Permit .
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2000 -00185
•�I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/07/2000
SITE ADDRESS: 11777 SW QUEEN ELIZABETH ST PARCEL: 2S110CD -00113
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 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: Install 2 commercial backflow prevention devices.
FEES
Owner:
Type By Date Amount Receipt
KING CITY RESIDENTIAL PRMT KJP 06/07/200C $64.00 KINGCITY
CENTER, LTD 5PCT KJP 06/07/200C $5.12 KINGCITY
BY LARRY DRAPER
LAKE OSWEGO, OR 97035 Total $69.12
Phone 1:
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone 1: 771 -9449 RP /Backflow Preventer
Reg #: LIC 000042 Final Inspection
PLM 34 -70pb
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.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
MAY - 31 -00 WED 10:42 AM City of King City FAX:503 639 3771 PAGE 2
• CITY OF TIQARD Plumbing Permit Application Plan Check •
13125 SW HALL BLVD. Commercial and Residential Rec'd By :
TIGARD, OR 97223 Date Rec'd 5 -31-00
(503) 639 -4171 Date to P,E.
•
Print or Type Date to DST 5-3 / -60 /
Incomplete or illegible applications will not be accepted Permits �.M Zaoo • pc�
Related SWR *
-
. Called
•
Name of DevelopmenUProjed FIXTURES i(indi iiduej). ;' : : .: ' :QTY.": • P ' •
Job Sink 11.50 •
Address Street Address Suite Lavatory • 11.50 •
•
•
777 S t.r1, Q4 e•r.i 3 a be i fp. Tub or Tub/Shower Comb. 11.50
Bldg e I City /State Zip Shower Only 11.50
�rVqm / �. Water GoseWrinal (Specify) 11.50 •
1 e Dishwasher 11.50
Owner Mailing Address Suite Garbage Disposal 11.50 •
•
1i 7 1-7 s Qt.L'ee E/l ' Washing Machine/Laundry Tray (Specify) 11.50
City /State Zip Phone
^.- 00� Floor Drain/Floor Sink 2' 11.50 • .
I a ±'1 0
Name 3' 11.50
rS E 4 ' 11.50 .
Occupant Mailing Address Suite Water Heater O conversion 0 like kind 11.50
Gas piping requires :a separate mechanical permit
City /State Zip Phone MFG Home New Water Service 28.00 .
•
MFG Home New San /Storm Sewer 28.00 •
Name . .
C f w L ./ 013 g Cv'e 2 Hose Bibs 11.50
Contractor Mailin Address Suite Rain Drains 11.50 •
•
.5 S 6 AAA s Drinking Fountain 11.50
Prior to permit Cit (State Zip Phone Other Fixtures (Specify) 15.00 •
issuance, a copy. V0.4/814 0, y, 210 b . 77i - 9y 9
of all licenses are Oregon Const. Cont., Board Lic.x Exp.
required if L i oP -(0-7 / 4 74Je4
expired in COT Plumbing Lic. B Exp.
database •3 Li-70P I3 _ 6- yd o-$
Name '
Sewer - 1st 100' 38.00
Architect • Sewer -each additional 100' 32.00
Or ' Mailing Address Suite Water Service - 1st 100' 38.00 • •
C ity /State Zip Phone Water Service • each additional 200' 32.00
Engineer - Storm & Rain Drain -1st 100' 38.00
Describe work to be done: Storm & Raln Drain - each additional 100' 32.00 '
New Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device ap_ - .
32.00 �tt
Resid ntial 0 Commercial Residential Beddow Prevention Device' 19.00 •
Additional description of work: .
Catch Basin • 11.50 •
• Insp. of Existing Plumbing ' 50.00 ' '
Are you capping, moving or replacing any fixtures? • cer/hr
Yes 0 No 0 Specially Requested Inspections 50.00 •
If yes, see back of form to indicate work performed by - parnv • ; •
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50 •
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL / , ti•. •
given is correct that I am the owner or authorized agent of the owner, and Isometric or riser d' • ram Is requited if Quantity Total is > 9 i t;Q
that plans submitted are In compliance with Oregon State Laws. 'SUBTOTAL ' ''
'`•` . $.11
Signature Owner/ e Date
S� " 3/' O�v 9% S URCHARGE + ...
Contact Perso dme Phone .
2 ?7/' S 9 Y "PLAN REVIEW 25% OF SUBTOTAL
�";1113Ar11 i E' �I78 o'; Y'- ",�1, +'. !� tara ": f r, . ? "' •', �'�' T.:54:;'r., ,L R fired on If fixtu .1 , total is > 9 L ;� � 1��;..y �C:•'.,._ .,ice'• ". 'z!!:. � is max' I,t , �? ^cr , . � ,. -:x; 1 ., d{�iir.: : h� TOTAL
NW ti ' I �
4 to L ow + I�' 4.1,..,,,,p;.:, I K• q' '� ti, T - Minimum permit fee is 550 +796 SurcAarge. except Residential Bacrdtow Prevention
lg tl : 'l g ;; Device, which is 925 + 796 surcharge
- 'A11 New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
I:WSi511Orm5 app•a0C 7/19r9a
•
MAY - 31700 WED 10:42 AM City of King City FAX:503 639 3771 PAGE 1
KING CITY
15300 S.W. 11tith Avenue. King City. Oregon 97224 Phone: 639.4082
FAX C O V E N S H E E T
DATE: 5 /
TO _ 1 41 0 f.t
ATTN: 1). � •
F R O M : ,
MESSAGE:
2
This transmittal contains. ` _pages, including this Cover
Sheet. If you experience any problems, please contact:
City of King City (503) 639-4082
• Fax Number (503) 639-3771
•
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested (0/Q /00 AM PM BLD
Location I 1 - 7 7 - 1 ((4.QJJ1 f 4 47� s.- p MEC
Contact Person '1R `7 - 2 ( -q 1 / ( 1 PLM V'-to 1g S
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
LUMBIN)
Post & Beam
Under Slab
Top Out r509s
Water Service
Sanitary Sewer
Rain Drains
tif.;F 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
Other Date ' I Inspector Ext J
Final
PASS PART FAIL DO OT REMOVE this inspection record from the job site.