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Permit CITY TIGARD PLUMBING PERMIT 0 4 A11111 4 ' EVELOPMENT SERVICES DATE ISSUED: PERMIT # PLM2000 -00273 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11032 SW 81ST AVE PARCEL: 1 S136C6 08600 SUBDIVISION: HERB + PEGGY'S PLACE 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: 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: Conversion of waterheater from electric to gas. FEES Owner: Type By Date Amount Receipt JOHNSON, ROLAND J + PRISCILLA PRMT BLD 7/25/00 $50.00 0003952 11032 SW 81ST AVE TIGARD, OR 97223 5PCT BLD 7/25/00 $4.00 0003952 Total $54.00 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 I Issued By: Permittee Signature: ,' i II i 1 Y \ \ �. �1 / Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin • ss day , CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential • Rec'd By TIGARD; OR 97223 Date Rec'd (503) 639 -4171 .• / 2 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit # � ° u>a0 - cn - Doa93 Related SWR # • --LCa. - JO yQ 9 Called Name of Development/Project FIXT `° _ Is QTY , PRICE AMT.` Job Sink 11.50 Address Street Address Suite Lavatory 11.50 i i 03 2 Q S I- Tub or Tub /Shower Comb. 11.50 • Bldg # Iiity/State 01 C ZC11ZZ Shower Only 11.50 ,Q & IIJJ�� Water Closet 11.50 0 8L-L\4 I ( /Lg O V1 Urinal 11.50 Owner 1( --.-:0 J ,-r Suite Dishwasher 11.50 ✓3 A A Garbage Disposal 11.50 City/State, . Phone Laundry Tray 11.50 T1 � 7u3 IRA-9 C23 e Washing Machine /Laundry Tray 11.50 Set-YY1, Floor Drain /Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11.50 4" 11.50 City /State Zip Phone Water Heater onversion 0 like kind 11.50 / Gas piping re uires a separate mechanical permit. ( I N Y1 e" y . Ste , ( " , MFG Home New Water Service 32.00 Contractor Mailing Addre Suite MFG Home New San /Storm Sewer 32.00 7470 51i -7 e+ ` Hose Bibs 11.50 Prior to permit t ,, p. Phone Roof Drains 11.50 issuance, a copy O � ? 2 23 Drinking Fountain 11.50 of all licenses are Oreg C gt Cont. Board Lic.# Ex Dale required if `y °` r -� 1 1 r 4 D Other Fixtures (Specify) 15.00 expired in COT - (c.., Plumbing L # 6 r Exp. at1 � v database 9- (c.., �" Name • Architect Sewer - 1st 100' 38.00 or- Mailing Address Suite Sewer = each additional 100' 32.00 En ineer City /State Zip Phone Water Service - 1st 100' 38.00 g Water Service - each additional 200' 32.00 Describe to be done: Storm & Rain Drain - 1st 100' 38.00 New Q( Repair 0 Replace with like kind: Yes 0 t�� Storm & Rain Drain - each additional 100' 32.00 Resint Commercial 0 Commercial Back Flow Prevention Device 32.00 Addition I description of work: .�._-�® 1 -e� e�-4 / F i i f ,iJ - Residential Backflow Prevention Device` 19.00 � Catch Basin 11.50 Are you capping, moving'6r 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. I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL 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 corn • e with Oregon State Laws. "SUBTOTAL E ? D 015 \ igrlas •f I 1e''91- D-7e Z_-U0 8% SURCHARGE q ..7� Co tact Person Na Phone "b` � ' oCI t tA.-t v � 10 e rt - 244 >6eO * *PLAN REVIEW 25% OF SUBTOTAL f, ` 1 BATH HOU b1 =78 00 j Required only if fixture qty. total is > 9 R 2 BATH HOUSE ;;�3t TOTAL 7 57 cr9 3 BATH HOU $285.00 > ; 0 (This fee includes, all plu fi xtures i n the dwellin and the first o -4 `Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prey ntion 100 fe0of s anitary * and water se'rvice)4,' Device, which is $25 + 8% surcharge `*All New Commercial Buildings require plans with isometric or riser diagram and plan review. I: \dsts \forms\plumapp. doc 11/18/99 • PLEASE COMPLETE: Fixt Type ° ' Quantity by Work Perforrn�ed I" .., ew> 4V, �e placedRemou /Ca ped i 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: \dsts \forms \plumapp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested F' 7 AM PM BLD Location // 3 L S'v if I Suite MEC Contact Person Ph a PLM ,„24-6f `L a 73 Contractor Ph 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 PLUMBING ost earn Under Slab A lIF A - AMPAIlr, Top Out / Water Service Sanitary Sewer Rain Drains Final PASS PART FIL MECHANICAL `- 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 �Y� Ext 1D7 Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested �y� AM PM BLD Location f/f 0 3 1 l Suite MEC Contact Person Ph f'IZ.3 PLM 1"C' G 0 Z73 Contractor Ph 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 MB Post & Beam Under Slab Top Out Water Service l Sanitary Sewer itb Drains gl' : S S 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 c 7e d Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.