Permit ,4 CITY OF TIGARD PLUMBING PERMIT
eIa DEVELOPMENT SERVICES PERMIT #: PLM2000 -00365
A.14-. II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 10160 SW WALNUT ST PARCEL: 2S1026C -01102
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 028 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: New gas water heater
FEES
Owner:
Type By Date Amount Receipt
RESHEY, JOSEPH A AND PRMT CTR 9/28/00 $72.50 27200000000
MARILYN L
10160 SW WALNUT 5PCT CTR 9/28/00 $5.80 27200000000
TIGARD, OR 97223 Total $78.30
Phone 1:
Contractor:
ENERGY MASTERS INC
7470 SW 76TH
(SUB'S CCB EXPIRES IN 1/2001) REQUIRED INSPECTIONS
PORTLAND, OR 97223
Phone 1: PH 244 -8880 Final Inspection
Reg #: LIC 00058556
PLM 26 -476PB
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: T- Permittee Signature: / / / ( Za
Call (503 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
- 13,125 SW HALL BLVD. Commercial and Residential Recd By Il ibi
Date Recd Z. 00
TIGAIID, OR 97223 Date to P.E.
(503) 6394171 Date to DST
Permit #p n t apoo 1o3(
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (individual) Qty Price Total
Job Sink 16.60
Address r0 1 Address l �� Wi ` . _ Ielile Lavatory 16.60
l :0 IA " � Tub or Tub /Shower Comb. 16.60
Bldg # Stat
jrA O E- 1-7 2-73 Water Only 16.60
( Water Closet 16.60
itov I h
Res P� 7 k / Urinal 16.60
Owner Mailing Address) vii . �1 1L'� ISsuLe Dishwasher
- 16.60
� �� Garbage Disposal 16.60
Cirtate c eip , Phor _� Laundry Tray 16.60
Na ' Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
Occupant Mailing Address Suite 3" 16.60
4° 16.60
City /State Zip Phone .
Water Heater nversion 0 like kind l 16.60
Gas piping req ires a separate mechanical permit. 1(0- V)
N A n �S I k MFG Home New Water Service 46.40
Contractor MaiJIq�P�Qdfe��ss 1 � � Suite MEG Home New San/Storm Sewer 46.40
(( �y{-� (( ((�� ;�1 Hose Bibs 16.60
Prior to permit rite ,Z ip ' Phone C 6 y O�.J Roof Drains 16.60
issuance, a copy 19 C) 172? ��ti�Lf4_ Drinking Fountain 16.60
of all licenses are Or o . Board Lic.# Exp e
required if 1 Z-( Other Fixtures (Specify) 21.75
expired in COT Plumbing Lic. # 1 .D (e�
. database -4=7 (p P8 (/
Name
Architect Sewer- 1st 100' 55.00
or Mailing Address Suite Sewer - each additional 100' 46.40
Engineer City /State Zip Phone
Water Service 1st 100' 55.00
Water Service - each additional 200' 46.40
Describ��yprk to be done: Storm & Rain Drain - 1st 100' 55.00
New O ep 'r 0 Replace with like kind: Yes 0 No) Storm & Rain Drain - each additional 100' 46.40
Residen ial Commercial 0 Commercial Back Flow Prevention Device 46.40
Additional description of work:
6 -F O__J:Ft4 JeVS T Residential Backflow Prevention Device' 27.55
1 Catch Basin 1 5.60
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 72.50
Yes 0 No 0 Inspections per /hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 65.25
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 16.60
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 complia with O on State Laws. *SUBTOTAL - P 6 - 1) Sign t o e p/ e t
i �4 L Date
CI _ 7-1-0-Z, 8% SURCHARGE /o
�
CoQ ct Person yatne � Phone
j (eX "PLAN REVIEW 25% OF SUBTOTAL
f BA HOUSEr$249120 Required only if fixture qty. total Is > 9
SHOUSE 350.00__ TOTAL .,{j;30
�)C HOUSE $399:00` BOO
wittm includes all . lumbing SittilaDthe dwelling and the Ora, . •MlnImum permit fee Is $72.50 + 8% surcharge, except Residential Backlow Prevention
' ( is c 0 Itr"toy :X:t ?[ l S 4LJ } €(S).0 T/ ) Device, which is $3825 + 8% surcharge.
"All New Commercial Buildings require plans with isometric or riser diagram and plan review.
I.tdstslformstplumapp_rev.doc 9/8/00
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 ldststfomtstplumapp rev.doc 9/8/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 - Lour Iitispection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested i ( AM / 3PM BLD
Location /0 / 4 S wa 4 t.tj Suite ` MEC
Contact Person Ph 563 _ t y7 � - 66 �v PLM .2
Contractor • Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: ' � / ' "4—r<4. S TN
Slab vv
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
PLUMBIN
Best & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
in
SS RT 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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 1 l _
Other
Date 1 (/\ / 0 d Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.