Permit CITY TIGARD PLUMBING PERMIT
maw l DEVELOPMENT SERVICES PERMIT B : PLM2000 -00122
'" '�' 13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 14805 SW 103RD AVE PARCEL: 2S111 CB -00500
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing for sewer connection. No reverse lateral.
FEES
Owner:
Type By Date Amount Receipt
MUNHALL, WALTER F JR AND PRMT GEO 04/14/200C $50.00 0001438
JEAN B 5PCT GEO 04/14/200C $4.00 0001438
14805 SW 103RD AVE
TIGARD, OR 97223 Total $54.00
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
1: Sewer Inspection
Phone Reg 1: Final Inspection
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain .. ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
I
Issued By: `/ �/� Permittee Signature �,1, ► - -- . ,. -
Call (503) 6 ' Ado ir ir by 7:00 P.M. for an inspection nee. : ' e next business day
CITY OF TIGARD Plumbing Permit Application Plan Chet 4_
13125.SW BALL BLVD. Commercial and Residential Rec'd ByiJ o$
TIGARD, OR 97223 Date Rec'd -(L Zetio
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
I ncom Incomplete or illegible applications will not be accepted Permit# WR# -O0 - b� �aZv 2
P 9 PP Related SWR #iZ� - `"
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Str a ddre Suite Lavatory 11.50
( �.) J L 03 Tub or Tub /Shower Comb. 11.50
Bldg # City /State Z Shower Only 11.50
- C i6;407_. cc 72-2
Name Water Closet 11.50
- 1-� : -f , MO ►J 11. P t-L - Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
t gC)J 5L1/4. lt)7tz -�
Garbage Disposal 11.50
Ci /Slat Zip Phone
----C‘6-M:› Ck. V-2/4 6" - ( i 3° Laundry Tray 11.50
Name Washing Machine /Laundry Tray 11.50
4 = 's-' 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.
o :.�-= t� BIZ MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00
Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database
Name
Architect Sewer - 1st 100' 38.00 3 c)0
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 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential B. Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
�p
�� Residential Backflow Prevention Device* 19.00
( _InQ4, tAt ' �j , (yei1 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 -,
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 compliance with Oregon State Laws. `SUBTOTAL i
Si nat re of Owner /Agent Date
p �g,. Q4. \ ._, ,� - ¢ - Ck - . _ 4 - 1 - �% 8% SURCHARGE ,
Contact P ers Name
KAI o� �,k,1t..:'�,v� � 2 (; 30 "`PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00 TOTAL --511.C°
3 BATH HOUSE $285.00
(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 sanitary sewer storm sewer and water service) 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:
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: \dsts \torms\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 1/0 VOzo AM M BLD
I
Location I L-{ X O S 1 �' Suite MEC
Contact Person (A t 4 Ph 2.x(0 3O ' t M 2 5'Ob12 2—
Contractor Ph SWR IMO
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 7 P
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof / / n
Misc: / J
Final
PASS FAIL
Post & Beam
Under Slab
Top Out
Water Service
S.'r
Rain Drains
&Ittpp FAIL
C ANICAL (-5/
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 r ' nspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date / v" Inspector d Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.