Permit • Ni,
..,
A CITY OF TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2000 -00139
c � l l l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/03/2000
SITE ADDRESS: 12010 SW TREEVIEW CT PARCEL: 2S110BB -06200
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 004 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: Install residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
FOUR D CONSTRUCTION PRMT KJP 05/03/200C $25.00 0001877
PO BOX 1577 5PCT KJP 05/03/200C $2.00 0001877
BEAVERTON, OR 97075
Total $27.00
Phone 1: •
Contractor:
REQUIRED INSPECTIONS
•
Phone 1: RP /Backflow Preventer
Reg #: Final Inspection
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 co ' f these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: - Permittee Signature: __ —/I‹: S
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin :..or
:MY OF Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
'503) 639 -4171 9 4 to P.E.
Print or Type Date to GAST
Permit LM a- oo i
Incomplete or illegible applications will not be accepted Related SWR #
Called
Name of Development/Project FIXTURES (individual) . . QTY PRICE ' AMT
Job Sink 11.50
Address Street Ad Ore F � � vi Su ite „ Lavatory 11.50
I Z 0/11 1 0 TA f-- 11 1G VV C I. Tub or Tub /Shower Comb. 11.50
Bldg # Cittyy /State Zip Shower Only 11.50
Ci
-' g f V C • Water Closet 11.50
Name , rh I * r70 /J Urinal , 11.50
Owner Mailing Address l v�� Suite Dishwasher 11.50
Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Washing Machine/Laundry Tray 11.50
Name
< Floor Drain/Floor Sink 2' 11.50
Occ upant . 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.
Nq% ( 1 . { V [ � � , , M m A.
i h 91' . MFG Home New Water Service 32.00
M g A ess Suite MFG Home New San/Storm Sewer 32.00
Contractor f,[ !a l i V ('. Hose Bibs 11.50
Prior to permit /Stat (( Zi Phone Roof Drains 11.50
Issuance, a copy v/(„4 Gdut 37 / '' 3s5= 5 75 Drinking Fountain 11.50
of all licenses are Oregon ns . � c �t. Bo rd Licit pD.a , ' �l ther Fixtures (Specify) 15.00
required if O� � y'7�L �� }O � � ( � i( /
expired in COT jlulrlbi� ic� (� n /2/3/ Date/ o
database Gy� SS r L7
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 Re, it 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential A Commercial 0 Commercial Back Flow Prevention Device , 32.00
Additional description of work: Residential Backflow Prevention Device' i 19.00
Catch Basin 11.50
Are you capping, moving or repta,cing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No Inspections per/hr ■
If yes, we 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 nser 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. � .
Signature of Owner /Agent Date 8% SURCHARGE
OR
Opp Z ail L J 57 fi N 91 "PLAN REVIEW 25% OF SUBTOTAL
!i L r Require only if fixture qty. total is > 8
.;, , J ' E . $178 ,A .,, r . r- s , .� r ,,-,7. a TO TAL r��
� b. HO SE $250 01 ' ii` ' il . r 7r ' r',, ,') ".47 tit ✓ 7 ' 4,u 'Et. 4 p�
O .285 00 ; ;:''"" e 2; iA ; : �"r +.~ `}
r � r cIudei Urrlbing res n' the dwelling nd a rst'�.�,ti i *Minimum permit fee Is 850 + 8% surcharge, except Residential Backflow Prevention
"
+a sari .: sews stomisewer an r ter ts s service ,t f �' ` Device, which is 825 + 8% surcharge
:ce „ �, , y
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
r.ldststfarmstplxmapp doc 11118/99
•
PLEASE COMPLETE:
b Work Peiformed��
.FixtureTy.pe .. .. �. ';..',,Quantity- Y '
.
Moved • I -Replaced 1RemovedlCapped
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 ldsts torms\phimapp.doc 11/18/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST l q 73
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 5/5/M AM PM BLD
Location ) 2- I 0 1NPA ) ► ■-P,(,L) Suite MEC
Contact Person aUt it-e_ Ph - 77,O —7 "/ 1 /S PLM V & Q) (3 9 r2 tJ
Contractor Ph
SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation s K I 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
l'AS.5 PART FAIL
LUMEin
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Ilanb PART FAIL
NICAL
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 D 5 Inspector
Other Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.