Permit CI TY OF TIGARD PLUMBING PERMIT
l DEVELOPMENT SERVICES PERMIT #: PLM1999 - 00102
'.: 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 16545 SW KING CHARLES AVE PARCEL: 2S115BC - 05200
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
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 and conversion of water heater.
FEES
Owner:
Type By Date Amount Receipt
SEIDEL, HERBERT APPL DRA 4/13/99 $25.00 KING CITY
16545 SW KING CHARLES AVE MISC DRA 4/13/99 $1.25 KING CITY
KING CITY, OR 97224
Total $26.25
Phone 1:
Contractor:
'b Tit, Com Go2T ab ATieoL, : IJ
I asss
34J{.9 -1-0 oQ q- 700g -5 /Sa REQUIRED INSPECTIONS
Phone 1: (o- a - 74f77 Final Inspection
Final Inspection
Reg #:
(osa 9 to
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may .btain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
_
Issu d By: \ . 1 � Permittee Signature: , Call (503) •39 -4175 by 7:00 P.M. for an inspection needed next usiness day
APR- 13 -'99 TUE 08:33 ID: FAX NO: #118 P02
CITY OF TIGARD RECEIVED Plumbing Permit Application Plan Check# •
13125 SW HALL BLVD. Commercial and Residential Recd ay a
TIGARD, OR 97223 APR 13 '1999 Date Recd - lL -
(503) 639 -4171 Dote to P.E.
COMMUNITY DEVELOPMENT print or Type Date to DST >�1-- 1.' - ^�1c
Incomplete or Illegible applications will not be accepted Permit# Pe.11 1919 - to
Related SWR # ,
Called - --
Name of Development/Project tt r pR M��i "r � .N 1s w s i� >^; r h -��7 1 °-`" 7 /� 0 ` JE
, r,. h.�m „r �. a�.r�,rri,�i *r, e.!. 9rt},�,.nirr,.f } >.�ur, r,.,�..;�a�5},',;cd,E.., t+ 4 „aA r.aa di�iS t ?e-I1 i
Job 16 S 'S_ 3 -.� )A pi r ts, J Q.t Ave Sink 9.00
Address Street AddtS$ 1 Suite Lavatory 9,00
Tub or Tub /Shower Comb, 9.00
Bldg # City /State Zip Shower Only 9.00
Name
TAd.w 'oQ q ?d' �` Water Closet . 9.00
Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
I (1 5'" l •ksC4leM" Washing Machine 9.00
City /State Zip Phone
Floor Drain /Floor Sink 2" 9.00
Name 3" 9.00
DRe79''✓ 6p•nt Cry -r? oeo- f 4" 900
Occupant Mailing Address SUlte Water Heater >p.converslon 0 like Kind 9.00
12 "b ' rte-- 2 Z KI Gas piping requires a separate mechanical permit. ,
City/State Zip Phone Laundry Room Tray 9.00
] 1LT;.n c17cc -K C20. 7Y77 Urinal 9,00
Name V
Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
9.00
Prior to permit City /State Zip ' Phone Sewer - 1st 100' 30.00
issuance, a copy
Sewer -each additional 100' 25.00
of all licenses are Oregon Conet. Cont Board Ue.# Exp. Data .. - -
required if - (l> (a s . q 6 1 /7/ CID Water Service - let 100' 30.00
expired in COT Plumbing Lie, # Exp. Data Water Service - each additional 200' 25.00
database Storm S Rain Drain - 1st 100' 30.00
Name Storm 8 Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
Or missing A4dress 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 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per/hr
Specially Requested inspections 40.00
per /hr
•
Rain Drain, single family dwelling 30.00
Are you capping, moving or replacing any fixtures? ' 4
-
Yes 0 No 0 Grease raps
9.00
If yes, see back of form to indicate work performed by t
f�,� '�
QUANTITY TOTAL M r + i .�',,� -y
;
fixture. FAILURE 'I 4 ACCURATELY REPORT FIXTURE Isometric or riser diegram is required if Quenlity Total is s : %I.g t rc ,4 1 ` ^ '
WORK COULD RESULT' IN INCREASED SEWER .FEES. ' SUBTOTAL T „ 77 7, ` ih a A .
e ro
1 hereby Acknowledge that I hav ad this applieation,that the information ''' '• ,f } {(� , y�y� { { ,w
given Is correct, that I am the owner or authorized agent of the owner, and VA SURCHARGE %r F
that plans submitted are in Compliance with Oregon State Laws. • ; t xs' j 1 / f % %
Si of Owner /Agent bate - .PLAN REVIEW 25% OF SUBTOTAL l'�a 1? s
Required only if fixture qty. rote) is > 9 i s ` '
6 f /z /44e7 TOTAL I ' '4, 4 01: , t4 45'
Contact Person Name Phone ; ` Ik t,',s i (*: I;(4 .. . '
_ `Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
1HgTf " 13 /) tx� yI 2. / Prevention Device. which is $15 ti 5% surcharge
"A11 New Commercial Buildings require plans with isometric or riser diagram
and plan review _
I:vdslmplumapp.doc 7/2.190
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested L i '1 S-q g AM PM BLD
Location !( anl cm04,Lio Suite MEC qq' d/ 2^(G
Contact Person OA ("' Ph '1 -3 3 PLM 099 o
Contractor Ph SWR
BUILDING;y rid ' °'-T' Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
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
MBI ', , yN
Post & Beam
Under Slab /
Top
Top Out
Water Service .7 .
Sanitary Sewer
Drains
„ ? PART FAIL
CIANICAL•°
BB am ..;..–
Rough
Li I
Gas Line
V--
A1C
S in D Dampers
__§,15,--' PART FAIL
ELECTRICAL, >'; M y
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE ' n !z, ' ..:2
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 C� /� � r
Other Dat e! / � In Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.