Permit •
M •
CITY TIGARD PLUMBING PERMIT
1 DEVELOPMENT SERVICES PERMIT #: PLM2000 -00278
i �' ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/31/2000
SITE ADDRESS: 11252 SW 105TH PL PARCEL: 1 S134DA 05300
SUBDIVISION: NODAK ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT 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: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: One residential backflow prevention device. One hose bib
FEES
Owner:
Type By Date Amount Receipt
MILLER, ANDREW J 5PCT JMT 07/31/200C $4.00 0004103
11252 SW 105TH PL PRMT JMT 07/31/200C $50.00 0004103
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: RP /Backflow Preventer
Final Inspection
Reg #:
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: / ��n Permittee Signature: 4/7
,07
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY 0F • - • Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Rec'd '7 3j -o7)
(503) 639 -4171 , , Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # e_ v, ,7s
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job /YO�. I� Sink 11.50
Address Street Address r , Suite Lavatory 11.50
I / .2-5 L f qJ. I 0.5 p1 Tub or Tub /Shower Comb. 11.50
Bldg # City /State I Zip z3 Shower Only 11.50
I GL / z
/J 1471- i Water Closet 11.50
Name
17 y / 1 l Urinal 11.50
Owner Mailing Address / ✓1 Suite Dishwasher 11.50
$ 4_
4 . aS AOa./ Garbage Disposal 11.50
City /State Zip Phone
Laundry Tray 11.50
Name Washing Machine /Laundry Tray 11.50
ce,, 'AlL QS cLi JL 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.
(e--/112.11-.. MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00
Hose Bibs 11.50 1 j co
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
- - - 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
Describ work to be done: Storm & Rain Drain - 1st 100' 38.00
New Re it 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential Commercial 0
Commercial Back Flow Prevention Device 32.00
Additional description of work:
c--- Residential Backflow Prevention Device" 19.00 /,...0,0
A---6r t � ck 0. 16 '/- Catch Basin 11.50
Are you cappinmoving or re I cing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 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 owner or authorized agent of the owner, and Isometric or riser diagram is required rf Quantity Total is > 9
that plans ubmitted are in compliance with Oregon State Laws. *SUBTOTAL so�
Si natur f caner /A Date (/
g II V t 1 ` I ' / R_ _X 8% SURCHARGE [,
Conta Person me �[/ Phone .. /
* *PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 --- Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00 TOTAL
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 \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 / J AM PM BLD rag
Location / / Z 5 -2- 5 `'+v Suite MEC
Contact Person Ph 22V- 6 4 /7. , PLM - 0 41 . 2 7)
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
PASS PART FAIL
P16 .1gAl altiV
ost & Beam
Under Slab j,K G
Top Out
Water Service 4- 64 4 0
Sanitary Sewer
Rain Drains
411A►► IP:. • RT 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 D kb Ins ector Ext
Other I p
Final
PASS PART FAIL DO • T - EMOVE this inspection record from the job site.