Permit CITY OF TIGARD PLUMBING PERMIT
�i DEVELOPMENT SERVICES DATE ISSUED: 02/07/2000
s 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: PLM2000 -00033
SITE ADDRESS: 15960 SW QUEEN VICTORIA PL PARCEL: 2S110CC -07700
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 051 JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 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: Water heater - like kind
FEES
Owner:
Type By Date Amount Receipt
MARTIN, GERALDINE L + PRMT BON 02/07/200C $50.00 KING CITY
MUELLER, ELEANORE P SPOT BON 02/07/200C . $4.00 KING CITY
15960 SW QUEEN VICTORIA PL
TIGARD, OR 97224 Total $54.00
Phone 1:
Contractor:
ACTION WATER HEATERS ONLY INC
8948 SW BARBUR BLVD #418
PORTLAND, OR 97219 REQUIRED INSPECTIONS
Phone 1: 503 - 643 -2737 Misc. Inspection
Reg #: LIC 108953 Final Inspection
PLM 26-571pb
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 -1
Issued By: 11 L/ Permittee Signature: /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne busi -ss -•
FEB - 07 - 00 MON 02:52 PM City of King City FAX:503 639 3771 PAGE 2
CITY OF TIGARD Plumbing Permit Application Plan Checks
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Read -2'7 -ex:)
(503) 639 -4171 Date to P.E. •
Print or Type Date to DST 4Z- 0 - op
Incomplete or illegible applications will not be accepted "'lt* P m t Z ' - 2 3
Related SWR x • Called
Nam of Development/Project Pt ; RLt34' i d . '" ' ; _ ''i': -w I = �° I ' -
/ S Gv - Ir « Sink - 11.50 ;�.
Job
"
Address Street Address t Suite Lavatory 11.50
I Tub or Tub/Shower Comb. 11.50 •
Bldg S q9/ IP /[n/ Shouter Only 11.50
' �' ` . Water Closet ' 11.60
/Naame ��
/fr S �GL•L' c- Gr_/' -• Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
A'S 4730` Garbage Disposal 11.50
City /State Zip Phone -
63 9 2-T �' -10 Laundry Tray 11.50
Name 5 Washing Machine/Laundry Tray 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address " Suite 3' - 11.50
•
4' 11.50
City /State Zip Phone
Water Heater 0 conversion {m-like kind 11.50
Gas piping requires a separate mechanical permit. I
X Pk/ 0-1-701] MFG Home Now Water Service 32.00
Contractor Mailing Address G � Suite MFG Home New San/Storm Sewer 32.00
4 )4krirSSw /9#- 2 I I,-/ Hose Bibs 11.50
Prior to permit Ci / e Zip Phone Roof Drains 11.50
issuance, a copy "'O K/44744 7'9939 f ) ,
of all licenses are Oregon Cons Cont. Board Licit Exp. Date Drinking Fountain 11.50
required if /498-67.5_-.5 Other Fixtures (Specify) 15.00
expired in COT Plumbing Uc. S Exp. Date
database e2 -lg 1-594 PR . 1(3-1-2000 , _ . •
Name '
Architect Sewer- 1st 100' 38.00 _
Or Mailing Address Suite Sewer - each additional 100' ` 32.00 '
Engineer City /State Zip Phone
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 0 Replace with like kind: Yes * No 0 Storm & Rain Drain - each additional 100' 32 -00
Residential O Commercial 0 -
Additional description of work: Commercial Back Flow Prevention Device 32.00 ' . •
Residential Backfiow Prevention Device' 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No Inspedions 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 • ':. 5t) ,:
Isometric or riser diagram is requires! n Quantity Total Is 9
given is correc that 1 am the owner or authorized agent of the owner, and .. .• ;
. ,; .:. , ..
....:r ,
that plans submitted : re in comp ante with Oregon State Laws. 'SUBTOTAL ; ; : • . , ; ;, ,,,•:; 4., ,
g� to • Agent Data
. a of • ` Ag GD 8% SURCHARGE ' ; : , .rck: ...::.;;;V:.. . , :.. J , aD
�- : �t Penao P one ; �� :w: :�;:�" : , as
v ' 1 ' ' 343,10.
" PLAN REVIEW 25% OF SUBTOTAL. ' , 'fp'g 4 ';` l'a'
�_{ �.. ' r- n.- rin- rrn..m. ,„ a t•e Required a+N n futuro qty. taw' > e �;,;ti• yr.• '!'.v I` '
0 n t j eT FV n � i` it rf ) 2 � P 1', 1 7n 2t 5a t - i l Y .
; :.; �n'.:..p 1;
e ,. v t t ', ` " TOTAL :....4�s. f t
J ?u + 4ay �/ to i , 1 x,
} 'A. r] Olaf `� 4.1 �, ,1y ' �t Y. 1� i) n a . * L ^ f � t.• * y.. , A ,. .. _
S.: 111 r `T o 1. I i t 9 t Y P .+21,..(..."..-.:.';/ l t �w +S 2iea?
t l. ;r 1 J 1 4, ,t ° .* fi t e` t I a , � , 6 !>�"' 5::. [:.: ii i..
�4+x1� �� y �� r�� � +�� l�nn� t� i F8 r Sr v ,�� 4 � �{11 w�i � t
1 N N 4 1 �� 1 l{ � r r C i / L } IP i
' -i t :., /. J`. - t .. � j� T z� t t4 r 'Minimum pent* Ise Is $50 4 e96 surcharge, except ResltleMial f3arJAlow Prevention
»tea 1 0 ^ , � . wrrd ' 7 ...1....4,Z.1,4- N.t ti`, 1 ,. ..d:,..,�r { .. .... ..z n : ;r.. DeAce, much is $25 + 8% surcharge
- All New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
ckenevormslpkunnpp.doe 11/16195
_ 3/6/00 Activities for Case #: PLM2000 -00033
9:13:27 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 2/7/00 BON DONE No Hold BON 2/7/00
PLMA005 Create Permit 2/7/00 BON DONE No Hold BON 2/7/00
PLMA740 Misc. Inspection 2/7/00 2/7/00 No Hold BON 2/7/00
PLMA799 Final Inspection 2/7/00 2/7/00 2/15/00 MRS PASS No Hold AKJ 2/15/00
PLMA050 (F) Issue permit 2/7/00 BON DONE No Hold BON 2/7/00
PLMA800 Case Fineled 2/15/00 AKJ DONE No Hold AKJ 2/15/00
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 / ! c Business Line: 639 -4171 BUP
Date Requested v�/ ' /(x) AM PM BLD
Location I S 49 C) QL�(.P ( ,41 111 ✓1 - Suite MEC
Contact Person U 4 €I Ph - 77 7' M 2 "ezo 3 .3
Contractor ,! 7t't UV A, 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
UMBIN
Post & Beam
Under Slab � I+
Top Out W , t
Water Service
Sanitary Sewer
�B rains
PART FAIL
HANICAL
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 D / b d r Inspecto 2 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.