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Permit CITY TIGARD PLUMBING PERMIT �r+� DEVELOPMENT. SERVICES PERMIT #: PLM2000 -00134 c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/01/2000 SITE ADDRESS: 12745 SW WALNUT ST PARCEL: 2S104AD -01200 SUBDIVISION: BELLWOOD ZONING: R -4.5 BLOCK: LOT: 003 JURISDICTION: TIG 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: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 100 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace and repipe existing water lines. FEES Owner: Type By Date Amount Receipt WILLENBERG, ROBERT T + JOYCE G PRMT GEO 05/01/200C $50.00 0001796 12745 SW WALNUT ST 5PCT GEO 05/01/200C $4.00 0001796 TIGARD, OR 97223 Total $54.00 Phone 1: Contractor: CROWN PLUMBING 23172 SW STAFFORD RD TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone 1: 771 -9449 Water Line Insp Reg #: LIC 000042 Final Inspection PLM 34 -70pb 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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued By : Permittee Signature: Call (50 ) 639 -4175 by 7:00 P.M. for . - inspection needed the next business day CITY OF YIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIGARD, OR 97223 Date Recd - (503) 639 -4171 Y /q .-------- Date to P.E. Print or Type Date to DST Permit #PIMPBmo x/3 Incomplete or illegible applications will not be accepted Related SWR# Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job Sink 11.50 Address Street W t treet Address Suite Lavatory 11.50 / a 7 tf5 3 LA/ ( APA-i / Tub or Tub /Shower Comb. 11.50 Bldg # City /State Zip Shower Only 11.50 Nam Water Closet/Urinal (Specify) 11.50 k n. 6 -a. -1 w 7 Hew (per q Dishwasher 11.50 Owner Mailii Addr s s Suite �J Urinal 11.50 / `f5 5 L L I tv« ( Garbage Disposal 11.50 Cit Zip 9 Phone �� a } 2-3 Laundry Tray 11.50 NaM Washing Machine /Laundry Tray (Specify) 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 Name Pia piping requires a separate mechanical permit. C- k-v -ryfi W. / D R A Cv"c�w •v Pia . c.i• MFG Home New Water Service 28.00 Contractor Mailing Address Suite MFG Home New San/Storm Sewer 28.00 5" x9 5 r, 6 4-cr 5 Hose Bibs 11.50 Prior to permit C /State Zip Phone Roof Drains 11.50 issuance, a copy f✓r+I _ /► O A ?72-C k 77/ -9y y y Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if ya(e / 06- e cfv Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date database 3 y-?t P tj oho - )-de.) 0 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 2 c- c' Engineer Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New g Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 11) Commercial 0 Commercial Back Flow Prevention Device 32.00 Additional description of work: n • Residential Backflow Prevention Device* 19.00 (,&f 5-eV. V c..<._ cy1..e,X f 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 , - Y I hereby acknowledge that I have read this application, that the information Isometric or nser diagram is required if Quantity Total is > 9 J v 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. 4 Si natu of ner /A e t Sig lst ' .1V\ Date S_,-) _ CO 8% SURCHARGE Contact Person Name Phone IA , t/N� VIA et tf f 41 Ivt T7/ 999 7 **PLAN REVIEW 25% OF SUBTOTAL V Required only if fixture qty. total is > 9 BAt 'OUSE ` , 78 OOa TOTA A OUS 250.00 , 4 j OUSE 28 0 ;- tY, _ ',* i s �a oil , b ( tw. a 'oiling e nd a first, *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention fee of Mal„ sewer alez= _ ervice s 4 ' ` = 1 Device, which is $25 + 8% surcharge **AII New Commercial Buildings require plans with Isometric or riser diagram and plan review I ldstsVormstplumapp doc 10/1/99 - - PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Dishwasher Urinal Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Floor Sink 2" 3" 4" Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE • I ldsts formstplumapp doc 10/1/99 CITY OF TIGARD BUILDING INSPECTION DIVISION • MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 / BUP Date Requested S/ 2-/©0 AM PM BLD Location I �� ((( Suite MEC Contact Person int T1' Ph S " 3?) PLM ?,Q -col 3 tf Contractor Ph - ? - 2/ - ?y L/ 7 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 �LUMBIN?a) Post & Ieam Under Slab Top Out a er Se e Sanitary Sewer Rain Drains 0 : 1 PART FAIL 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 A . Inspector 12 Ext Final PASS PART FAIL DO 'OT REMOVE this inspection record from the job site.