Permit CITY OF TIGARD
PLUMBING PERMIT
I;� DEVELOPMENT SERVICES PERMIT #: PLM2000 -00313
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/30/00
SITE ADDRESS: 12286 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00300
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 3
OCCUPANCY GRP: A3 FLOOR DRAINS; 16 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: 0 SF RAIN DRAINS:
SINKS: 3 URINALS: 1 GREASE TRAPS: 1
LAVATORIES: 4 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI
FEES
Owner:
Type By Date Amount Receipt
BURNHAM PACIFIC PRMT CTR 8/30/00 $429.50 27200000000
10135 SE SYNNYSIDE RD SUITE 25 PLCK CTR 8/30/00 $107.38 27200000000
CLACKAMAS, OR 97015 5PCT CTR 8/30/00 $34.36 27200000000
Phone 1: Total $571.24
Contractor:
AL'S PLUMBING
1173 TAMARA AVE S
SALEM, OR 97306 REQUIRED INSPECTIONS
Phone 1: 503 - 375 -3449
Reg #: LIC 00095618
PLM 27 -27PB
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: kel'j'/ �� Permittee Signature:
fl otaik
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# - 7a C
13125 HALL BLVD. Commercial and Residential Rec'd By Ai-1
TIGARD, OR 97223 Date Rec'd R/ .72/073
(503) 639 -4171 Date to P.E. 5449
Print or Type Date to DS
Permit # PZ H &'rP'C'O l . 3
Incomplete or illegible applications will not be accepted Related SWR #o?OOU 'ova 7
Called
Name of Development/ lect I FIXTURES (individual) QTY PRICE AMT
Job .-- 1} Sink 3 3 11.50 ,3
Address Street Address Suite t" Lavatory q 7► 11.50 & , c�J
122S(p '). Se � LS C-Q l a � ■ Tub or Tub /Shower Comb. mo 11.50
Bldg # City /State Zip Shower Only 11.50
C 1 Off, q122--5 Water Closet 3 3 11.50 .3,50
Name
7
1J `CN Lam. , L, Urinal
/ ' 11.50 iJ S(�
Owner Mailing Address Suite Dishwasher 11.50 f
1Ar314• rJ •�,,.,D, Garbage Disposal 11.50
City/State Zip Phone
r n �-, q - 4A� Laundry Tray 11.50
Name Washing Machine /Laundry Tray 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" / / I& 11.50 l0't" •aO
4" 11.50
City/State Zip Phone r
Water Heater conversion 0 like kind 11.50 [�
Na a Gas piping requires a separate mechanical permit. 1 r
MFG Home New Water Service 32.00
PaIS \ , 1l-� •
Contractor Mailing Address Site MFG Home New San/Storm Sewer 32.00
\ \ 7� ayr.%=Ne. 4 . S. Hose Bibs 11.50
Prior to permit City/State Zip Phone Roof Drains 11.50
issuance, a copy S (' �' 37j
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if S S toss Le - of Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database Z•1- •Z, - IL-01
Name
Architect hoc Tr IS01.4.0 . 9 C. , Sewer - 1st 100' 38.00
' - - or Mailing Address - Suit 4it Sewer - each additional 100' 32.00
\ 7 iJ • ' N \ A Water Service - 1st 100' 38.00
Engineer Q ity /State Zip Phone
(1 ext. .an V I ^ c ZC q Water Service - each additional 200' 32.00
Describe w to be done: Storm & Rain Drain - 1st 100' 38.00
New Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial t1.-- ,
Additional description of work: Commercial Back Flow Prevention Device ' 3 32.00 %, 0
_ Residential Backflow Prevention Device' 19.00
J. - l.�.. r "V _1ai.C1hT Catch Basin 11.50
Are you capping, moving-or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 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 , 1 11.50 a . Op
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 Total is > 9
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL
that plans submitted are in compliance with Oregon State Laws. 1.0*
Si gnat re o caner /A t Date
g ZZ 00 _ 8% SURCHARGE
'
Con r Name i s Phone
cr � �o lei - �_C ) **PLAN REVIEW 25% OF SUBTOTAL • /07.3
1 BATH Ho6SE $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 $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm 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:ldstsVormslplumapp.doc 11/18/99
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink /* 3 3
Lavatory l� 3
Tub or Tub /Shower Combination
Shower Only
Water Closet 3 3
Urinal 1 1
Dishwasher 1
Garbage Disposal I _
Laundry Room Tray
—
Washing Machine
Floor Drain /Floor Sink 2"
3" 11E, 5
4"
Water Heater
Other Fixtures (Specify)
a3 “kr\ - 1 -- o -- D2P) 1 )3 • L
•
COMMENTS REGARDING a BOVE:
(\ ,
•1,04
o..„,„ (C ot a547) o.-v a3� • o
1:1dstsVorrnstplumapp.doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested b- 3') AM PM BLD
Location (2 7-(7-(6 � 5'' S oil 7 �9 Suite MEC •
•
Contact Person / Ph 5Z) - gl if:3W PLM , li4.-tio 7(3
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
PA ART FAIL
‹ .(ffin_WIG_,
st & Beam
Under Slab
Top Out
OC Water Service
Sanitary Sewer
Rain.Drains `
`P SS PART FAIL /
MECHANICAL
Post & Beam
Rough In
V
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 Date
Other / d �� 0 Inspector �i�/.di /✓t� • Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Requested qI Z# AM PM BLD
Location Suite MEC
Contact Person `131- • Ph ' Z6 - 4
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg cess:
3 a SGN
Crawl Drain Inspection N 1 es:
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
T FAIL
PLUMBING
Under Slab
)1 7 - 5
Water Service
Sanitary Sewer 1 t
Rain Drains
Fi
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 p D / v Inspector �� Ext
Final
PASS PART FAIL DO NO REMOVE this inspection record from the job site.