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Permit CITY TIGARD PLUMBING PERMIT �t DEVELOPMENT SERVICES P ERMIT #: PLM2000 -00118 - - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/12/2000 SITE ADDRESS: 14305 SW PACIFIC HWY PARCEL: 2S110A6 -00200 SUBDIVISION: CANTERBURY PLACE ZONING: C -G BLOCK: LOT: 1 -3 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: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replacing water piping FEES Owner: Type By Date Amount Receipt KOLVE, G C PRMT BON 04/12/200C $50.00 0001368 14389 SW PACIFIC HWY 5PCT BON 04/12/200C $4.00 0001368 TIGARD, OR 97224 Total $54.00 Phone 1: Contractor: KEEFER PLUMBING INCORPORATED PO BOX 562 HILLSBORO, OR 97123 REQUIRED INSPECTIONS Phone 1: 503 - 640 -7451 Water Line Insp Reg #: LIC 065481 Final Inspection PLM 34 -94pb ORIG 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 (ling (503) 246 -1987. �I Issued By: bu�- �c ,.� Permittee Signature l 61,L1 Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan Check# GSA 13125 SW HALL BLVD. Commercial and Residential Rec'd By '? TIGARD, OR 97223 Date Rec'd LI - t A 0'5 7) (503) 639 -4171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit #L7f Related SWR # • Called Name of velopment/Project FIXTURES (individual) QTY PRICE AMT Job C. 1 Sink 11.50 Address street Address p Suite Lavatory 11.50 1 4 3 0 5 9 roc. y Tub or Tub /Shower Comb. 11.50 Bldg # City /State Zip Shower Only 11.50 1'1 q --727-: Water Closet 11.50 Nam e° ci .e 1- ( / C Urinal . 11.50 Owner Mailing Address Suite Dishwasher 11.50 Garbage Disposal 11.50 � O ✓ G70CoS City/St to Zip _ Phone ' Laundry Tray 11.50 `r- c0.�a�'1v� _ Name /� Washing Machine/Laundry Tray 11.50 �� 12 a l U LA GL LA t=I� Floor Drain/Floor Sink 2" 11.50 Occupant Mailing Address / Pad{ Suite 3° 11.50 14 3 lJ� Pad{ W + 4° 11.50 City /State Zip J Phone T U 2Z4 Water Heater 0 conversion 0 like kind 11.50 a Gas piping requires a separate mechanical permit. P(00v012.--t MFG Home New Water Service 32.00 Contractor Mailing AddreAs /� Suite MFG Home New San/Storm Sewer 32.00 Mailing ® is Hose Bibs 11.50 Prior to permit tttvM to I Zip �} Phone Roof Drains 11.50 issuance, a copy °l1 i I S iPOYO Od"' t z Lp 47 / of all licenses are Oregon Const. Co Board Lic.# p. ate , �/ Drinking Fountain 11.50 . required if (Q Cj C-/ ' "j /30/0 2 !%�' Other Fixtures (Specify) 15.00 expired In COT Plumbing Lic 4,74 I', Exp. Date ' -1 `C��(1J t iS t' 5 a) 660p database T CT - 7M1/60 / ��"`""" y "t ��� Name " Architect Sewer -1st 100' 38.00 Or Mailing Address Suite Sewer - each additional 100' 32.00 Engineer City/State Zip Phone Water Service - 1st 100' 38.00 Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New 0 Repair yi Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commerciaf' Ad itional description of work: Commercial Back Flow Prevention Device 32.00 �{-� Q Residential Backflow Prevention Device* 19.00 c �� r<<< r ti3 1 yt , (� _ Catch Basin 11.50 Are you capping, moving or replacidg any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No A 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. QUANTITY TOTAL I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Taal is > 9 given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL that plans submitted are In compl' nce with Oregon State Laws. C'0 60 ure of n /Ag n DM � / 60 8% SURCHARGE Con t P on la e m Phone I . 0 'll 42146-7141;-/ ** PLAN REVIEW 25% OF SUBTOTAL 1 BA HOUSE $178. Required only If fixture qty. total is > 9 2 BATH HOUSE $250.00 TOTAL 3 BATH HOUSE $285.00 (This fee Includes all plumbing fixtures In the dwelling and the first . *Minimum permit fee is S50 + 89G surcharge, except Residential Backflow Prevention -• 100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge **Ail New Commercial Buildings require plans with isometric or riser diagram and plan review. IAdstsUormstplumapp.doc 11/18/99 ti PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed /Capped 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: I:ldstsVormstplumapp.doc 11/18/99 4/21/00 Activities for Case #: PLM2000 -00118 4:31:33 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMC003 Application received 4/12/00 BON DONE No Hold BON 4/12/00 PLMC005 Permit Created 4/12/00 BON DONE No Hold BON 4/12/00 PLMC710 Water Line lnsp No Hold BON 4/12/00 PLMC799 Final Inspection 4/19/00 MRS PASS No Hold AKJ 4/20/00 PLMCO50 (F) Issue permit - 4/12/00 BON DONE No Hold BON . 4/12/00 PLMA800 Case Fineled 4/20/00 AKJ DONE No Hold AKJ 4/20/00 • • • Page 1 of 1 I CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 5 iness Line: 639 -4171 BUP Date Requested "I � AM x PM BLD Location / L Y) S P � C Suite MEC Contact Person Ogesr. Ph 11 VD — 7610 f PLM 7,Q'aO-Co /l Contractor L Ph SWR BUILDING Tenant/Owner C G1Ai1 - • aiC(41 4ll, ELC Retaining Wall U ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: n_v pri"orSlab (_Y 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 PLUM Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Fin- . ig PART FAIL 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 Other Date / / Inspector Ext Final PASS PART FAIL • 0 NOT REMOVE this inspection record from the job site.