Permit CITY OF TIGARD
PLUMBING PERMIT
0I n DEVELOPMENT SERVICES PERMIT #: PLM1999 -00334
- ..��! 13125 SW Hall Blvd., T OR 97223 (503) 639 -4171 DATE ISSUED: 10/15/1999
SITE ADDRESS: 11255 SW WILLOW WOOD CT PARCEL: 1S134AC-02616
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R -4.5
BLOCK: LOT: 173 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: 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: Install a new gas water heater for an existing dwelling.
FEES
Owner:
Type By Date Amount Receipt
REIMEIER, HAL H DENISE A PRMT DST 10/15/199. $50.00 99- 319112
11255 SW WILLOWWOOD CT SPOT DST 10/15/199. $4.00 99- 319112
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor: •
MT TABOR PLUMBING
13324 NW GLENRIDGE DR
PORTLAND, OR 97229 REQUIRED INSPECTIONS
Phone 1: 646 -8512 Misc. Inspection •
Reg #: LIC 00011094 Final Inspection
PLM 34 -358PB
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: "72 2-
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#
13125 SW.HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 1 Date Rec'd
(503) 639 -4171 D to to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be pied Permit #.��''''/�rQ9 6a•33V
Related SWR #
Called
Name of Development/Project FIXTURES (individual) • QTY PRICE AMT
Job Sink 11.50 _ -
Address Street Adaress 14)/a,c4 /Woof Suite Lavatory 11.50
I / 2-5 C-T". _ Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip Shower Only 11.50
1 G � Water Closet/Urinal (Specify) 11.50
Name i6' 6 / � i �
` c- Dishwasher 11.50
Owner Mailing Address Suite Urinal 11.50
Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Name 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 conversion 0 like kind / 11.50
Gas piping requires a separate mechanical permit.
Name
'nn o PL E6- MFG Home New Water Service 32.00
•
r! t't
Contractor Mailing Address Suite -
MFG Home New •San/Storm Sewer 32.00
13 /at/� -1Pi Hose Bibs 11.50
Prior to permit C•1y /State Zip Phone • Roof Drains 11.50
issuance, a copy 012 7 1 A - MO Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Licit Exp. D. to
required if 11 41' S / OV Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # e V /6d
database 3V- 3S" Pe
Name
Architect 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 3161 ne: Storm & Rain Drain - 1st 100' 38.00
New 0 R air Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential A) Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
IA) H ! Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are you capping, mo��{ng or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes /I�) No 0 Inspections per/hr
If yes, see back of orm 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 i mpliance with Oregon State Laws. 10
Signature of Owner Date O / ,
8 /o SURCHARGE /, ..-.7 Contact Person N ? - 0-C 7 Z -PLAN REVIEW 25% OF SUBTOTAL 1
1 BATH HOUSE $178.00 / Required only if fixture qty total is > 9
'2 BATH HOUSE $250.00 TOTAL `) a' 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 Prevention
000 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
• "All New Commercial Buildings require plans with isometric or nser diagram and
plan review
I doc 10/8/99 - - --
•
7
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:
(.0/1/ d - e Si o n/
I dstslfortnslplumapp doc 10/8/99 -
CITY OF TIGARD BUILDING INSPECTION DIVISION • MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
UP
Date Re uested // �'( AM /1 S (�PM BLD
Location //e2-53 OCd-I C 2) d C_ Suite EC / 99 C - oZ)3 77
Contact Person ijk) Ph tq'1Ctct - (30334
Contractor (( Ph SWR
BUILDING Tenant/Owner ELC q19- 00 0 e1
Retaining Wall ELR
Footing - /� /
Foundation �C/ (, S D� � ,��- FPS
Ftg Drain \
Crawl Drain I Cti0g1 CVO eS' IL - WV SIT
N
Post & Beam � f I �r- �u+ '� �LI.��Y+�t.hti►1a -
Ext Sheath /Shear 6L.eG
Int Sheath /Shear
Framing \ ` L =1= = —L3 - `tt ( ` ' U UL) Cam(- -T r '� J —
Insulation
Drywall Nailing
Firewall
Fire Sprinkler n
Fire Alarm , V :� `�'�1 DO Il Q-1—r( /� \ &fa �C� C ∎i � —
Susp'd Ceiling �1 . \ 2-e_ Q
Roof `VL ZL.L� e _� � �l e... �2 r/\
Misc:
Final W� C
RT FAIL
LUMBIN
Pos eam
Under Slab ' 1
Top Out to n /� C L^ 1 V ,p.. e_
Water Service t►` L' `�Ci� `1 1 l � 7�� j � �� � 1�' (� � l
Ra
Sanitary Sewer
/A---V\ {i C 7A. s Q \
Ra' Drains (� � � � G� /
PASS BART,, FAIL
fECHANIC
PosT&geam
Rough In
Gas Line
Smoke Dampers � (� V lA A /f1/1 /k
S PART (FA115
�/`/�n 1 X � L-/1/-\ 6 ',
ELECTRICAL n A / -
Service (L - C �(.L/� / \ -Pzi W` e-c ` vvv 5
Rough In
UG /Slab
Low Voltage \/�
Fire Alarm �?"7 LAck.-- v.v. v v- > -
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 /J ` �
Other Date I I �/ Inspecto Y (A Ext,
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.