Permit CITY TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM1999 -00356
.44 ��III 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
•
SITE ADDRESS: 12050 SW SUMMER CREST DR PARCEL: 1S134CD-04600
SUBDIVISION: BURLWOOD ZONING: R -4.5
BLOCK: LOT: 006 JURISDICTION: TIG
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft'
WATER CLOSETS: WATER LINE: 80 ft
DISHWASHERS: RAIN DRAIN: ft
•
Remarks: Replace existing water service line.
FEES
Owner:
Type By Date Amount Receipt
MILLER, DANIEL A AND LINDA L PRMT DST " 10/28/199c. $50.00 99- 319405
12050 SW CREST DR 5PCT DST 10/28/199 $4.00 99- 319405
• TIGARD, OR R 97223 97223 .
Total $54.00
Phone 1:
Contractor:
FULLMAN SERVICE CO LLC
5221 SW CORBETT
PORTLAND, OR 97201 -3716 REQUIRED INSPECTIONS
Phone 1: 224 -5221 Water Line Insp
Reg #: LIC 122310 _ Final Inspection
PLM 26 -443PB
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 Signatur • �/h/!��( /� /�Y/i
Call (503) 639 -41 5 by 7:00 P.M. for an inspection needed the next business day
•
CITY OF TIGARD Plumbing Application Recd By
Date Recd
13125 SW HALL BLVD. Commercial and Residential
a
TIGARD, OR 97223 \/ Date to P.E. Date to DST
(503) 639 -4171 Permit # �i'G‘14I�r DrS 354
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Devlopment/project , +.r x p ; * • Single Family Resliidences Only ,-" '' - -"A t- ' 4 - - " ; , • Job
.., .:, Y ; . ?,c M. • .,tip. R ' � Sati,4 . e'k,,, • :. .;River;+
-O 1.BATH HOUSE.$140.00 - r . jj --Q ,2 BATFIHOUSE 5195.00
Address Street Address Suite/ _ a -m. -01110 3 BATH HOUSE $225:00 -' " = = -
I ldg ZaSv 14 u rh T .i r t � 0Gfe tS .. .� ty, Cr �jn, Fee�iicludes a{�pltimbi flocttires In the dwelling erid ttte first 100feet ;��; # City/State 4 Zip water service, sanitary and See ice, sary sewer d storm sewer. S fees b ;::.: elow.
V c, 7223 ..; . „...._.: ,._:. < -. -,, . ,ryn : ... :.: yt.4--.a ..
Name, ✓ N FIXTURES (individual) QTY PRICE AMT
xd'iect) f //e-1/- Sink • 9.00
Owner Mailing Address Suite Lavatory 9.00
sa ""`� .-- Tub or Tub /Shower Comb. 9.00
City/State Zip Phone
570 - 0 7,3 Shower Only 9.00
Name - Water Closet 9.00
�_- Dishwater 9.00
Occupant Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
City/State Zip Phone Floor Drain 2' 9.00
3° 9.00
Na ( ( / .J i/( G _ Le 4 9.00
Contractor Mailing Addres s '� Suite Water Heater 9.00
�21( St / c6f Laundry Room Tray 9.00
City / St a /� t, Zi Phone
i /c 42 / 1 2 ( a2 - .S-Z..1 Urinal 9.00
O n Const. Cont. Board Lic.# e
a Other Fixtures (Specify) 9.00
Attach Copy of ��Z /0 _ /I, 63 9.00
Current Plumbing Lic. # Exp. Date 9.00
License Z g - y y3 ,e - 3 / coo
Sewer - 1st 100' 9.00
COT Business Tax or Metro # Exp. Date Sewer - each additional 100' 30.00
Name Water Service - 1st 100' go' 25.00 25
Water Service - each additional 200' 30.00
Architect Mailing Address Suite Storm & Rain Drain - 1st 100' 25.00
or
Storm & Rain Drain - each additional 100' 30.00
Engineer City/State Zip Phone Mobile Home Space 25.00
9 Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Ad ' ron 0 Alteration 0 Repair (9' Pollution Device
to be done: Residential Non - residential 0 Residential Backflow Prevention Device' 15.00
Additional description of work Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
Insp. of Existing Plumbing 40.00
Existing use of 40.
9 Specially Requested Inspections 40.00
building or property
per hr i
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property
Are you capping any fixtures? Yes ❑ No G, QUANTITY TOTAL " = ::
Isometric or riser diagram is required if Quanity Total is > 9
I hereby acknowledge that I have read this application, that the information
given is correct. that I am the owner or authorized agent of the owner, and 'SUBTOTAL i. - :r C.
that plans submitted are in compliance with Oregon State Laws. 4 ` ""
Signature of Owner gent Date 1 1SURCHARGE •'�° -1-',..7: �mi_ - _ 4 /-
CAWS 7 C PLAN REVIEW 25% OF SUBTOTAL ' , :4,1 , -.
Contact Person Name / Phone Required only it fixture qty. total is > 9 s ^
TOTAL -_ - � ,--z: '
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
is \fists \plmapp.doc
Prevention Device, which is $15 + 5% surcharge
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
( q / p BUP
Date Requested /0(?- t AM PM BLD
Location 1050 SW/KM e/Ci"e-ST C Suite MEC
Contact PersonSc..f74n YLL. /ILllfls.) Ph ; 5 ? ( PLM
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
PAS —P._s. RI FAIL
(CUMBING
Post & Beam
Under Slab
To
Water Servic
Sani ary ewer
Rain Drains
Final
PART FAIL
ECHANICAL
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 G
Other Date n r� ( Inspector P Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.