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Permit CITY TIGARD PLUMBING PERMIT 4 , DEVELOPMENT SERVICES PERMIT #: PLM2000 -00114 � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: SITE ADDRESS: 15211 SW REGENT TERR PARCEL: 2S111 DA -10400 SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R -7 BLOCK: LOT: 097 JURISDICTION: TIG 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: Residential backflow prevention device. FEES Owner: Type By Date Amount Receipt LEGEND HOMES PRMT BON 04/10/200C $25.00 0001290 12755 SW 69TH AVE 5PCT BON 04/10/200C $2.00 0001290 STE 100 TIGARD, OR 97223 Total $27.00 Phone 1: 503 - 620 -8080 Contractor: MARTIN SANDERS PO BOX 307 NORTH PLAINS, OR 97133 REQUIRED INSPECTIONS Phone 1: 647 -5567 RP /Backflow Preventer Reg #: LIC 11608 Final Inspection PLM 5742 ® 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:. UC4-kc ,t, Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the neict ��� business day CITY OF TIGARD Plumbing Permit Application Plan Check 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIGARD, OR 97223 Date Recd 4 -f0 - (503) 639 -4171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# PN4 AO A91 Related SWR # II Called /e., (..._) 0 0 CP A '-' )( Name f velop t/Pr 'ect FIXTURES (I QTY PRICE AMT J L Sink 11.50 Address Stree ddress Suite Lavatory 11.50 I5 52-11 S � � V Tub or Tub /Shower Comb. 11.50 Bldg # Cit/State Zip d Shower Only 11.50 itp //1608-.- �V ` Water Closet 11.50 Name // L ,,,,,„...S �` /ot.-._ eS Urinal 11.50 Owner Mailing dress c Lk Suite Dishwasher 11.50 2,76 S 0 6 7 1 /C C.) Garbage Disposal 11.50 City/State /2 Ppo �- a[ D V rZe Tice..- v S 7 2 � p SOO L.) Laundry Tray 11.50 Nft.d 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 0 like kind 11.50 Name C Gas piping requires a separate mechanical permit. �c. ✓ A \ J 4 ■ Ca 611hI c : 9 MFG Home New Water Service 32.00 Contractor Mailing Address eicai k..v drress n / - Suite - /Sock I MFG Home New SaNStorm Sewer 32.00 o75/Y .;07 Hose Bibs 11.50 Prior to permit Ctty / State Zip 57 Phone Roof Drains 11.50 issuance, a copy N v P le, iy� 40 g t7 p 1 if Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if -s'71 5 ‘t..10 ,(> V Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date database J i ‘. b L1 �i 0 ( )0 Name V Architect (�C� Sewer- 1st 100' 38.00 Mailing Addr L z�' it Or 9 'n Sewer - each additional 100' 32.00 Engineer City /State Zip Phone ��J Water Service - 1st 100' 38.00 9 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 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commercial O Additional descripti n of work: 4-) Commercial Back Flow Prevention Device 32.00 V 4 //c, Residential Backflow Prevention Device' / 19.00 4 U� 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 SEWER FEES. QUANTITY TOTAL �pU I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required If Quantity TdTal Is > 9 given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL that plans submitte are in compliance • h Oregon State Laws. • Z CO S of er/ Date 474-'10 - CX) 8% SURCHARGE Contact Pqrpon Name Ph e ■ Pl t, '\ 4., 6 'mPLAN REVIEW 25% OF SUBTOTAL 1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9 f°2 BATH HOUSE $250.00 TOTAL 27 6° `.3 BATH HOUSE $285.00 : ' , iE (This fee Includes all plumbing fixtures in the dwelling and the first , 'Minimum permit fee Is $50 + 8% surcharge, except Residential Backflow Prevention 100 feet of sanitary sewer stone sewer and water service) Device, which is $25 + 8% surcharge **All New Commercial Buildings require plans with Isometric or riser diagram and plan review. 1:ldstsVormatplumepp.doc 11/18/99 } PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved I 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: VdstsVormslplumapp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested /— / S aZ AM PM BLD Location / Z // S' L 7 - e � rte+- S MEC Contact Person Ph PLM 7- oo —0o W Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler �. Fire Alarm R Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam XP1RED Under Slab 27G e Top Out /'� Water Service Sanitary Sewer Rain Drains • 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 Date /' 5 t2 2 Inspector ,(,i , / � v-P • Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.