Permit CITY TIGARD PLUMBING PERMIT
10 r;"` DEVELOPMENT SERVICES PERMIT #: PLM2000 -00301
Ail DATE ISSUED: 8/15/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14870 SW 104TH AVE PARCEL: 2S111CB -01303
SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5
BLOCK: LOT: 017 JURISDICTION: TIG
CLASS OF WORK: NEW 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: 1
TUB /SHOWERS: SEWER LINE: 30 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing house to newly installed sewer lateral. Reimbursement District #1$ fee paid on 8/15/00,
receipt # 004503. Work is to include 30' of line work and reversing the plumbing under the house.
FEES
Owner:
Type By Date Amount Receipt
DEVERS, JAMES R + SUSAN M PRMT DEB 8/15/00 $88.00 0004503
14870 SW 104TH AVE 5PCT DEB 8/15/00 $7.04 0004503
TIGARD, OR 97224
Total $95.04
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: Sewer Inspection
Reg #: Misc. Inspection
Final Inspection
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
o bt in copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
c Issu By : Permittee Signature: f‘ a
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD .. - Plumbing Permit Application Plan eck#
13125.SW HALL BLVD. Commercial and Residential Rec'd _ -
TIGARD, OR 97223 Date Rec'd ?"lS
(503) 639 -4171 Date to P.E.
Print or Type Date to D -----
Incomplete or illegible applications will not be accepted Permit# L11 --
Related SWR # `• ~t:60 rYV-,
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job /-?(-' .7 ,zE d Sink 11.50
Address Street Address / /* Suite Lavatory 11.50
/�� 2U &� -) /D 1 ! Tub or Tub /Shower Comb. 11.50
Bldg # _City /State I Shower Only 11.50
Name�I'
/� � � Z Water Closet 11.50
/ /`� /z Urinal . 11.50
Owner % ilJt� C �f.7 Suite Dishwasher 11.50
�7 / 0 .. › G -e, Garbage Disposal 11.50
C i ate Zip Phone Laundry Tray 11.50
', -1 % ?c de 7722_7 : . -lz�l
Naorfe 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
Na m n Gas piping requires a separate mechanical permit.
W _ 1 I� v
MEG 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' v 38.00 ct:1tl?• 0 °"}
- - - or Mailing Address - Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone 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
Residential Backflow Prevention Device* 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existin P It{m bing or Spec ly Requ sted 50.00 by
Yes 0 No 0 Inspections `c .k)M.. -x.17 f LUHf I ) , per /hr
If yes, see back of form to indicate work performed by Rain Drain, sing) 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 > s
that plans s miffed are in compliance with Oregon State Laws. *SUBTOTAL ,) , -
Signat �� /j of caner /Agent Date 8% U7 k p ` � � ,� � 8/a SURCHARGE 7-6Y
Contac erson Name Phone
* *PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only rf fixture qty. total is > 9 _
2 BATH HOUSE $250.00 TOTAL
3 BATHHOUSE $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
'L.00 "All New Commercial Buildings require plans with isometric or riser diagram and
_ .r plan review.
lidsts \forms\plumapp.doc 11/18/99 6 tOu b I}- a 3 Do - 7
6u) )14 35 10 4 3o
95 .
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
Date Requested ir z-y AM v PM BLD
Location l 1 f 7 c) 5 w lo s/ Suite MEC
Contact Person Ph PLM �ivG — & 0 3 ®/
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
PA_S_S____PART FAIL
Post
PPLUMBIN ,
Under Slab �/ p- 7 / 4 4 5'P 1' ✓t //. r 7
Top Out
Water Service ' ilk '
Sanitary Sewer ✓/ 5
Rain Drains
Fi PART FAIL !A444.4., / / b - e .c �
ANICAL A 00
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 — Inspector i _ ice/; Ext
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 9
- 1/ AM PM BLD
Location / I & 7 U .54/ /U V Suite MEC
Contact Person Ph Co.3 9f - '/ PLM e.v--O U 30 r
Contractor Ph SWR
Tenant/Owner ELC
R ing 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 j j ,/ A
Fire Alarm ,� /�` � MOW/
Susp'd Ceiling ! ��
Roof 7 i ir� //f
Misc:
gr; PART FAIL f
LUMBIN
ost & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
in
PART FAIL
ANICAL
ost & 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 ' r
Approach /Sidewalk
Other Date I I Inspector Ext 7 fr /
Final
PASS PART FAIL ' 0 NO REMOVE this inspection record from the job site.