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Permit i A CITY OF TIGARD PLUMBING PERMIT i, DEVELOPMENT SERVICES PERMIT #: PLM2000 -00226 ' �' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/19/2000 SITE ADDRESS: 11492 SW LAUREL GLEN CT PARCEL: 2S110AC - L0004 -- SUBDIVISION: LAUREL GLEN ZONING: R - 4.5 __ BLOCK: LOT: 004 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: 1 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER LINE: 100 ft DISHWASHERS: RAIN DRAIN: 0 ft Remarks: Install roof drains, Sewer line, and water lines for existing dwelling. FEES Owner: Type By Date Amount Receipt DON BUSS PRMT GEO 06/19/200C $87.50 0003098 440 NW HILLTOP RD 5PCT GEO 06/19/200C $7.00 0003098 PORTLAND, OR 97210 Total $94.50 Phone 1: Contractor: . PERKINS + SON PLUMBING 8524 NE 147TH PL BOTH ELL, WA 98011 REQUIRED INSPECTIONS Phone 1: 206-488-3535 Sewer Inspection Water Line lnsp Reg #: LIC 00118162 PLM 37 -391 PB Rain Drain Insp Final Inspection • ORIGINAL • 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. A lp/ Issued B • / / __-- Permittee Signature / 400 Call (503) 6 -4175 by 7:00 P.M. for an inspection neede: t - next business day CITY 6-. !GARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential - Rec'd By TIGARD, OR 97223 y j Date Rec'd (503) 639 -4171 Date to P.E. . Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit # -oolP Related SWR #ate =dv /y 7 Called Name of Development/Project FP(1 -R "(individua ' > '" QTY r. 'PRIC %AMT ` Sink 11.50 Job Lcurcl 4k41 Si _ 11.50 Address Street Address Suite Lavatory //'/72 L4aa`I Co (C.41 cf Tub or Tub /Shower Comb. 11.50 Bldg # City /State Zip Shower Only 11.50 T/(,41Q0 , 0Q 572.24/ Water Closet 11.50 Name Do U 11.50 Doti g�S � . Owner Mailing Address , 11-� Suite • Dishwasher 11.50 C 'IO J.W . pL l, Z ryl • Pd phone Garbage Disposal 11.50 A N tiket4 6A 972/0 2gr-1 ?/j Laundry Tray 11.50 Name Washing /Laundry Tray 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. • MFG Home New Water Service 32.00 P/ k1 NS e 5- c Pi. f MFG Home New San /Storm Sewer 32.00 • Contractor Mailing Address Suite T:5-2 y NE 111 /L Hose Bibs 11.50 Prior to permit City /State Zip �i Phone Roof Drains 11.50 issuance, a copy .I✓JI'YI `E o r e vii} filar (1141-Yps,S Drinking Fountain 11.50 11.'f0 of all licenses are Oregon Const. Cont. Board Licit 'Exp. Date 15.00 required if 1 37- 3 7/ PR Other Fixtures (Specify) expired in COT PI(lmbing Lic. # Exp. Date . database // F/6.2 Name • Architect Sewer - 1st 100' I 38.00 31 or • Mailing Address Suite Sewer - each additional 100' 32.00 Water Service - 1st 100' /. 311.00 3/ 40 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 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 O. 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. N. °° °�• -- QUANTITY TOTAL " :.!W I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 3 46,,,::44 i given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL sN`uv; °R n ..,, that plans submitted are in compliance with Oregon State Laws. X'•a�.; �, ;,,,, , re f Ow jer /A Date 'A-X,11.' - V, , 71.51) Signatu !r/A 8% SURCHARGE ' ` :` if 0 0 Contact Person Name Phone ' " k as 53 o 5-31-1/7W **PLAN REVIEW 25% OF SUBTOTAL '- Required only if facture qty. total is > 9 _ ,.. Al `s : °' BAT i;t OUSE f igiro . P ' ri TOTAL • l BATFINOti,SEf 5 tO0 " - (This fee nc al ) fixtures 3 e dwel in an t he fi ' � •Minimum permit fee is 350 + 8% surcharge, except Residential Backflow Prevention 1OO feet r rtof n $ewer and service J ,,V, ,, Device, which is $25.+ 8% surcharge **All New Commercial Buildings require plans with isometric or riser diagram and plan review. lldsts \forrnslplumapp.doc 11/18/99 PLEASE COMPLETE: f,'91 pe Q " tew 14: SMiiied:=1, 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: • • 1:1dsts\forms\plumapp doc 11/18/99 IF \., \ 4....''' —, e CITY OF TIGARD BUILDING INSPECTION DIVISION MST / 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 ��F7 GU Date � Z � � BUP ate Requested (�-/ V� "6 AM PM BLD Location 510 44 A C7 1--- Suite _ MEC Contact Person l i L1 q Z- Ph PLM Q rY — _,6 Contractor / r / CD ('_,i1 574 Ph SWR BUILDING :,, Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation (/q FPS Ftg Drain SGN Crawl Drain Inspection: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation 7/ Drywall Nailing I Firewall Fire Sprinkler f Fire Alarm ___53 ..3 Susp'd Ceiling Roof / Misc: l .f Final PASS PART FAIL ?ok_:a6 .-Cif - (6/ • ost. & Beam Under Slab 4/f./ Top Out n; / Water Service - Rain Drains Fi ASS PART FAIL ANICAL " Post & Beam j�+ % o�� . IF Rough In 1 Gas Line Smoke Dampers Final PASS PART FAIL J / ` '/j /W ELECTRICAL jrf / / Service II -41 __ Rough In . UG /Slab �� i _ ,_/ ' �� Low Voltage �w Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Dat Inspector frvg Ext Final PASS PART FAIL ' O NO REMOVE this inspection record from the job site. I CITY OF TIGARD - 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 -z, BUP Received Date nested �/ AM s PM BUP Location /1 �f sageyt Suite 4 610 Z003 — czif zi Contact Person Ph i t 3 - 30‘4 M I 17 ,7 z Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC 2 2 0 ( 1 1 Footing Foundation ELG _ Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear - Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling \\ Roof Other: — Final PAS T FAIL Pest -& Beam Unde - • " • gh -In 0� ►a - ervice Sanitary Sewer / Rain Drains _ Catch Basin / Manhole Storm Drain Shower Pan Other: Fig " •I • RT FAIL Po t& Beam Rough -Irk aOne Smoke Dampers Fi PAS PART FAIL ELECTRICAL Service UG /Slab Low Voltage Fire Alarm • El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SI I El Please call for reinspection RE _ _ El Unable to inspect – no access Fire Supply Line ADA i 6 � J 1 Approach/Sidewalk • Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL