIVISION J MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 5/2 AM /S / PM BLD
Location IC.p I CO O LI Pper _ MEC
Contact Person alai/ Ph 2/1.40' 'I/ S9, PLM 7iO0 — CY)/ q 7
Contractor t _ ,,/)Ph SWR
BUILDING Tenant/Owner j(1T` ELC . Retaining Wall U ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: VI / jr f / Slab "I SIT
Post & Beam U 2 q / 3
Ezt Sheath /Shear v 7
Int Sheath /Shear ��,, _ems
Framing p,GC.c SS
Insulation
Drywall Nailing
Firewall
Fire Sprinkler witin"P-44i■
Fire Alarm •:
Susp'd Ceiling _
Misc: d� iftli'W ` ��
Final
PASS PART FAIL
Adak
os
nder eam Q 0v�%� ve
Top Out
Water Service v/ � • ����' • i i�� ...-
Sanitary Sewer 7 ����MB F
Rain Drains 11
� /_� i r'�ju►�� /
( F dit) FAIL � •_i e
7' A � 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
(3)„...)
ADA Approach /Sidewalk Date "4 Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING.INSPECTION DIVISION •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested y AM PM BLD
Location 4/ 6o Sw 60 -eA g& 5 r�� ✓ y Suite *f C-- MEC
Contact Person �/ Ph 23 V/C - PLM ,?Gvd ' UO /97
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
Firewall •
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
(P LUMBING
ost t Tea
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
PART FAIL
iiTTJJ HANICAL
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
Other Date i Inspector /7 /71 Ext
Final
PASS PART FAIL DO OT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 6394171
BUP
Date Requested AM PM BLD
Location / e-/ C 6 - ctA/t4-, & - 11-) A' y Suite MEC
` /
Contact Person J).o C.J4 vri �► -' Ph D` 3 6' �t' ( 5 Z `' PLM -2-pvv_ ti //7
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspect'. y tes: / SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -�
. Fire Alarm / „AW/ M
Susp'd Ceiling �1�� -
Roof
Misc:
Final
PASS PART FAIL l_
P L U MBING ) Afr, /
Post & Beam
Under Slab
Top Out f � � pc, /y«
Water Service
Sanitary Sewer
Rain Drains
Fin l
PART FAIL
WCTIANICAL •
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
Other Date 6 Inspector 0 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.