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Permit • CITY OF TIGARD PLUMBING PERMIT 1 , i t, DEVELOPMENT SERVICES PERMIT #: PLM2000 -00235 - - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/23/00 SITE ADDRESS: 14865 SW 104TH AVE PARCEL: 2S111CB 01309 SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5 BLOCK: LOT: 018 JURISDICTION: TIG CLASS OF WORK: OTR 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: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of less than 100' of sewer line to connection existing house to newly installed sewer lateral. Reimbursement fee of $8,000.00 paid on this date, receipt # 0003234. FEES Owner: Type By Date Amount Receipt KNUTSON, GENE H MARION B PRMT DEB 6/23/00 $50.00 0003234 14865 SW 104TH 5PCT DEB 6/23/00 $4.00 0003234 TIGARD, OR 97223 Total $54.00 Phone 1: Contractor: PHIL PAULSON EXCAVATING 1939 SE BROOKWOOD AVE HILLSBORO, OR 97224 REQUIRED INSPECTIONS Phone 1: 503-693-6610 Sewer Inspection Final Inspection Reg #: Pti 6 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 -0011 -0080. You may obtain copies of these rules or direct questions to OUNC b Iling (503) 246 •:7 Issued B : a Permittee Signatur • "- 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 Rec'd k / TIGARD, OR 97223 Date Recd h -.0 3- 3 Oc (503) 639 -4171 Date to P.E. Print or Type Date to DS,T Incomplete or illegible applications will not be accepted Permic# l - 60a3 Related SWR #e Called Name of Development/Project FIXTURES (individual) QTY PRICE . AMT Job Sink 11.50 Address Street Address , Suite Lavatory 11.50 j 7 O440 5 U) Of - AA , ' Tub or Tub /Shower Comb. 11.50 Bldg # CW.State . Zip /CO4 ©i 37P-� Shower Only 11.50 me Water Closet 11.50 Of iJ€_ 1 4-)1.4.1 - 5e 1 )...) Urinal . 11.50 Owner Mailing Address y� 41, Suite Dishwasher 11.50 %l05 � � / 01- - not Garbage Disposal 11.50 City /State Zip Phone /,�epA,2 ' 04-- 9729: , Laundry Tray 11.50 Name Washing Machine /Laundry Tray 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 Gas piping requires a separate mechanical permit. parrie MFG Home New Water Service 32.00 Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00 jg3Y c4- ki2DO ''? »v2 Hose Bibs 11.50 Prior to permit City /State Zip Phone Roof Drains 11.50 issuance, a copy /1/LL5,,/16 e ak 41,76.1_,? 6,9 -6 fo/O Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if /4/f 3 23 ,--7-e)?-- Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date database Name Architect Sewer -1st 100' / 38.00 3z,0C) Or Mailing Address Suite Sewer - each additional 100' 32.00 Engineer City /Slat Zip Phone Water Service - 1st 100' 38.00 Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New 0 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 �'�� 7 NE Residential Backflow Prevention Device* 19.00 /,../ST 41.--1-4'D i.4-)f P- L_,/ N _- 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. I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL given is correct, that I am the ow r r authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9 that plans submitted are in co is e with Oregon State Laws. *SUBTOTAL U: S; nature of infr /�ge t Date vc) 8% SURCHARGE , U� Con act (Person Name Phone ,/k.) Il tkir • (3' _l(9 * *PLAN REVIEW 25% OF SUBTOTAL 1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9 2 BATH HOUSE $250.00 TOTAL / /Cc� 3 BATH HOUSE $285.00 7 � (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 \forms\plumapp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Vv 3 Date Requested '-� AM PM /� BLD y 1� Location / 5 ID V 4U-e - Suite MEC / Contact Person ��XyCrL Ph 6 34 `�' PLM g — DD,?3 5 - 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 Misc: AMP" Final PASS PART FAIL ild(‘7/ l' �.L- Post & Beam Under Slab Top Out Water erv' Rain Drains el PART FAIL 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 / 0 Other Date Inspector . Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.