Permit ..., c .
CITY OF TIGARD
^ ,.,,,„, DEVELOPMENT SERVICES F'ERMPLUMMBING PERMIT
TM98 -0233
Tigard, (503)639-4171 DATE ISSUED: 07/15/98
PARCEL: 251O3BA -00133
SITE ADDRESS...: 11720 SW LYNN ST
SUBDIVISION • LERON HEIGHTS NO. 2 ZONING: R -4.5
BLOCK • LOT •023 JURISDICTION: TIG
CLASS OF WORK..:OTR GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
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)...: 100
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS - 0 RAIN DRAIN (ft)...: 0
Remarks: Installation of a sewer line to a single family dwelling.
Owner: FEES
HOWARD CORNUTT & JANICE CORNUTT type amount by date recpt
11720 SW LYNN ST PRMT $ 30.00 DLH 07/15/98 98- 307386
TIGARD OR 97223 SPCT $ 1.50 DLH 07/15/98 98- 307386
Phone #:
Contractor
HOWARD CORNUTT
11720 SW LYNN ST
TIGARD OR 97223
Phone #: 244 -3040 $ 31.50 TOTAL
Reg #...
REQUIRED INSPECTIONS
This perwit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. fill 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 wore
than 188 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 - 8001 -0010 through OAR 952-0101-0080. You way
obtain copies of these rules or direct questions to OUNC by calling
1503)246 -1987.
Issued By:
.147(&:jr&._,_______
Permittee Signature: .q.,,..., c _ . 6
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By . LE/
TIGARD, OR 97223 Date Rec'd '/ / S/9,/ ,
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# / /y ?d 6 33
Related SWR #
Called
y ( Name of Development/Project FIXTURES (individual) QTY:: PRICE , AMT ,
Job 4erOri /71Q4A -es Sink 9.00
Address Street Address Suite Lavatory 9.00
8 7 ZO c W LQ rl Tub or Tub /Shower Comb. 9.00
Bldg # City/ to Zip Shower Only 9.00
73a- re,/ ° 97123 Water Closet 9.00
Na ��.,/ / //��
770 r'/I a.r (-Jaw // _ ( mod r/7 /,/r5L' Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
// 7_w -Sui h .1 Washing Machine 9.00
-
City/State Zip Phone S03
° 9 71 3 5'9 o 5/ 338 Floor Drain/Floor Sink 2" 9.00
/ 3" 9.00
�e Gs Boll E 4 " 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name
4 am fe j Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
// 7-7,0 -5 "-fin', 9.00
Prior to permit City/State Zip Phone So3 Sewer - 1st 100' / 30.00 30
issuance, a copy ��d 4,e q 7 zz3 S I`0 y 3 3 S?
Sewer - each additional 100' 25.00
of all licenses are Orglon Cons4. Cont. Board Lic.# Exp. Date .
required if Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
or Mailing Address 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?
Yes O No O Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL
I hereby acknowledge that I have read this application, that the information ��
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE
that plans submitted are in compliance with Oregon State Laws. • I,
Signature of Owner /Agent Date * *PLAN REVIEW 25% OF SUBTOTAL
R equired only if fixture qty. total is > 9
�� 7 -/ S - TOTAL
C ontact Person Name Phone 1/ . sd
�7 ^3O U `Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
f - �o vv a.rd C r n u� 7 7 d Prevention Device, which is $15 + 5% surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram ,.4
and plan review W
0
v1
I: \dsts\plumapp.doc 7/2/98
N
dl
PLEASE COMPLETE:
fixureTYPe Quanti b. Wor
New Moved Replaced . Removed /Capped
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:
•
1:ldsts\plumapp.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION i9__ D 2-3 3
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Requested �l l AM �PM BLD
Location /1 2-D Suite MEC
Contact Person Ph 47 sI
Contractor Ph SWR
BUILDING 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
PLUMBING
Post & Beam
Under Slab 1 # , � ■ I
To; 0 - —
`�,•!'
ni ary S -.- Rain • rains
Fi -1
PART FAIL L ✓1� _ _ � _ / i ; �i, ���►
CHANICAL
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 f3 Inspector " Mr , 2-
Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.