Permit CITY TIGARD PLUMBING PERMIT
* *VOW' DEVELOPMENT SERVICES PERMIT #: PLM2000 -00275
• 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 12050 SW KAROL CT PARCEL: 2S102BB 00410
SUBDIVISION: KAROL COURT ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 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: ft
Remarks: Replacement of water heater with like kind.
FEES
Owner:
Type By Date Amount Receipt
KRAUSHAAR, STEPHANIE E + PRMT DEB 7/26/00 $50.00 0003998
BEDNAREK, CHRISTOPHER F JR
5PCT DEB 7/26/00 $4.00 0003998
12050 SW KAROL CT
TIGARD, OR 97223 Total $54.00
Phone 1:
Contractor:
JACOBS HEATING +NC INC •
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 234 -7331 Top -out Insp
Reg #: LIC 1441 Final Inspection
PLM 26 -548PB
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 B _ 62-1//LAJOI p Permittee Signature: 4
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan C lb 13' 5 SW HALL ;SLVD. Commercial and Residential Recd : 1
TIGARD, OR 97223 Date Recd 7 - O°
(503) 639 -4171 Date to P.E.
Print or Type Date to DS �
• Incomplete or illegible applications will not be accepted Permit# LM 9 - �6
Related SWR #
Called
Name of Development/Project °FIXTURES!: individual ";. r'` 7"GTY`'- "vPRICAMT
Job a o. ecl (ut , e ic_ -
Sink 11.50
Address Street Address C+- Suite Tub Lavatory
I or Tub /Shower Comb. 11.50
cos ®S CO �� IC.
Bldg # City /State Zip .
Shower Only 11.50
Name Water Closet 11.50
C y ^� 'tv^►S i3CC`,uare-JC � 12- Urinal ,11.50
Owner Mailing Address Suite Dishwasher 11.50
I 2650 Sic) kLiat "c9 I at Garbage Disposal 11.50
City /State Zip Phone
T1 Q∎^6 (')2 91,3D-3 Co3r - Co'A Laundry Tray • 11.50
Ne Washing Machine /Laundry Tray . 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.5Q
4" 11.50
City /State Zip Phone
Water Heater onversion O like kind 11.50
Gas piping req ires a separate mechanical permit. / / /•Si'
Name
31CC� � ■'4 -Pp,.i \ 6 - A I MFG Home New Water Service 32.00
Contractor Mailing Address uite MFG Home New San /Storm Sewer 32.00
y`-/ 'T'-/' se r'1 i Wo u.,Cie_ Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy Po r OR c i 7 aQ 0Z 3 Lt 7331
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if ) L-/ L/ / Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database t (o - j Lf Er 1P ,-
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
• 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 t) 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 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.
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 *SUBTOTAL ,. ;�,.�q, ":;;
Isometric or riser diagram is required if Quantity Total is > 9 _ :; Y ; j t ` ` ` , ,, - -;
l /
that plans submitted are in compliance with Oregon State Laws. " SZ-`
Signature of Owner /Agent �1 Date o F, F
. /Ii -C.Jc t -l�tek c.c) , I L( 8% SURCHARGE .,; ;F. <r ° ; r,
Con ct Person Nam )
Phone �`;�-` =, =T
t
1 S J a 3 733 * *PLAN REVIEW 25% OF SUBTOTAL ``
� ;::. Required only if fixture qty. total is > 9 : =;'.z ;i
1 .,' HO SEAS 81it0 k 0 , y .; ;.. ` , T „. TOTAL
4 A H oUE 5250 M ; v r it _,' �.PT ,- ..- 1.� :�` ` _ ° ' , w a. VON y •,, 4-- '' v; /
h�. ter °>♦o '� 'r�K� �� 3= e���� F;F,:� � - ..
T h% s foe f t ctR s � ues{a t t t0t fi z t ares in;tt;e dwellf`ng a e -1� *Minimum permit fee is $50 + 8 %.surchar e, except Residential Backflow Preven
tion e�
�� { -� `- � Haa ra4� �� may, ��� Device, which is $25 + 8% surcharge m �'�; P 9 p � t
00 feet of sanity # i / 8 1 sti�rtn =sewer antf water service) - 1
�c..r.... >.�,.v �.:,.�1 „ - .a' >a- �+&'..�,:,..>, rs: da >�.,.. - - .,� ,s ue. A= •',..: ..'< - �` 'w
"All New Commercla =u1Rit regwre p ans satnetric rrudcPr dia and
plan review.
I:\dsts \forms\plumapp.doc 11/18/99
PLEASE COMPLETE:
ISe::17tt'ntqotffttiofyvr,rW[PtorracAA7;
?V. - 0(j : 7 1: 1 0,0,47C: Rci 1 Imod!Cp€ 0,i
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:
hcists \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 Reque ted ? 3 () AM PM B
�
Location /,2-C1 ry 5c- ` ��` • Suite 1H — 00Z06
_ G
Contact Person K Q Ph j r/ LM" !7 - 0 d 7S
Contractor Ph SWR
BUILDING° `, ' _ Tenant/Owner 42 2 0,0_ G u 4727
Retaining Wall ELR
Footing
Foundation Access: FPS
Ftg Drain C / %My
Crawl Drain Inspection Not6s:
SGN
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
31nBl
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
- in Drains
• RT FAIL
ANIC
Post & Beam
Rough In
Gas Line
Smo. - Dampers
11
it ,1,1.„ FAIL
4
Rough In
UG /Slab
Low Voltage
kAlarm
PART FAIL
S
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 7 proach /Sidewalk Date f 36 /00 Inspector / y��
w) Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.