Permit CITY TIGARD PLUMBING PERMIT
l DEVELOPMENT SERVICE PERMIT #: PLM2000 -00064
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 03/02/2000
SITE ADDRESS: 09495 SW LOCUST ST A PARCEL: 1 S126DC 04800
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 2 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: Replace 2 electric water heaters with like kind.
FEES
Owner:
Type By Date Amount Receipt
BAKER, JAMES +MATHESON, ROBERT PRMT KJP 03/02/200C $50.00 0000401
BAKER, DIANE R 5PCT KJP 03/02/200C $4.00 0000401
9495 SW LOCUST A
PORTLAND, OR 97223 Total $54.00
Phone 1:
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone 1: 643 -5535 Misc. Inspection
Reg #: LIC 001009 (CORRECT #10967) Final Inspection
PLM 34 -42PB
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 c- e•r•ance wit . •• oved plans.
This permit will expire if work is not started within 180 days of iss!ariice, or if work is suspende• for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Ut ity
Notification Center. Those rules are set forth in OAR 952 -0601 -0010 through OAR 952 - 0001 -00:0.
You may obtain co ' s of these rules or direct questions OUNC by calling (5, 23) 246 -1987.
Issued By: Permittee.Si ture: / / __
Call (503) 639 -4175 by 7 :00 P.M. for an inspection neede • - - • usinesss_�.� .
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125' `v l 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 (o DS
Incomplete or illegible applications will not be accepted Permit# i 0 6 °‘5 /
Related SWR #
Called
Name of Development/Project ( z"'°
r° FIXTURES intlivi "dual) `: ? PRICE�;� AMT'"
Job (r 8 \ -t- QSJOC Sink .....,... 11.50
Address Street Address -- 1te Lavatory 11.50
O 5 5 i D t 0C U,St Tub or Tub /Shower-Comb. 11.50
Bldg # City /State Zip Shower Only r 11.50
Name Water Closet 11.50
Se A-- Dishwasher • 11.50
Owner Mailing Address Suite Garbage Disposal 11.50
Washing Machine 11.50
City /State Zip Phone Floor Drain /Floor Sink 2" 11.50
Name 3" 11.50
mare -d- QSSos . 4" 11.50
Occupant Mailing Address S 1te Water Heater 0 conversion 'like kind h 11
R l t 5 5 Lo k DCUc�t A Gas piping requires a separate mechanical permit. 23.0
City /State Zip Phone Laundry Room Tray 11.50
" el ena.a3 aL{5 ,zi.i 5 Urinal 11.50
Name
Ke t•\ ?t U v'f` b i (j Other Fixtures (Specify) 15.00
• Contractor Mailing Address Suite
i 3 85 51P (mtI +on
Prior to permit /State Zip Phone Sewer - 1st 100' 38.00
issuance, a copy 6 ti"I-n of cr OD- 0-3 , 553 5 Sewer - each additional 100' 32.00
of all licenses are Of ego,0 Const. Cont. Board.Lic.# p Date!
required if 7 O 6. 4-343- ( /.z 6 t 03 Water Service _ 1st 1 38.00
expired in COT Plumbing Lic. # Exp. gate i Water Service - each additional 200' 32.00
database 3 % -Uze3 (0/3Q/03 Storm &.Rain Drain - 1st 100' 38.00
Name 1 Storm & Rain Drain - each additional 100' 32.00
Architect Mobile Home Space 32.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 32.00
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device* 19.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: YesA No 0 Any Trap or Waste Not Connected to a Fixture 11.50
Residential 0 Commercial 0 Catch Basin 11.50
Additional description of work:
Insp. of Existing Plumbing 50.00
per /hr
50.00
Are capping, moving or eplacing any fixtures? Specially Requested Inspections per/
hr
Yes 0 N • 0
Rain Drain, single family dwelling 45.00
f yes, see back of form to ind ate work performed by Grease Traps 11.50
"fixture. FAILURE TO AC_ CU - • TELY REPORT FIXTURE
WORK COULD RESULT IN I REASED SEWER FEES. QUANTITY TOTAL q. _, °:
I hereby acknowledge that I hay- ead this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 1 ;Z'-"; :_; -'' _<
given is correct, th 't I am the . n -r .r authorized agent of the owner, and *SUBTOTAL i , '` '�`' `:
that plans submitt • ar- ' coin, . '- - wit Oregon State Laws. ` s' ,.> S 0 . �
.
Signature of O D ate SURCHARGE . � �. 3�� D
.:,,. Agen ,,.r..«�,,
_ 6/9. �9'6
Contact Person Na e P one * *PLAN REVIEW 25% OF SUBTOTAL .'!`" '
he. ( N-e SS .1- 3, 553 5 Required only if fixture qty. total is > 9 ;-:a .
MHOUS ; .� TOTAL ,:. Ey �i O
r 4-BATH pJ *Minimum permit fee is $50 + 5% surcharge, except Residential Backflow
x . fee it(cl'�cles< #11 lum fixtures the et a) 4he;:fi'rst Y 1 Prevention Device, which is $25 + 5% surcharge
- :: om' P i* , ' , 3 * *All New Commercial Buildings require �pf; sapftaiyyggv�terstcrten ;sewet�andrw� �,rgerylce��� • �� � � � � g quire plans with isometric or riser diagram
and plan review -
t 7
1: \dsts\formslplumapp.doc6 /2/99 V I I ��
()_L ,{ or\
-PLEASE COMPLETE:
0 tm
. ' .........
. , • :•. , . ,, . .• • • .
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:
hdstsVormslpluenapp.doc 6/2199
CITY OF TIGARD BUILDING INSPECTION DIVISION - MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date a Requested s/ 2 7/C)O AM PM BLD
Location 6 /99S S LD Suite M EC
Contact Person ShafiAl, Ph LJ"_co z_
Contractor - Ph �t SWR
BUILDING, = .;,r: x Tenant/Owner D8t<itt'frTO 6y ,A- s50G.. =7 ELL
Retaining Wall ELR
Footing Access: ,-
Foundation i % 61}aa—it 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 .RT FAIL
MBI
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer ..r - tt
Rain Drains (. 1 , l" s
art
_ PART FAIL /
MECHANICAL
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
SITE
•
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 Date _ o Inspector / 7 7 Ext �
Other 1
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site