Permit CITY TIGARD PLUMBING PERMIT
14c DEVELOPMENT SERVICES PERMIT #: PLM2000 -00088
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/17/00
SITE ADDRESS: 11455 SW SHROPE CT PARCEL: 2S103AB -04800
SUBDIVISION: WALNUT GLEN ZONING: R -4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: OTR 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: Installation of residential backflow prevention device for irrigation system.
FEES
Owner:
Type By Date Amount Receipt
S M SCHLESINGER PRMT DEB 3/17/00 $25.00 0000762
7000 SW HAMPTON ST 5PCT DEB 3/17/00 $2.00 0000762
#124
TIGARD, OR 97223 Total $27.00
Phone 1: 503 - 968 -6500
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: RP /Backflow Preventer
Final Inspection
Reg #:
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 ma abtairt copies of these rules or direct questions to OUNC by calling (503) 246 -1987. •
Iss ed By: deOlPYPLAZ.,.. Permittee Signature: ; �� ; �'
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan C
13125 S.W MALL BLVD. Commercial and Residential Recd By •
TIGA OR 97223 Date Rec'd � -87-0
Date to P.E.
(503) 639-4171 Date to OF or Type Permit # litN�e? W
Incomplete or illegible applications will not be accepted
Related SWR#
Called
Name of Dev FIXTURES (individual) . QTY PRICE AMT
Job &JQ` /i(,(' Lem) Sink 11.50
•S treet Address Suite Lavatory 11.50
Address Ci !/ y5s Sh rv� _ Tub or Tub /Shower Comb. ' 11.50
Bldg # it y /State ria Zip Shower Only 11.50
r J l a 97 Z1-5 Water Closet 11.50
Name pp . J 11 ) 11.50
U• /'7Y 2e S l'.h I Q S ?FtgJ 1- U rinal
Owner ailing ress J Suite Dishwasher 11.50
I0 . 2312 Log Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
l rd , ('7R 97Z��. /°?6f 9�0g" �° `� Washing Machine /Laundry Tray 11.50
Nam•+ `ll
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
Gas piping requires a separate mechanical permit.
Nam
JH 13 Ides MFG Home New Water Service 32.00
Mailing Address Suite MFG Home New Sari/Storm Sewer 32.00
Contractor Po 23/2.0 Hose Bibs 11.50
Prior to permit City /State p Zip Phone n �[ Roof Drains 11.50
issuance, a copy �; ark _ O /, 9 r/ 94.9-G40 794.9-G40 Drinking Fountain 11.50
of all licenses are Ore Const. Cont. Board Lic.# Exp. Date Other Fixtures (Specify) 15.00
required if
expired in COT Plumbing Lic. # Exp. Date
database
Name
Architect Sewer -1st 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' 32.00
Describe work 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 AI Commercial 0 Commercial Back Flow Prevention Device , 32.00
Additional description of work: Residential Backflow Prevention Device* j 19.00 /9°x1
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
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 �r
that plans submitted are in compliance with Oregon State Laws.
o Ign u of ner /A en Date 8% SURCHARGE
ContacctPemon Name � Phone /\ "PLAN REVIEW 25% OF SUBTOTAL
5. ► 11'25 Sc.) - 1 I Qs/ r q � o 0 v Required only if facture qty. total is > 9
BA HOUSE$178.00" ' `•r i }[ • s ': TOTAL � �
YV ' , O E 250 W -
�� a n � SMr• x A T u
i 9y:4, 285001 c `� 2 . sl ` « ,
i t .
'i _t, r d � a u � d � es ail u mbing�ures n e tswetling and ttielirst 'Minimum permit fee is $so 8% surcharge, except Residential Backflow Prevention
- 88111IarY.8eWe1 8tortrISBYYer4n •,VyetelteCVlCe r : ;> ,'v ; _ Device, which is E25 8% surcharge
" New New Commarei al Buildings require plans with isometric or riser diagram and
plan review.
i:ldststformstpiumapp.doc ll/t Vf# /o?J .2--
• �
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced RemovedlCapped
•
•
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: ldstsVormslplumaPP.doc 11 /18/99
5/5/00 Activities for Case #: PLM2000 -00088
4:53:07 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 3/17/00 DEB DONE No Hold DEB 3/17/00
PLMA005 Create Permit 3/17/00 DEB DONE No Hold DEB 3/17/00
PLMA750 RP /Backflow Preventer No Hold DEB 3/17/00
PLMA799 Final Inspection 4/19/00 MRS PASS No Hold AKJ 4/20/00
PLMA050. (F) Issue permit 3/17/00 DEB DONE No Hold DEB 3/17/00
PLMA800 Case Fineled 4/20/00 AKJ DONE No Hold AKJ 4/20/00
•
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• Page of
CITY OF TIGARD BUILDING INSPECTION DIVISION MST I ( 7q 9-00 347
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / �/O.J AM PM BLD
Location (1 (- S S S rb Suite AN MEC
Contact Person PA S. Ph �)d�S Q
Contractor Ph L/' 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 i _ . _=��— •
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS P • RT FAIL f� A��f
•� UMBI Tri► �, •
Post & Beam �G/ v '
Under Slab
Top Out
Water Service 1
Sanitary Sew: dr� /�/
Rai ' rai :
' PART
�!''CHANICALW /
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 I 1 Inspector W Ex
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.