Permit C ITY OF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM1999 -00111
..� � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: -
SITE ADDRESS: 14110 SW 97TH AVE PARCEL: 2S111 BA -00109
SUBDIVISION: TIGARDVILLE HEIGHTS 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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Residential alteration
FEES
Owner:
Type By Date Amount Receipt
THOMAS D. PARKER APPL BON 4/16/99 $36.00 99- 314596
14110 SW 97TH AVE MISC BON 4/16/99 $1.80 99- 314596
TIGARD, OR 97224
Total $37.80
Phone 1: 620 -7674
Contractor:
JOHN D PLUMBING
5235 SW 153RD AVE
BEAVERTON, OR 97007 REQUIRED INSPECTIONS
Phone 1: 644 -5165 Top -out Insp
Final Inspection
Reg #: LIC 000895
PLM 34 -257
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: 6- 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#
13125 SW HALL BLVD. Commercial and Residential Recd By w +
TIGARD, OR 97223 Date Recd - ;
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # PGM ( - Q"III
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job l':7)2-... --C-(2- Sink 9.00
Address Street Address Suite Lavatory 2 9.00
\ t� 5 'Al P�IC Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only ) 9.00
Tic-1,"-' C V 1 774
Na T Water Closet I 9.00 /�
V ltk� 1.- It--IPA., Dishwasher 9.00 /
Owner Mailing Address I Suite Garbage Disposal 9.00
ARC) SW 1 iah<Vf Washing Machine 9.00
City /State Zip Phone
, --5-
61-14 ab -16�F Floor Drain /Floor Sink 2" 9.00
Name 3" 9.00
VC- 4" 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 9.00
Urinal 9.00
Narne Other Fixtures (Specify) 9.00
LACA --1 ' ID. t I-4C5
Contractor Mailing Address Suite 9.00
ID-Z-7° S1,, -1 l�ct--1/40 t - ap 9.00
Prior to permit City /State Zip Phone Sewer - 1st 100' 30.00
issuance, a copy ' ,a( v►._A QQ 6V1 C E ,, - S l6�
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp..ate
required if b°153� ' -10 - 2O1 Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database 5 - ZE1 ' 1 Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect t2 Ef"t t ( // t� - - ) t Mobile Home Space 25.00
Or Mailing Address , `/ Suite Commercial Back Flow Prevention Device or Anti- 25.00
1 -9'6 1 A�/C- Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device* 15.00
vCj ,a OF- L,tL{ -3- -q6pe__. (Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes • No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential a 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 • No O Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL 1,
I here• acknowledge that I have read this application, that the information
giv: n is c that I am the owner or authorized agent of the owner, and 5% SURCHARGE �/U
th..t plan• su itted are i 'compliance with Oregon State Laws. DD
Si i natu a of wner /Ag. Date * *PLAN REVIEW 25% OF SUBTOTAL
Required only it fixture qty. total is > 9
2--- 4--12- �� TOTAL -7W
co , ct Pe on Name OF Phone
t ( 3 - °16oZ *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
t_d�� Prevention Device, which is $15 + 5% surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
l: \dsts\plumapp.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
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3 "
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I. ldsts\plumapp. doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
!-- ("/'-q7 BUP
Date Requested LP AM PM BLD
11
Location I J/ d 1 711)..e. Suite MEC
Contact Person atities Ph (40 PLM 1 - Q0) I I
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing ACC @S
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
PAS PART FAIL
LuM
Post eam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
Other oach /Sidewalk Date l i Inspector 7
Ext '7
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.