Permit - CITY OF TIGARD
- ° 0100 i DEVELOPMENT SERVICES PLUMBING PERMIT
' 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #. „ „ „ „ „ .: PLM9B -0445 ■
DATE ISSUED: 12/03/98
PARCEL: 2S1O2BB- -00830
SITE ADDRESS...: 10440 SW JOHNSON CT
SUBDIVISION ° B ROOKS I DE PARK NO. 2 ZONING: R-4.5
BLOCK..... „. „... LOT..,.... ...... :006 JURISDICTION: TIC
CLASS OF WORK.. :OTR GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE.... :SF WASHING MACH.... „.: 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP.. :R3 FLOOR DRAINS ° ° ° „ „.: 0 TRAPS • ° 0
STORIES ° 0 WATER HEATERS.....: 0 CATCH BASINS„.„°„°.: 0
FIXTURES LAUNDRY TRAYS.....: 0 SF RAIN DRAINS.....: 0
SINKS 0 URINALS 0 GREASE TRAPS ° 0
LAVATORIES„.„ „: 0 OTHER FIXTURES°„„ „: 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 30
WATER CLOSETS.: 0 WATER LINE (ft) „. „: 0
DISHWASHERS..„„: 0 RAIN DRAIN (ft)...: 0
Remarks: Repair to existing sewer line only.
Owner: -- FEES
ROBERT VINATIERI type amount by date recpt.
10440 SW JOHNSON COURT PRMT $ 30.00 GEO 12/03/98 98- 311276
TIGARD OR 97223 PCT $ 1.50 GEO 12/03/98 98- 311276
Phone #: 439 -0406
Contract or -
MOORE UNDERGROUND INC
29243 SE STONE ROAD
GRESHAM OR 97080 -
Phone #: 663 -0212 $ 31.50 TOTAL
Reg #..: 126605
REQUIRED INSPECTIONS --
This permit is issued subject to the regulations. contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 186 days of issuance, or if work is suspended for sore
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 -as10 through OAR 952 -0001 -0680. You may
obtain copies of these rules or direct questions to OUNC by calling -
(503)246 -1987.
Issued By ;µ / L / / /::/ Permittee Signature° •
+ + + + + + + + + + + + + + + + + + + ++ +++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Check #
13'! 25 S W 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 DST
Permit # G7
Incomplete or illegible applications will not be accepted
J
��.1 Related SWR #
ii l7v f (4 ` c Called
I �IL �
Name of Development/Project FIXTCIRES'(incJividual);;0r;" M' P IC
,,.�.� ��� . h H,��� °< .. ,.i,.._ ,.N`'"' QTI`(� R 14 NARAT';`
Job Sink 9.00
Address S reef dr`enss ` ' � Suite Lavatory 9.00
`v �� `'HS�z Tub or Tub /Shower Comb. 9.00
Bldg # �City /State Zip
�lJ ft
l�l _ / a Shower Only 9.00
Kil Ipp � Water Closet 9.00
N - ( t \A vi F ' ii s'll Dishwasher 9.00
Owner M Address Suite Garbage Disposal 9.00
( O 4W) H Washing Machine i 9.00
.. City /State Zip Phone
Tics, _J 6 Y -070 _ Floor Drain /Floor Sink 2" 9.00
Na a 1 3" 9.00
t‘itA 4" 9.00
Occupant Mailing Suite Water Heater 0 conversion 0 like kind 9.00
- Gas piping requires a separate mechanical permit. _
City /State Zip Phone Laundry Room Tray - 9.00
_ _ Urinal 9.00
Name
M cc.,v � U I�, ie k Other Fixtures (Specify) 9.00
Contractor f r piling Address , � ✓ Suite 9.00
(1q7 . _ . 9.00
Prior to permit City /State Zip Ph Sewer - 1st 100' 30.00 30-, . issuance, a copy Nei - dl�e Y v -uZ( Sewer -each additional 100' 25.00
of all licenses are Oregorf Const. Cont. Board Lic.# Exp. Date
required if / Up 4 0.5 Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # . Exp. Date Water Service - each additional 200' 25.00
database Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
- • Or Mailin Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device* 15.00
(Irrigation timing devices require a separate
Describe work to be done: • restricted energy permit.)
New O e air X Replace with like kind: Yes 0 No Any Trap or Waste Not Connected to a Fixture 9.00
Residential Commercial 0 Catch Basin 9.00
Additional description of work: .
t1, _.. t) t aa• / ate of Existing Plumbing 40.00
5 e\c,A� a`� 4 6 7C per /hr
n `( � Specially Requested Inspections 40.00
q per/hr
Are you capping, moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes No O Grease Traps 9.00
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL „ < <; ` < °„ , . �
Isometric or riser diagram is required if Quantity Total is > 9 t�
WORK COULD RESULT IN INCREASED SEWER.FEES. *SUBTOTAL ; "" a
I hereby acknowledge that l have read this application, that the information i ?=.-i--,.., . - / 7
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE
that plans submitted are in compliance with Oregon State Laws. ... �" " ` " ' ` `'
P P 9.
Signature oo Owner /r Date i * "` k ` *':
*PLAN REVIEW 25% OF SUBTOTAL
.--- -- ---- /4/� / 12/3//e) Re uired only if fixture qty. total is > 9 _ ,;T'
Y `
Contact Person Name Phone TOTAL °_ � „ ; >,° % ', 3f (jl
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention•Device, which is $15 +5% surcharge
* *AII New Commercial Buildings require plans with isometric or riser diagram
and plan.review
l: \dsts\pium app. doc 7/2/98
PLEASE COMPLETE:
New Moved Replaced RemovedlCapped
......................................................................................................................................................................................
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:
I:\dsts\plumapp.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -41711 V) )
3 BUP
�b�� D ate R equested A - - qi AM PM K BLD
Loca i on d `t Ji Z'' 41JL4L4 It Suite MEC
Contact Person DA Ate Ph 40:), ! c� � -
Contractor L. AmIL 5r"�'IU/eJ_raill Ph 63-16;_/— SWR
BUILDING ,,„ ,,,:, Tenant/Owner ELC i
Retaining Wall ELR
Footing Access: INIarer
Foundation . _ � � o FPS
Ftg Drain p C'� L ��,/ /w 11 SGN /
Crawl Drain InS ectio otes:
Slab SIT -
Post & Beam
Ext Sheath /Shear `+�._ --- ;�;` _
��°� -�
— °
Int Sheath /Shear ' ----2=2. - S
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
p_ASS—FAI L
( 'PLUMBING �:7ti °.':mm`'
Under Slab
r edyi .
Top Out �
Wa , 30
h L
-�x' /
:F•.. . i /,�% l / /
Fin. -
y PART FAIL
,...: HANICAL ` -
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
$ITEe - '-,,ti..-:,;:,:;!: . a _
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
Approach /Sidewalk Date ` ` t Inspector �" it________________ Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site..