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Permit C ITY OF TIGARD PLUMBING PERMIT O bF , ,,& DEVELOPMENT SERVICES PERMIT #: PLM2000 - 00192 I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/8/00 SITE ADDRESS: 15760 SW 88TH AVE PARCEL: 2S1 11 DD 01100 SUBDIVISION: STRATFORD ZONING: R - 4.5 BLOCK: LOT: 047 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 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: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of residential backflow prevention device for irrigation system. FEES Owner: Type By Date Amount Receipt SCHMIDT, FRANK M + TINA M PRMT DEB 6/8/00 $25.00 0002811 15760 SW 88TH 5PCT DEB 6/8/00 $2.00 0002811 TIGARD, OR 97223 Total $27.00 Phone 1: Contractor: JAMES R. DENNY PO BOX 160 SHERWOOD, OR 97140 REQUIRED INSPECTIONS Phone 1: 590 -1945 RP /Backflow Preventer Reg #: LIC 11804 PLUS BACKFLOW Final Inspection P 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 m. • • al - • •ies of these rules or direct questions to OUNC by calling (503) 246 -1987. • Issue. By: �/ ��� Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection nee €1 the nekt business d CITY OF TIGARD Plumbing Permit Application Pla heck# 13125 SW HALL BLVD. Commercial and Residential Rec By TIGARD, OR 97223 Date Rec'd 40'"q-00 (503) 639 -4171 Date to P.E. ----- Print or Type Date to D Incomplete or illegible applications will not be accepted Permit# - Related SWR #_ Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job Sink 11.50 Address Street Address - rz. Suite Lavatory 11.50 1 3 -1 7 6 O S. ''tf ( Tub or Tub /Shower Comb. 11.50 Bldg # Ci y State Zip Shower Only 11.50 / 7 it i ) 0 le 9'7 " ,zy Water Closet 11.50 N F m ../1.n -" S c, Urinal 11.50 Owner Mailing Address S 1 t, Suite Dishwasher 11.50 / '7 6. C) S 4)' S I Garbage Disposal 11.50 City /State Zip Phone Laundry Tray 11.50 :- ,c. v�e 9' -�zj Namr#J Washing Machine /Laundry Tray 11.50 Al-77,1 Q 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. T"tifn e S �� 4 / 4_ �5 Ciq,c--- MFG Home New Water Service 32.00 Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00 'Qj B cx / C 0 Hose Bibs 11.50 Prior to permit City/ tate Zip Phone Roof Drains 11.50 issuance, a copy S w c /2 9 -'7 /e-/ 0 .5 / 9 -' Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if / / U ( y _ 3 0 .- 0 I Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date database 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 g Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New 61- Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commercial 0 Additional description of work: Commercial Back Flow Prevention Device 32.00 Residential Backflow Prevention Device* c- 19.00 1. 40 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 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 --- co that plans submitted are in compliance with Oregon State Laws. ?5' ( Si• ature of, ner /fir nt a 8% SURCHARGE L'},l' Cy V . ..t Person N m V Phone � ,. -- 390 /9L/,5 * *PLAN REVIEW 25% OF SUBTOTAL 1 HOUSE $178.00 / Required only if fixture qty. total is > 9 ,'2 BATH HOUSE $250.00. TOTAL 7 �' 6 3 BATH HOUSE $285.00 j (This fee Includes all plumbing fixtures in the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention 100 feet of sanity se wer -_.,. .�.. �__- storm sewer and water , , , , , Device, which is $25 + 8% surcharge _ � _ m� - All New Commercial Buildings require plans with isometric or riser diagram and plan review. odsts\forms\plumapp . doc 11/18/99 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet 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:ldsts\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 CP /2-I /C)( AM PM BLD Location I S (-Pd 5 ,?)g - t'^ Au-e Suite MEC Contact Person ,TGI, Ki.A Ph Sq0 `I 9 YS ( LIV 7&1& "GNU 9 a 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 A I 41 Susp'd Ceiling Roof Misc: Final PASS PART FAIL cUMB1NQ .) Post & Beam Under Slab Top Out Water Service 4t Sanitary Sewer Rain Drains py 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 Other Date 1‘) / lo Inspector n Ext Final �/ PASS PART FAIL DO NOT REMOVE this inspection record from the job site.