Permit CITY OF TIGARD
PLUMBING PERMIT
''1'? DEVELOPMENT SERVICES PERMIT #: PL /16/19 - 00286
.+ we'll 13125 SW Hall Blvd., Tigard, OR 972 (503) 639 -4171 DATE ISSUED: 09/16/1999
SITE ADDRESS: 17005 SW 92ND AVE PARCEL: 2S114D0 00101
SUBDIVISION: COOK PARK ZONING: R - 4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: UNK 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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 365 ft
Remarks: Installation of 365 feet of rain drain lines.
FEES
Owner:
Type By Date Amount Receipt
CITY OF TIGARD PRMT DEB 09/13/199 $134.00 99- 318254
13125 SW HALL BLVD PLCK DEB 09/13/199. $33.50 99- 318254
TIGARD, OR 97223 5PCT DEB 09/13/199 $9.38 99- 318254
Phone 1: 639 -4171 Total $176.88
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone 1: 503-639-5296 Storm Drain Insp
Reg #: LIC 00002439 Final Inspection
PLM 34 -29P
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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
//
Issued By. P ermittee Signature:C , ..■-A■ ■ - -a
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b a' : ss day
r
__CITY OF TIGARD__ - Plumbing- Per_mit�Application - -= = = _ -P,ar; c
13125 SW HALL BLVD. Commercial and Residential Rec' By •
TIGARD, OR 97223 ./ Date Rec'd 9 /3-99
(503) 639 -4171 4 �f Date to P.E. I -mo
Print or Type
,if 99 ' o � Date to DST ��` ,"
Incomplete or illegible applications will not be accepted Permit #pGf // "- Gt)09Io
Related SWR # A.//9
Called ' _I I -"q
Name of Development/Project ;FIXTURES -individual = P
., -���- �
t '- QTY: .:.:, ' RIGE;• °•; - rAMT °
Job °(amt 194-¢,e 1 io. / //'#..J z e Sink 11.50
Address Street Address Suite Lavatory 11.50
f'iooS S g7_4D Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip
Shower Only 11.50
"60420 e t 2Z3
Name Water Closet/Urinal (Specify) 11.50
�-
C i G f t t 6s Dishwasher 11.50
Owner Mailing Addr s Suite Garbage Disposal 11.50
('12 t t"' PaAM0 Washing Machine /Laundry Tray (Specify) 11.50
City /State Zip Phone
T? 6-44,0 , D2. 97 2227 (9.34_ dint Floor Drain /Floor Sink 2" 11.50
Name 3" 11.50
mwJ'cE 4" 11.50
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
City /State Zip Phone MFG Home New Water Service 28.00
MFG Home New San /Storm Sewer 28.00
Name
t) 1 , PL.UY1$I K.7C Hose Bibs 11.50
• Contractor Mailing Address Suite Rain Drains 11.50
C D 4-CLO 5,WI '111 AO D Drinking Fountain 11.50
Prior to permit City /State Zip Phone Other Fixtures (Specify) 15.00
issuance, a copy ' ,p 97 1 23 Co 3() 5 zg to
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if 24'e5
expired in COT ' Plumbing Lic. # J Exp. Date
database 34 Z-
Name
Sewer - 1st 100' 38.00
� P
Architect k S - 5 Sewer - each additional 100' 32.00
Or Mailing Address Suite Water Service - 1st 100' 38.00
1(0 /64 S , Lt- eagir5 fr ?D f- G
Engineer City /State Zip Phone Water Service - each additional 200' 32.00
V7 2Z tL z f 727"; Storm & Rain Drain - 1st 100' 1 38.00 j��
Describe work to be done: 7 Storm & Rain Drain - each additional 100' 02,05" 32.00 q t,
New 0 Repair 0 Replace with like kind: Yes 0 No O Commercial Back Flow Prevention Device 32.00
Residential 0 Commercial 0
Additional description of work: Residential Backflow Prevention Device* 19.00
�) LI DPk/ 10 L1 Catch Basin 11.50
1
Insp. of Existing Plumbing 50.00
Are you capping, moving or replacing any fixtures? per /hr
Yes 0 No O_ Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by . per /hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling . 45.00
WORK COULD RESULT IN INCREASED StWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL r.:_ '`' ` _T °;'
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 ' ''" ``` ' li ,;- °,1
that plans submitted are in compliance_with Oregon State Laws. *SUBTOTAL Z''' "'
Si nature nt of Ow er /Age Date
G N I*" - on N J --f ' 5 65 7% SURCHARGE ':-`� I` -:.° st
Contact
ame Phone : > >; 9 *
GRA/ -1 Ref 41 2-L , • (.0246;23 **PLAN REVIEW 25% OF SUBTOTAL `sRI MOW 2So
1 8it'91 HOUSE: 178AQ` 5 = x Required only if fixture qty. total is `.. `t MIN J
,.; .�.a q Y re q y. t l s 9 �r:�_��:�.� : t p
li
2 =LATH - lotiSE $250 imp ' : M , _ €4 43 :" ,-' , Y -.. _,_ ' 0
3�BATH tlOf 1$E $285.0(1 _ TOTAL ' q ' op ,:,3,iii
(T isExfee= includes a ll p lumbing fixtures in'the; dwelling, s iid.the°first
�'•Y ��,- ' , ' -2.m. , - ,, -- *Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
t
`" � '" �_ �" u.= ° _; p ° ge, exce g10 fee S ry sewer stomt sews 4,911 f er se►vice) 'e i
Device, which is $25 + 7% surcharge
**All New Commercial.Bulldings require plans with isometric or riser diagram and
plan review.
I: \dsts \forms\plumapp.doc 8/5/99 .
PLEASE COMPLETE:
- Irerfoilife'd;4*;x4540
4116Vga bic� 4 - - gtV,44A4K4ftglag,X4', 444 Red/Ca
.4 M
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2"
3 „
4 "
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
hdsts\forms\plumappdoc 8/5/99
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Recd
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Inco or illegible applications will not be accepted Permit #
Related SWR #
Called
Name of Development/Project =' `
P 1 FlXTURE,S � indiViiliial
n (. ,•�� :;;°�' � .,,�'.w s''M GiT�Y - PRICE AMT
Job K1t'p•QIG }z 4,40 • / /sec A/re �� Sink 11.50
• Address Street Address 1 {{ Suite Lavatory 11.50
41OO ' Sc,) Q'Z•1 Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip Shower Only • 11.50
"TTGrs420 i 0I2_ el 'I 2Z3
Name Water Closet/Urinal (Specify) 11.50 •
C t o f Dishwasher 11.50
Own Mailing Addre s Suite Garbage Disposal 11.50 -
1 $u) 1.64 AIM) Washing Machine /Laundry Tray (Specify) 11:50 - -
City /State Zip Phone Floor Drain/Floor Sink 2" 11.50
T ■ D2-, 97 2-2 (04 d171
Name 3 " 11.50
•
it mCA J 52. 4" 11.50
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50
• Gas piping requires' a separate mechanical Kermit.
City /State • Zip Phone MFG Home New Water Service 28.00
MFG Home New San/Storm Sewer 28.00
Name
. Hose Bibs 11.50
Contractor Mailing Address Suite Rain Drains 11.50
Drinking Fountain 11.50
Prior to permit City /State Zip Phone Other Fixtures (Specify) 15.00
issuance, a copy
of all licenses are Oregon Const. Cont- Board Lic.# Exp. Date I
required if .
expired in COT • Plumbing Lic. # Exp. Date
database
Name
Sewer - 1st 100' 38.00 ,
Architect Sewer - each additional 100' 32.00
or Mailing Address Suite Water Service - 1st 100' 38.00 •
Engineer City /State Zip Phone
Water Service - each additional 200' 32.00
Storm & Rain Drain - 1st 100' 100 38.00 .
Describe work to be done: Storm & Rain Drain - each additional 100' q,(�s 32.00 ab�
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00
Residential 0 Commercial 0
Additional description of work: Residential Backflow Prevention Device* 19.00 ,
Catch Basin 11.50 1
Insp. of Existing Plumbing 50.00
Are you capping, moving or replacing any fixtures? per/hr
Yes 0 No 0 Specially Requested Inspections 50.00 j
If yes, see back of form to indicate work performed by per /hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.0 j
WORK COULD - RESULT IN INCREASED SEWER FEES. Grease Traps 11.50 1
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL P';'
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required a Quantity Total is > 9 '
that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL
Signature of Owner /Agent Date .::,M4 �:,, , l *
7% SURCHARGE
Contact Person Name f Of Si
Phone ' I.
",, - -
s
•
• * *PLAN REVIEW 25% OF SUBTOTAL �' r ;-a 3
1,'BATH HHOUSE 178:00 t ' %'` '> "<'_= '< " •_�k.�- Required only if fixture qty. total is > 9 '°'> J
2,_AW: OUSE$250 00 , j. fi v TOTAL ® fi
fir ` ' g ,,'wY. ,+�. � ,
• �3 m HO 5E $ 285 . e. � * .,,:: ; 1 � ( j
N.7 ncludes'ail plumbing fiutiOssin th @;dwelling and firtt; -
*Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
00,_eetp f n • S@{y @t - rnt,8@w @r dt1d� f6`r:5 @tVIC@ , : Device, which is $25 + 7% surcharge
**All New Commercial Buildings require plans with isometric or riser diagram and
• plan review.
I:tdststforms'plumapp.doc 8/5/99 •
•
10/7/99 Activities for Case #: PLM1999 -00286
2:29:04 PM -
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 . To Done By Disp. . Level By Updated Notes
PLMC003 Application received 9/13/99 DEB DONE No Hold DEB 9/13/99
PLMC005 Permit Created 9/13/99 DEB DONE No Hold DEB 9/13/99
PLMC007 Plans routed to Plans Examiner 9/13/99. DEB DONE No Hold • DEB 9/13/99
PLMC730 Storm Drain Insp 9/13/99 9/13/99 NOTE No Hold RDP 9/13/99 This permit covers the Gazebo
and Picnic Shelter. There is a
total of 365 lineal feet of rain
water storm drainage. The
Contractor will dig out the areas
• outlined in red. The Inspector of
Record Geoprge Steele will
. look at outfall, pipe size and
depth.
PLMC799 Final Inspection 9/13/99 9/13/99 No Hold RDP 9/13/99
PLMA007 Plans routed to Plans Examiner 9/13/99 RDP DONE No Hold RDP• 9/13/99
PLMA008 Plans Approved /Routed to DST 9/13/99 9/13/99 9/13/99 RDP DONE No Hold RDP 9/13/99
PLMC015 DST Post Review Complete 9/16/99 BON DONE No Hold BON 9/16/99 -
PLMC040 (F) Ready to issue 9/16/99 BON DONE No Hold BON 9/16/99
PLMCO50 (F) Issue permit 9/16/99 GEO DONE No Hold DST 9/16/99
PLMC735 Rain Drain Insp 9/20/99 9/20/99 9/20/99 GS PASS No Hold AKJ 9/20/99
PLMC730 Storm Drain Insp 9/20/99 9/20/99 9/20/99 GS PASS No Hold AKJ 9/20/99
PLMA800 Case Finaled 9/27/99 JMT DONE No Hold JMT 9/27/99
•
•
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