Permit ,, CITY OF TIGARD
PLUMBING PERMIT
h * I tiPI 6 DEVELOPMENT SERVICES PERMIT #: PLM1999 -00429
c � l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 12/13/1999
SITE ADDRESS: 10490 SW JOHNSON ST PARCEL: 2S103AA 01914
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: ACS 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: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Re- routing plumbing •
FEES
Owner:
Type By Date Amount Receipt
BADGER, QUENTIN J EUNICE PRMT BON 12/13/199E $50.00 99- 320391
10490 SW JOHNSON ST 5PCT BON 12/13/199, $4.00 99- 320391
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
LARRY CAMERON PLUMBING
1812 SE 158TH AVE
PORTLAND, OR 97233 REQUIRED INSPECTIONS
Phone 1: 503-256-2705 PLM /Underfloor
Reg #: LIC 49792 Final Inspection
PLM 26 -366PB
ORIGIN A
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 a questions to OUNC by calling (503) 246 -1987.
��, I�
Issued By: .f �lil� /,4/L` Permittee Signa re: �I 4.4 A A
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b i -ss day
•
CITY ... 1GARD Plumbing Permit Application Plan Chec
13125 S �' HALL BLVD. Commercial and Residential Rec'd By
TIG4. D, OR 97223 Date Reed 2-13 "I° (50639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# pm tern-4
Related SWR #
Called
Name of Development/Project : F TUR (individual) QTY ( AMT
Job '• Sink 11.50
Address Street Address Suite Lavatory 11.50
d ® .5Z) riefAtgAd Tub or Tub /Shower Comb. 11.50
Bldglt City /State Zip Shower Only 11.50
Name Water Closet 11.50
Wiv7 f f5 n ' O/- Urinal 11.50
Owner ailing Address S� Suite Dishwasher 11.50
/d % 9,0 SO 6/ / L . Garbage Disposal 11.50
City /State Zip Phone
776/60 9 ft- Laundry Tray 11.50
"Name ��" �j Washing Machine /Laundry Tray 11.50
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. teit `, � 11 /7� A J / L�/�� MFG Home New Water Service 32.00
Contractor M ' ing Addres (J / Suite � MFG Home New San /Storm Sewer 32.00
/L'Z' 5-45- /5J277 Hose Bibs 11.50
Prior to permit /St e {{ Phone / Roof Drains 11.50
issuance, a copy ` � j " G�,/5 Drinking Fountain 11.50 .
of all licenses are regon Cons . Con oard Lic.# Exp. Date
required if 6. ,66 /8 3/ -I d Other Fixtures (Specify) 15.00
expired in COT Pluntbin Lic. # Exp. Da / RQ _ Cat \I,�
//7
database Z' / /
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
9 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," 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
' ,/, 4 ' '6 PL/1 �e- Catch Basin 11.50
re y capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 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. :, ••, .:; £
Isometric or riser diagram is required if Quantity Total is > 9 acknowledge that I have read this application, that the information QUANTITY TOTAL
I hereby . '� ✓, y '. ,
g PP ": ' 0,•'•.). , :N r 1:,'
given is correct, that I am the owner or authorized agent of the owner, and
that pla ubmitted are in compliance with Oregon State Laws. *SUBTOTAL -- M ,g .:777,74 r_ a
Si . re of Owner /Age Date " "'
/ � ' . .. _ � /' / l Z-j3 - f 9 8% SURCHARGE `:;: ;;% 1.4 00
ontact Person / f Phone
4 ` ,.
72 � 6 „ � Z56-- Z7a 5' **PLAN REVIEW 25% OF SUBTOTAL ;: -: ` . ;.. ,:,,{;�
1�B. TH�HQ[�5 178 Required only if fixture qty. total is > 9 T
t#ATH�H X25000 m i TOTAL ,� , r J
W
i3A.T H $285; , z r
t .t =' fee tt es ll plu t dwelling and the)first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
•6101WOJi5 411 : ::** k:S , diet efand`Water sOilee tE A Device, which is $25 + 8% surcharge
**Ali New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I: \dsts \forms\plumapp.doc 11/18/99 -
PLEASE COMPLETE:
ii 'L w %!47,419v0q:-;
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:
1:1dstskformslplumapp.doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24- Hou%Inspection Line: 639 -4175 Business Line: 639 -4171
� BUP
Date Requested (e)-(1`4(q, , AM id
BLD
Location lQ 4f 41 ° � ) crUh 1/ A S Suite - /g i 00 L/
Contact Person .CJ's e AL ' Ph LM q'- `f -
Contractor Ph SWR /`c9 ' 0
BUILDING 4 , 4;!;_ „4',X, Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation fe.. S f � 1 60 FPS
Ftg Drain / SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear //
Framing y(X, N/L4
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
Under Slab nikk.i
ap �
Top Out
Water Service ��
Rain Drains 4:1 —' 2 /
PART FAIL
CHANICAL,, ;; ` , a c
• 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
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 (, l
Other Date 1 Inspector �� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • •