Permit CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
'NU�d���11 PERMIT # PLM98 -0126
-� -c:_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05 / 08 / 98
PARCEL: 25111DA -01500
SITE ADDRESS ....: 08720 SW LODI LN
SUBDIVISION - APPLEWOOD PARK NO. 1 ZONING: R -7 PD
BLOCK • LOT °011 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:R3 FLOOR DRAINS......: 0 TRAPS : 0
STORIES • 0 WATER HEATERS • 0 CATCH BASINS ° 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS ° 0
SINKS.........: 0 URINALS 0 GREASE TRAPS - 0
LAVATORIES • 0 OTHER FIXTURES 0
TUB /SHOWERS...: 0 SEWER LINE (ft)....: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Install backflow prevention device
Owner: FEES
LEGEND HOMES type amount by dat recpt
6900 SW HAINES ST PRMT $ 15.00 JSD 05/08/98 98- 30560E
TIGARD OR 97 223 SPCT $ 0.75 JSD 05/08/98 98- 305606
:::a::
or —
MART SANDERS
PO BOX 307
NORTH PLAINS OR 97133
Phone #: 647 -5567 $ 15.75 TOTAL
Reg #..: 11068
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backflow Prey
Tigard 'Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 -8801 -8010 through OAR 952 -0001 -8080: You may
obtain copies of these rules or direct questi.ns to OUNC by calling
(503)246 -1987.
Issued By. Permittee Signature: ;./ �� ,_
++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
CITY OF TIGARD Plumbing Permit Application Plan Check #
13125 SW-HALL BLVD. Commercial and Residential Rec'd By °� " ..,.• i
TIGARD, OR 97223 Date Recd
•
(503) 639 -4171 7 7- 0 6r 6 Date to P.E.
Print or Type Date to�p5�,1`
Incomplete or illegible applications will not be accepted permit (T 2
Related # & Called
Name of Development/Project On back indicate Work Performed by fixture.
Job / 1 4.5 n FIXTURES iiii 600,al ° ` : - -! "° AM°`
/� � vod� �:��..,�,�,�.r(.,�,.;,, � 1�..�����._ _��"`� QTY��� PRICE, ,AMT
Address Strtset Address / Suite Sink " 9.00 •
i 7 7 - ......$ ` -r f Lavatory 9.00
Bldg City /State Zip
Ca / �` 5 , Tub or Tub /Shower Comb. 9.00
Name Z Shower Only 9.00
L� Q..._ CD 1 O S Water Closet 9.00
Owner / Mailing ress Suite Dishwasher 9.00
t, iv ) ih , ',4 64- 7-00 Garbage Disposal 9.00
. City/State /) Zip Phone
/ / / y o eo Washing Machine 9.00
Tr;s gist O LJ t . e C� C ) i V t1
Name' }��j , Floor Drain 2' 9.00
/ r''UCXe I 3" 9.00
Occupant Mailing Address Suite 4" 9.00
City /State Zip Phone Water Heater 0 conversion 0 like kind 9.00
Laundry Room Tray 9.00
Name j , Urinal -- 9.00
6, S c+ 'P -$. Other Fixtures (Specify) 9.00
Contractor c ling Address Suite 9.00
U . 307
Prior to permit Ci /State Zip S 7 Phone 9.00
issuance, a copy /y' s , ( �7G r ` C 0 � 0 ,S'S Sewer - 1st 100' 30.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date Sewer - each additional 100' 25.00
required if S7 'i- Z St - 3 O 5 Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200'
database / r 4C.) G� `f-CSb 25.00
Name C Storm & Rain Drain - 1st 100' 30.00
Architect Storm & Rain Drain - each additional 100' 25.00
or Mailing Address Suite Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Engineer City/State Zip Phone Pollution Device
Residential Backflow Prevention Device* ' 15.00
Describe work New 0 Addition 0 Alteration 0 Repair O Any Trap or Waste Not Connected to a Fixture 9.00
to be done: Residential 0 Non - residential 0 Catch Basin 9.00
Additionaldescription of work: Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
• per /hr
Rain Drain, single family dwelling 30.00
Existing use of
building or property Grease Traps 9.00
Proposed use of QUANTITY TOTAL Y =J 'W °
building or property Isometric or riser diagram is required if Quanity Total is > 9 - ,_ f ;
*SUBTOTAL „V ''1, ,,
I hereby acknowledge that I have read this application, that the information " ' : . 1
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE w , r -, ii. ' '" '
that plans submitted are in compliance with Oregon State Laws. 2, �.: F
Signatu
r/ nt Date "'PLAN REVIEW 25% OF SUBTOTAL We '' e - u
Required only if fixture qty. total is > 9 .�0 4 - : _
TOTAL _ -° r:'
Contact Person Name Phone E.,"
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
„...____
I 9(z....loz---) and p lan review
dstslplumbapp.doc 5/5/98
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed/Capped
• •••-•-•'•-•
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3 "
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
•
COMMENTS REGARDING ABOVE:
.Acists \plumbapp.doc 5/5/98
CITY OF TIGARD BUILDING INSPECTION DIVISION -
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 1 AM PM BLp,
Location �-� w Z . Suite MEC
Contact Person Ph PLM 9g -661 Z
Contractor r' Ph SWR
BUILDING: Tenant/Owner
ELC
Retaining Wall ELR
Footing Access: 75
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam b.-e-s=- r rT e- r t 6
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final ` / s_ i
PAS PART FAIL
LUMB
----•= Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
- - Rain Drains
�l$y' •
A 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 l K Inspector
Other ) �. O \ 4 Ext
Final
t�
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.