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Permit , • ,. CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PE DEVELOPMENT PLM2000 -00154 -- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/16/2000 SITE ADDRESS: 13530 SW 121ST AVE PARCEL: 2S103CD -04400 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: 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: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of sewer line - 1st 100'. Reverse plumbing required. FEES Owner: Type By Date Amount Receipt BROWN, MICHAEL J + PRMT KJP 05/16/200C $38.00 0002226 RIES, JUNITA M INSP KJP 05/16/200C $50.00 0002226 13530 SW 121ST AVE 5PCT KJP 05/16/200C $7.04 0002226 TIGARD, OR 97223 Phone 1: Total $95.04 Contractor: BCS PLUMBING PMB 449 SW FARMINGTON ALOHA, OR 97007 REQUIRED INSPECTIONS Phone 1: 503 - 642 -7922 Sewer Inspection Misc. Inspection Reg #: LIC 00094079 PLM 34 -259PB 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 c.. .:s of these rules or direct questions to OUNC by calling (503) 246 -1987. By: ' Issued B / Permittee Signature: C-. - Y 9 i�C � // Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busine day CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 - SW HALL BLVD. Commercial and Residential Rec'd By TIGARD, OR 97223 Date Rec'd (503) 639 -4171 Date to P.E. Print or Type Date to DS G 20 Incomplete or illegible applications will not be accepted Permit# ts't Related SWR #,S W Q 41-4 Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job Sink 11.50 Address Street Address �7 ,r- Suite Lavatory 11.50 /_ j 3U 5 u.). /d ig , Tub or Tub /Shower Comb. 11.50 Bldg # City /State Zip 774 49 �2 97A Shower Only 11.50 Name Water Closet 11.50 ( Y 7� �/ /C vs l U /A) ; 7 /,8i(. /iti Urinal , 11.50 Owner Ma g Addres Suite Dishwasher 11.50 g 5 0- Garbage Disposal 11.50 C /State Zip Phone Laundry Tray 11.50 Name( ,-/-117 Washing Machine /Laundry Tray 11.50 61 Floor Drain /Floor Sink 2" 11.50 Occupant Mail' Address J Suite 3" 11.50 4" 11.50 City /State Zip Phone Water Heater 0 conversion 0 like kind 11.50 Name ` M J Gas piping requires a separate mechanical permit. .---, - ! c- , MFG Home New Water Service 32.00 Contractor Mailing Address Suite MFG Home New San /Storm Sewer 32.00 /77B B / Q Hose Bibs 11.50 Prior to chanica• . F� �,.,-zyvPhone Roof Drains 11.50 issuance, a copy .� ��t '''' " ' f i`4h ( 71 � OP y1t+A Drinking Fountain 11.50 of all licenses are regon Conet. Cont. board L Exp. Date / required if ( q¢O 7l 9/� x/ 2000 c ' Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Ex . Date r database 34 A$ 3D-,;20 t ame Architect 1 /` 7 A.1 � . A. u Sewer - 1st 100' 38.00 or Mailing Address / .- Suite Sewer - each additional 100' 32.00 ' D/,?- S. l-f!n'1ic ites Water Service - 1st 100' 38.00 Engineer City /State Zip Phone 1 7 � /n 6/ D ` 9 3 - I _S 5, ., Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New 0 Repair Cr 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 Existing Plumbing or Specially Requested 50.00 Yes 0 No i' 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 if Quantity Total is > 9 that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL Signpture of Own /Agen Date n T ,� 8 /o SURCHARGE � 5 -1d -63d Conta arson Na Phone r �t. * *PLAN REVIEW 25% OF SUBTOTAL 1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9 tyi 2 BATH HOUSE $250.00 TOTAL 15 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 L 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 \forrns\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 S Z i/00 AM PM BLD Location I S 30 12_1 Suite r, MEC Contact Person �l I I Ph g C�q. L{ (D I el PLM 00 — CO i Sq 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 I UMB D)a / Post & Beam Under Slab Or/ • Top Out – / Water Service (Sanitary Sewer. lain brains Fi PART FAIL / A ar CHANICAL ri✓ 111I — Post & Beam I 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 reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date Other Inspector /927 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 / VOC3 BUP Date Requested S/ ( AM PM BLD Location ) ' S 30 1 2.1 Sf Suite MEC Contact Person CA)/ Ph 4& - 17,2 PLM 7 – CO O l S 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 t/ l Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm / Susp'd Ceiling Roof AMIN% r /�� Misc: wr Final PASS PART FAIL Post & Beam /- Under Slab Top Out Water Service Rain Drains �� Final iar FAIL ��� / / /r" ri i i/i.► /_/ sir Ari` C MEL H AL Post & Beam / 06 —Z b j y Rough In Gas Line Smoke Dampers g • � f�� • Final —� PASS PART FAIL :/�%/%"_� W 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 � � 3/ O Approach/Sidewalk he Date IS Ins CY Ext Final PASS PART FAIL D • NOT REMOVE this inspection record from the job site.