Permit C ITY OF TIGAR I G I N A L PLUMBING PERMIT
/er DEVELOPMENT SERVICE - R PERMIT #: PLM2000 -00242
- - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/00
SITE ADDRESS: 16500 SW 72ND AVE B -07 PARCEL: 2S113AA -00900
SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: I -L
BLOCK: LOT: OOD JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B 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: Building Water Service
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT DST 6/28/00 $50.00 0003345
15350 SW SEQUOIA PKWY #300 -WMI
5PCT DST 6/28/00 $4.00 0003345
PORTLAND, OR 97224
Total $54.00
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Water Service Insp
Reg #: LIC 172
PLM • 26 -83PB
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: it - Permittee Signature: �� • /
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 ft __
13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, Of 97223 Date Recd is ?.7 ov
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Ai
Incomplete or illegible applications will not be accepted Permtte 'I atm - eVo?5(0 - 1
Related e
Called
Name of Development/Project FIXTURES (individual) - QTY PRICE AMT
Job _. L 5 E.i ) k, Sink 11.50
Address Street Address 41 Suite Lavatory 11.50
/4 5O® S t� ? Tub or Tub /Shower Comb. 11.50
Bldg 0 City /State Zip Shower Only 11.50
Name /�
- 776- cl -`'t' � � Water Closet/Urinal (Specify) 11.50
r'y /
� Dishwasher 11.50
Owner l Maili Address Q Suite . 3� Urinal 11.50
/55 > 2 ' .514 S4 both- r I Lt' + y Garbage Disposal 11.50
"Ti City/State 6-0414d 9 Zip one
7a,1 9.1-1-b 3o 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 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
D g A /` - , 1 1/Va � l�d+r✓ MOJ PhAer MFG Home New Water Service 28.00
Contractor Mailing Addreesss i USuite MFG Home New San/Storm Sewer 28.00
3 L t\ SE )3 Hose Bibs 11.50
Prior to permit C jty/ ?Q . ( j) p Phone c � Roof Drains 11.50
issuance, a copy YY py G� a ^�` °�
Drinking Fountain 11.50
911 licenses are Oregon Const. Cont. Board Lice Exp. D to
required if D /7a /a a3itx Other Fixtures (Specify) 15.00 ate
expired in COT Plumbing l.icc 8 3 Exp. 3%
database �
Name
Architect Sewer - 1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' \ 32.00
Water Service • 1st 100' /6o 38.00 -38 -
Engineer City/State Zip Phone Water Service - each additional 200' 32.00
Des be work to be done: Storm & Rain Drain - 1st 100' 38.00
Nev Repair 0 ReplaVth like kind: Yes 0 NpAC Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial
Additional description of work: Commercial Back Flow Prevention Device 32.00
i3 , /► �, ^� 5 o` Residential Bax�xflow Prevention Device' 19.00
('-- `���[ ° �� • 1 �� Catch Basin 11.50
Are you capping, moving or placing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No Inspections per/hr
If yes, see back of form to indica 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 1 have read this application, that the information Isometric or rises diagram is required if Quantity Total Is > 9 /9
given is correct, that I am the owner or authorized agent of the owner, and
'
that plans submitted are in co lian•= with > • : State Laws. 'SUBTOTAL'
Signature of OwneNAg j Da/ ! ex 8% SURCHARGE es
Contact Peron IV!✓ //'�/ .. !A �
c.� � �-7 /1 "PLAN REVIEW 25% OF SUBTOTAL
., : ., I l 1 _ .. . - - Required only If fbdxue qty. total is > 9
TOTAL
_ 9,40
..,,,,.,„,,5„.....„.,-,.f.,,.,,,,
• r :x , ; ,
..,;.1'.1 - 2. ' , .. k r ' ; ), : ' . ; �v. S 'Minimum permit fee is $50 + 8% surcharge, except Residential Bacldlow Prevention •
..1.: Yj / n.. + 1 ,r r,. 1' t. 7: 7:11..:,11 ,. ';'.',1),` : Device, which is $25 + 8% surdfarge
"AU New Commercial Buildings require plans with isometric or riser diagram and
plan review.
tldstslrormslpl mepp.d c 1011/99 - -
•
PLEASE COMPLETE:
• Fixture Type • . Quantity by Work Performed l
New Moved 1 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:
•
tldslsVormslplumap9.doe 1011199 -
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -417
BUP
Date Requested e-/0 AM PM BLD
Location /605 -54/ 2 2- Suite 7 MEC
Contact Person Ph _2.5 — Y 5 - PLM - 60,2 C/
Contractor Ph SWR
BUILDING Tenant/Owner � � � _„,2-01t 3 C 2 l/ ELC
Retaining Wall 6 Q .p)-e IC J 7 • 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 Q i
Firewall `� Fire A Fire Alalarm cilY
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
Post & Beam
Under Slab
To � Out
Sanitary Sewer
Rain Drains
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date ` `� " Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.