Permit • CITY OF TIGARD PLUMBING PERMIT
Pi ' DEVELOPMENT SERVICES PERMIT #: P /14 /20 -00039
+� a..i_ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/14/2000
SITE ADDRESS: 10055 SW INEZ ST PARCEL: 2S111BC -00500
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 019 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: 5 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Re- routing plumbing and connecting within 5' of the house. Septic tank must be pumped, filled, and inspected.
FEES
Owner:
Type By Date Amount Receipt
MARSHALL, JAMES H + ANNETTE L PRMT KJP 02/14/200C $88.00 00- 321688
10055 SW INEZ ST 5PCT KJP 02/14/200C $7.04 00- 321688
TIGARD, OR 97223
Total $95.04
Phone 1:
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED INSPECTIONS
Sewer Inspection
Phone 1:
PLM /Underfloor
Reg #: LIC 81837
PLM 26 -445PB Final Inspection
•
ORIGINA
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: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed then business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By (G,1 7
TIGARD', OR" 97223 Date Rec'd Z- - 1 1 4= 700O '
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit #_ PIaI
Related SWR # d Zff
Called
Name of Development/Project 1 FIXTURES=` (itidividual)a: ;; ' ` `' , 4;174i 'PRICE! :AMT ''
Job • Sink 11.50
Address Street Address Suite Lavatory 11.50
/0 0 $ S S rrel.eZ S1. Tub or Tub /Shower Comb. 11.50
Bldg # Cit /State Zip
� Shower Only 11.50
I / e ✓d OR 97 .yv
Water Closet 11.50
Name / I w L rr ,rn
J"o,ftOS /f C/gn'& -e 4.eska(i Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
/O11).C =rue? Si. Garbage Disposal 11.50
City/State Zip Phone Laundry Tray 11.50
, D2 97a aci (.• - 4VeA •
N r Washing Machine 11.50
,raWnt s H. e 4,40a, L• Ma r514...1, Floor Drain /Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
/DOS.t 544, .: Sf. 4" 11.50
• City/State Zip Phone
T1512;44 D2 9 7. 24t G.2.4/-64,D=. G Water piping 0 conversion 0 l hani kind 11.50
Na � � G piping requires a separate mechanical permit.
D� fit • MFG Home New Water Service 32.00
• Ides r d t r�` A e. 7
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00
Po r n X .a 3 I &s- Hose Bibs 11.50
Prior to- permit City /State Zip Phone Roof Drains 11.50
issuance, a copy t („A ' Q 972,21 /o.S4- sc b Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
•
required if 5)/ g"3 7 010 a Other Fixtures (Specify) • 15.00
expired in COT Plumbing Lic. # �cp. Date
database 2 4 y l� j r6 `'& 7,I 2v A ow
Name
Architect Sewer - 1st 100' I . / 38.00
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 QV Commercial 0
Commercial Back Flow Prevention Device 32.00
Additional description of work: p(
f »‘ b �d k c L k fp Residential Backflow Prevention Device` 19.00
"1 D Cl 7 'Ser,J Q t,- Catch Basin 11.50
Are you cap ring, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested / 50.00 �
Yes 0 No 0 Inspections -- Ire. - i (DL , I bt�1,v■101 per /hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling J 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY •::..
TOTAL ' a` `i` ``
I hereby acknowledge that I have read this application, that the information : =::' . :'' . ;12s< _ - %- -'
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required 't FQuantity Total is > 9 ° x,,., ,; ;::
*SUBTOTAL
that plans submitted are in compliance with Oregon State Laws. ,-
ILIL ature of Owner /A• ent , Date
8% SURCHARGE - : f1
,/;� `ti- _ m //// -. -.�/ ' -141-.200 1 . ° ' - ' = el
2 • ct Person Name Phone
A n n e.±t., 4 rs „ C.o I( $e lit- ,6 lion -PLAN REVIEW 25% OF SUBTOTAL ":�
G ,
._, 3 , �� - _ Required only if fixture qty total is > 9 , 3i sp%
Ifj9*$E .. F . t g0 TOTAL >. �` " ;-, ' ; t
1 ) 3 :45 0 C2 ! r; r x g n.- z, y < - ; ;i: si` ::zi
d i I »c tide a pouttibin X> WC@ n d�weltin 1id a first ° . i `Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
0.91.1 _ t Qt` 8at,ita y SeW@ Sf�Qrrf 1art 4: iAhdt@i 6�9 *14 �, Device, which is $25 + 8% surcharge
"Ail New Commercial Buildings require plans with isometric or riser diagram and
plan review.
l: \dsts \forms\ptumapp.doc 12/17/99
PLEASE COMPLETE:
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T.:
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 12/17/99
- y CITY OF TIGARD BUILDING INSPECTION DIVISION MST •
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 2 /VV- AM PM BLD
Location / 6 SS f2'i Suite MEC
Contact Person Ph PLM X1 1' 6 a O
Contractor Ph SWR
Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post &Beam
Sheath /Shear
Int
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling �v
Roof
Misc: ' � /L /,' ��irLatiel
Final r -
P RT FAIL
LUNISIN
Apir
Post & earn
Under Slab - _.
Top Out
. Water Service
Sanitary rains wer / �i �L �� �L / L _ i _%�
F �
r/ 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 `1 }� / /f�
Approach /Sidewalk Date 6 p V Inspector . Ext yz
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.