Permit CITY OF TIGARD
•
// DEVELOPMENT SERVICES PLUMBING PERMIT
• .41.31- 13125 SW :Hall Blvd., Tigard, 0R97223(503)639-4171 PERMIT # ° ° ° ° . ° ° PLM9870304 -
• DATE ISSUED: 09!02/98 .
PARCEL: 2S101AA— 6400
SITE ADDRESS...: 12323 SW 66TH AVE
S U B D I V I S I O N . . . . . : WEST PORTLAND HEIGHTS ZONING: C —G
BLOCK LOT °024 JURISDICTION: TIG
CLASS OF WORK °° :ALT GARBAGE DISPOSALS.: 0. MOBILE HOME SPACES.: 0
TYPE OF USE :COM WASHING MACH ° 0 BACKFLOW PREVNTRS ° °: 0 ,.
OCCUPANCY GRP ° ° :B FLOOR DRAINS 0 TRAPS 0
STORIES 0 WATER HEATERS 0 CATCH BASINS. ° ° ° °. °: 0
FIXTURES LAUNDRY TRAYS.....': 0 SF RAIN DRAINS. °. ° °: 0
SINKS 8 URINALS° ° ° ° ° ° °o °: 0 GREASE TRAPS 0
LAVATORIES 0 OTHER FIXTURES 1
TUB/SHOWERS..: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 6 • WATER LINE (ft) ° ° ° : 0
DISHWASHERS : 0 RAIN DRAIN (ft).'° • : 0
Remarks: remove.and replace existing fixtures with ADA compatible fixtures. No
new fixtures to be added.
Owner: FEES
FARMERS INSURANCE EXCHANGE type amount by date recpt
12323 SW 66TH AVE PRMT $ 135 °00 GEO 09/02/98 98- 308794
PORTLAND OR 97223 5PCT $ 6.75 GEO 09/02/98 98- 308794
Phone #.:
Contractor
PREMIER PLUMBING •
17576 SW FARMINGTON
STE 443
ALOHA OR 9.7007.
Phone #: 642 -7868 $ 141 °75 TOTAL
Reg #. ° : 124547 •
REQUIRED INSPECTIONS
This .permit is issued subject to the regulations contained in the Misc. I n s p e c t i o n
Tigard Municipal Code, State of Ore. Specialty Codes and all other Drinking Drink Fount a i •
applicable laws. All work will be done in accordance with Final Inspection .
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
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- %01- 0010.through.OAR 952-0601-0080. You may -
obtain copies of these rules or'direct questions to.OUNC by calling •
(503)246-1987.
/ /
Issued B L/ Permittee Si nature: %D �A66, 4 4
y jam. �!�!� / /�.. 9 L
„_
++++++++++++++++++++++++++++++++++++++++++.+++++++ + + + + + + + ±- , + + + + + + + + + + + + + + + + + + + +"
Gall 639 -4175 by 7 :00 p.m.- for an inspection needed the next business day.
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + ++
•
CITY OF TIGARD Plumbing Permit Application Plan Check # _A " "' 41'11 i
13125 SW WALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # PGf�//�3 y
Related SWR # e jSS —0 ?7;,
Called
Name of Development/Project iFIXTU�RESrj (inclividuap aka 2;"A ,R:f4 rQT1FJ" PRIC AMT '
Job ,ej z . /�StJ /Z. Sink C7 9. 00 -7,2 y ,
Address 1 Street Addre Suite Lavatory
/,z, ?o23 flc) 6 T~ Tub or Tub /Shower Comb. • r
Bldg # City /State Zip Shower Only
Name T /e•-,4VaJ' (O Water Closet 9.00
Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
City /State Zip Phone
-
Floor Drain/Floor Sink 2" 9.00
Name 3 " 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray
Urinal 9.00
N a m p
/enilleiC� / /A/C- / Other Fixtur s(Specify) • ��
�Mj���(((
Contractor ailing Address Suite illa er Am mumwal 9 I� 1
/7675 Sw rf�i?A9/.0eT, yy 3 9.00
Prior to permit City/State Zip Phone Sewer - 1st 100' 30.00
issuance, a copy ,..9e y70 7 6 r' ',8'
Sewer -each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if / 7 e //...,' Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date q Water Service - each additional 200' 25.00
database 'j"•g y 9 . 7/9 G l - l - / - Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
per/hr
Are you capping, moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes O No O Grease Tra 9.00
If yes, see back of form to indicate work performed by
QUANTITY TOTAL 1;: :.,;.-;: '7.,.f:
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9 ,a' 4-
4::
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL t ' : `
1 hereby acknowledge that 1 have read this application, that the information . ' . 6 f ? . 1 a 4 3 °
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE ; - 34, 4 r
that plans submitted are in compliance with Oregon State ,P : : , �;
Laws.
Signal / / ure•oY Date **PLAN REVIEW 25% OF SUBTOTAL fT t k �'
„�•�' Required only it fixture qty. total is > 9 w % C�/
•—• / U y TOTAL t ( L , '
,,�..
c Perso ame Phone ,, _,•�
a .. < ,,.<.f
' N / - � /' / - /G /r \ / � 2 - 'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
( !l/ Prevention Device, which is $15 + 5% surcharge
**All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I: \dststplumapp.doc 7/2/98
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet r�
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
, �� 4,6444141
COMMENTS REGARDING ABOVE:
- 0,69-u4Ar
I:tdsts\plumapp.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
• BUP
1 50 6 D ate Requested - — ° i AM / ( PM BLD
Location vZ - . // �� /� uite MEC
Contact Person ��l.(��!l� -L' �h- Ph 3C r5 L 9? 1 / i!
Contractor Ph SWR
BUILDING Tenant/Owner ELC •
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
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
LUMBINGT
Post & Beam
Under Slab -
Top Out
Water_Se_ rvice
Sanitary Sewer — - -- -- -- -_- - -- .
()3 pin fl ins - - -- - _. _ -�' = =s✓.
ina •
PART 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date Cam/ ? 7) Ins Ext
Other / -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.