Permit . 0 p y
CITY F T I GA R PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2000 -00276
-' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
DATE ISSUED: 7/28/00
SITE ADDRESS: 09130 SW SUMMERFIELD CT PARCEL: 2S111D6 -03600
SUBDIVISION: SUMMERFIELD NO.8 ZONING: R -7
BLOCK: LOT: 422 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: Installation of residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
RICHEN, SYLIVA M PRMT BLD 7/28/00 $25.00 0004063
9130 SW SUMMERFIELD CT SPOT BLD 7/28/00 $2.00 0004063
TIGARD, OR 97224
Total $27.00
Phone 1:
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
-- Phone 1: 503 - 642 -7323 RP /Backflow Preventer
Reg #: LIC 00000241
PLM 26 -162PB
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: , i-�,�_ Permittee Signature: /yf /L E.6 a ll (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
1312E-SW BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 r RECFI / • Date Rec'd
(503) 639 -4171 �1(- Date to P.E.
Print or Type JUL 2 1 2OOf? Date to DST
Incomplete or illegible applications will of be accepted Permit # A../yoZOad -4
COMMUNITY OEVELOPMEIf SWR #
Called
•
Name of Development/Project FIXTURES (individual) , QTY PRICE AMT
Job MVw Sink 11.50
Address treetAddress Suite Lavatory 11.50
Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip Shower Only 11.50
Name Water Closet 11.50
Si /tdi '4 /; ,4, Urinal . 11.50 i„t
Owner Mailing Address Suite Dishwasher
11.50
11336 5 5.4,410-1C4/ G7- Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Nathe . 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 Gas piping requires a separate mechanical permit.
' f / . `4
/�I Y-. MEG Home New Water Service 32.00
Contractor Mailing Address % Suite MFG Home New San/Storm Sewer 32.00
/MO .,1•L) .,1•L) t) �,,, ,L Rd Hose Bibs 11.50
Prior to permit ty/State Zi Phone Roof Drains
11.50
issuance, a copy �� ct ? ea Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Ex . Date 15.00
Y Z.D.- Other Fixtures (Specify)
required if ° LC{
expired in COT Plumbing Lic. # Exp. Date
database 7 /2-P.5 - -342-e4
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
g 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 Commercial 0 Commercial Back Flow Prevention Device 32.00
Additional description of work:
/f � Residential Backflow Prevention Device* t 19.00 25,a,
I i, t 9 /1 / G ti"t Pe c J Catch Basin 11.50
Are you capping, moving or replacing any fiictures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 NO Inspections per/hr
yes, see back of form to ind' ate work performed by Rain Drain, single family dwelling 45.00 • fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COU D RESULT IN INCREASED SEWER FEES. • QUANTITY TOTAL
I hereby a o ledge that I have re • • this application, that the information Isometric or riser diagram is required if Quantity Total is > 9
given is Gorr that I am the owner' authorized agent of the owner, and * SUBTOTAL �
that plans bmitted are in compli. A • gon State Laws. Z5)2>
Signet re 3 O wner /A t Date c -
g �_ gfft �/ - � ( l _ 8% SURCHARGE 2.�
Conte b(P on Name L ,,
f ho o
I, /'kNC'� coil . -3Z3 PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total Is > 9
2 BATH HOUSE $250.00 - , .. . . _ . _ ... TOTAL
' Z7 cT)
._3 BATH HOUSE $285.00 :, . ;� -
:;(This tee in*ludes :ell plumbing j fixtures in the dwelling and the first . . " *Minimum permit fee is $50 + 8% surcharge, except Residential Bacldlow Prevention
(100 feet of eanit8 S wer storm Sewe and water service Device, which is $25 + 8% surcharge
� e �� -�
--" "All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i dstsVonnsiplumapp.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)
fj Fly Puuk) -PoJ 6 tE CMG (C -
- iYtri
COMMENTS REGARDING ABOVE:
I: ldstslformslplumapp.doc 11/18/99
CITY OF TIGARD.BUILDING INSPECTION DIVISION • r MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
- Date Requested 7 f 1 AM PM BLD
Location q/ 3v J � 5ct,n t r 7'/ I C-4 Suite MEC
Contact Person Ph TV 73 7-3 PLM (t -GVo? 7 (0
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation /, R 5 / c / / 64 c FPS
Ftg Drain T c• I" z �" 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
(PLUMBINP / A
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer v c�
Rain Drains
4 71ac✓
Fi
AS PART FAIL
CHANICAL
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 7
Approach/Sidewalk ��
Other Date Inspector 17 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.