Permit A - CITY OF TIGARD PLUMBING PERMIT
di I 6, DEVELOPMENT SERVICES PERMIT #: PLM2000 -00150
��' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: y — i''_ —6)0
SITE ADDRESS: 16625 SW QUEEN MARY AVE PARCEL: 2S115BC 02000
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 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 residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
FRANCES MCCOLE PRMT KJP 05/12/200C $50.00 KINGCITY
16625 SW QUEEN MARY 5PCT KJP 05/12/200C $4.00 KINGCITY
KING CITY, OR 97224
Total $54.00
Phone 1: 503 - 624 - 5010
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: RP /Backflow Preventer
Final Inspection
Reg #:
ERtGtiNt AL
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 cop' of these rules or direct questions to OUNC by calling (503) 246 -1987.
6
Issued By: ' Permittee Signature: `m d
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
MAY-10-00 WED 02:23 PM City of King City FAX:503 639 3771 PAGE 2
CITY OF'TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Recd By ■
TIGARD, OR 97223 Date Redd ,- t 0 -00
(503) 639 -4171 Date to P.E.
Print or Type Date to DST S.-40
Incomplete or illegible applications will not be accepted
Permit*
p 9 P Related SWR * .
Called
1 "i'. ttr.;rr'a ^: ;r.�' � }nny le £:z i u� �'
Name of OevelopmentlPro }ett • X_ � 11, � ..:` � � •- . .; "v r.c r.... ,.., . , E:1 7,4■ ... `'3
Job Sink . •, ... 11,50
Address Street Address ,t Suite Lavatory 11.50
/6445 SGT 04(4 f 4 "IRIF i Tub or Tub /Shower Comb. 11.50
Bldg a I /N City/State ly 0 Zip 1 �I Sho O 11.50
L C V 11,50
Water Closet/Urinal (Specify)
Nam
Dishwasher 11.50
•
Owner Mailing Address Suite Urinal -I 11.50
_ I 11.- Garbage Disposal 11.50
City/State . Zip • - Laundry Tray y 11,50
Name Washing Machine /Laundry Tray (Specify) '11.50
Floor Drain/Floor Sink 2" 11.50
occupant mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone 11 •
Water Healer 0 conversion 0 like kind .50
Gas piping requires a separate mechanical permit.
•
Na MFG Home New Water Service 28.00
Contractor M g Address •Sate MFG Home New San/Storm Sewer 28,00
Hose Bibs 11.50
' Prior to permit City/State • Zip Phone Roof Drains 11.50
issuance, a copy Drinking Fountain 11.50
•
of all Iloenses are Oregon Cont. Board Lic.# Exp. Date Other Fixtures (Specify) 1 5: 00
required If -
expired In COT Plumbing Lic. # Exp. Date ,
database
Name
Architect Sewer- let 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service -1st 100' 38.00
Engineer City /State Zip Phone ' Water Service - each additional 200' 3 2. 00
•
' Describe work to be done: Storm & Rain Drain -1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain- each additional 100' 32.00
Residential 0 Commercial O Commercial Back Flow Prevention Device 32.00
Additional description of work: .
5 p / /t J x� E 2 1 N S �A L �AT N Residential BaokfloW Prevention Device' , 19
/ Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 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 FEES. - TOTAL
I hereby acknowledge that I have read this application. that the information r
Isometric or riser diagram Is required if Quantity Total Is > 9 ' ,- AJ
given Is correct, that I am the owner or, authorized agent of the owner, and *SUBTOTAL i' ^'1'. " '` ' `'
that plans, submitted are in compliance with Oregon State Laws, : •'' ••i;;'
Signature of Owner / nt one . /�, Q . C_ Date, i / O f J
��, �, P tt (JI�j (� -(� 8% SURC a
` ao
Contact erson Name Phono .. :
* *PLAN REVIEW 25% OF SUBTOTAL ,. : - ,,. :
. R: • uimed onl if rodure • . total Is > 9
{ y Q j : �kTH+ u y� 1;7 "' • c , $; rpY�r n• ? t k ' � t F p •-0r31xi "lt y:, r lirti`i5't TOTAL
tk4,, . Fn{ S , �.� u y / i: '' f� rr , . C .., �3y-. i4 . , , h : • 1 . o • .' in M�: ,, 5r r �Ii Fr1-
. L' '^""a,`?1? kg s, r Y ,AA ,'i ∎: yy.i4 YM1 rFAF' �.�,1 , .,_; ".�: .?=l n� g �� . .. - . ', � 'TfI;C.�Ol3' y g , .� A Q '+,�'v:.t�s� '(�';c"rr(: � :,ot,. ; �r li a r, ,::{ ;' , t;;.bl "ia « .c,� >
( t "` doa x g a " t y• ¢ except d Prevertflon
� iii' "'�e;'tl �' " � Ui��. a�g �' h�tifi�,' q�1��J�( � �r 1 ,y � �. -Minimum Residential Ba
p
r 10 y . •?. " " w u ". r L.,. ...a: �.;a ,A,�1'"G.Y i�A' % � I.li,���;: � Y <MI�:
`!1 leet f' $ iiai *h0 i. ( Y� °. d "a�:..,!+N.-. �+ whkh Is 525 r 8% surcharge
x i.,,.,...� _s•�.•..!Y . ti!)!�?.. W�. .owlfi �a:u�t: .s,.a.. -�x Device,
"All New Commercial Buildings require plans wan isometric or riser diagfam and
plan review.
I:\asts* mstpiumspp.doc 1o1/139' - . -
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested S / 1 9 0 0 AM PM BLD
Location / (.Q CO S Q LJ l i Suite MEC
Contact Person c■(ZLnbeS Ph Co 2 -Sol 0 PLM ) Sd
Contractor Ph SWR
BUILDING - -.:., Tenant/Owner V ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
' Slab 610 SIT •
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof of/
Misc: _ _ _
Final ���4-,I T -
PA S•ART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer • `
Rain Drains
Fin I
S 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 /1-`-
Othe�ach /Sidewalk Date I Inspector /2.12 . Ex
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.