Permit CITY OF TIGARD
A,o„ ,,,, A DEVELOPMENT SERVICES PLUMBING PERMIT
i ii- i i PERMIT #.......: PLM96 -0329
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 02/12/97
PARCEL: 25101AA -09800
SITE ADDRESS...: 12570 SW 69TH AVE
SUBDIVISION....: MLP95- 0013 ZONING: MUE
BLOCK........... LOT ........ .....:001
CLASS OF WORK..: NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE :COM WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:B FLOOR DRAINS......: 0 TRAPS.......... .... : 0
STORIES........: 0 WATER HEATERS : 1 CATCH BASINS : 2
FIXTURES - -- - -- LAUNDRY TRAYS.....: 0 SF RAIN DRAINS.....: 0
SINKS...........,:, 0 URINALS........ . 0 GREASE TRAPS........ 0
LAVATORIES.....: 4 OTHER FIXTURES....: 0
TUB /SHOWERS....: 0 SEWER LINE (ft)...: 1
WATER CLOSETS..: 4 WATER LINE (ft)...: 1
DISHWASHERS • 0 RAIN DRAIN (ft)...: 1
Remarks: Construction of a new 8,217 sq ft two story professional office buildin
g
Owner: FEES --
J T ROTH JR type amount by date recpt
12540 SW 68TH AVENUE #B PRMT $ 214.00 B 02/12/97 97- 290314
PLC{ $ 53.50 B 02/12/97 97- 290314
TIGARD OR 97223 5PCT $ 10.70 B 02/12/97 97- 290314
Phone it: 639 -2639
Contractor: ----
ACI MECHANICAL
12300 SW 69TH
TIGARD OR 97223
Phone #: 503- 598 -4798 $ 278.20 TOTAL
Reg #..: 000683
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Line Insp
applicable laws. All work will be done in accordance with Top—out Insp
approved plans. This permit will expire if work is not started Storm Drain Insp
within 180 days of issuance, or if work is suspended for more Rain Drain Insp
than 113@ days. Misc. Inspection
Final Inspection
Permittee Signature: &F -
Issued By: f t----.
Call for inspection, — 639 -4175
Ca_ 1 ∎ ire'. levy lActitAS
V P i - /V - .3(% \1-41 (0 =
14
CITY OF TIQARD Plumbing Application Recd By I I '4alh P P .
13125 SW HALL BLVD. Commercial and Residential D Recd b° -' 't..-
Date to P.E. /
TIGARD, OR 97223 O V96,
(503) 639 -4171 1` 1 6 r , Date to DST /( /9 9�
Permit 0 r �G r ail D Zq
Print or Type %o ' ' Related SWR $ 514)(L tin - 66 'I
Incomplete or illegible applications will not be accepted carted O) i'f9'a 930
s' /qua /t: c li are/
5 i le - 9% Orb9
Name o1 DevetopmenuProlea FIXTURES (individual) ` QTY PRICE AMT
Job gtioc4Aulay,4/(G Q ZkI Sink 9.00
Address Street Address Suite
Lavatory S/ 9.00 34
Ja57o SW 00 Tub or Tub/Shower Comb. 9.00
Bldg s � Cit � y/ • State J Zip Shower Only 9.00
Name / ! 4Q/!J 972 Water Closet u q 9.00 36
1 , 7 ' 7 fa , tom • Dishwasher 9.00
i Mailing Address J Suite Garbage Disposal 9.00
Owner /0 Sid 4f3a s _ Washing Machine _ _ - 9.00
City/State Zip Phone Floor Drain 2• 9.00
. p T i rr . a 02 97223 6 Z639 3• 9.00
-
/ti /A a' 9.00
Occupant Nang Address Suite Water Heater . L. 940 /DO
Laundry Room Tray 9.00
City/State Tip Phone Urinal
9.00
Other Fixtures (Specify) - 9.00 •
Name , A // /
A. c • -T �a/IC . h.. It /C-0/ _ . . 9.00
Contractor Mailing Address Suite 9.00
/2300 S 69 ' 9.00 .
City/State Zip Phone
o r r ij o e r k i /d at 97ZZ3 99g- - .. . 9.00 _
Consl Cont. Board Lic.# Exp. Date 9.00
Albrob Copy of ‘73I? g • z - 97 9.00
Currentt Llc s Exp. Date Sewer - 1st 100' / 30.00 30
License 3 - 1 PIS /1- 30 - 96 Sewer - each additional 100' 25.00
COT Business Tax tro Exp. Date -
/63/(1 Water Service - 1st 100' / 30.00 0
�
me
- / ' 9 7 Water Service - each additional 200' 25.00
f Architect D • w • D Se-914- storm a Rain Drain - 1st 100' / 30.00 3
Or Address Sx •ie Storm 8 Rain Drain - each additional 100' 25.00 I
6 j . /3'i PZ Mobile Home Space 25.00 I
Engineer City /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
P�'t CA • 97233 _ E0 /5 Pollution Device / .25
Cesare* work New III Addition 0 Alteration 0 Repair 0 Residential Backfiow Prevention Device' 15.00
to be done: Residential 0 Non- resioential- di • Any Trap or Waste Not Connected to a Fixture 9.00
Additlonal desuipuon of wort Basin 9.00 / g
de) 6 „«. Z.-.°r- ..2 Vary t 1/4 Insp. of Existing Plumbing - 40.00
perfir
=ng use of Specaly Requested Inspections 40.00
1 wading or property /VIA family Rain Cram. single fam� dwelling 30.00 0.00
Proposed use of /� /y Grease Traps 1 9.00
building or property Olefe5 /a... � a-4/ 4. I _
QUANTITY TOTAL
Are you capping . moving or replacing any fixtures? Yes ❑ No ig Isometric or riser diagram is required d Chaney Total is • 9
(H yes see back of form) 'SUBTOTAL 2 l 14 , Id
1 hereby acknowledge that I have read this application. that the information
i
1 givens correct. sat I am the owner or authorized agent of the owner. and 5% SURCHARGE I O .7a p
that clans sub rhed - re in , ofance with Oregon State Laws.
j 3ignatu en • ge- Date PLAN REVIEW 25% OF SUBTOTAL .44 ei....f /4- future 2916 Revoked only if re qty. total is > 9
AAA TOTA� V . rson Phone
n 6 *Minimum permit fee is S25 • 5% surcharge. xcept Residential 8axdcflow
/� 7 Prevention Device, which is S15 • 5% surcharge rn/
i:tdsts■plmapp.doc 8/96 ` (J
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
•
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
— 3"
•
4 ". - .
Water Heater
Laundry Room Tray
Urinal .- .
Other Fixtures (Specify)
;OMMENTS REGARDING ABOVE:
•
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: S 1 "?...--2 c 9 A.M. P.M. MST:
Location: / S 7 0 BUP:
Tenant: Suite: Bldg: MEC:
Contractor. _ Phone: ? — 4 7 r PLM: g(e; 0,3 aq
Owner: Phone: ELC:
•
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Stone
Footing Roof UndF_USlab Rough -In Ceiling Water Line
Slab Framing op Ou. Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Fumace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spkh /Alm Crawl/Found Dr Heat Pump Low Volt
Approved •prov Approved Approved Approved
Appr /Sdwlk Not Approved • . • 'proved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
O Ca11 : "' K i' O • eins. =• on f =• • $ r wired befo next inspection D Unable to inspect
Inspec i _ ,/ Date: r Z-2/ 97 Page of
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: a 1 19 7 A.M. X P.M. MST:
Location: /r-1 5 7 0 6.y' T!k BUP:
Tenant: Suite: Bldg: MEC:
Contractor:t C- - Phone: 4 (--/-07 el./y PLM: q Q, ?j 2,7
Owner: Phone: ELC:
ELR:
SIT:
BUILDI B LDG (con's) MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab •
Shear /Sheath Fire Spklr /AJm Crawl/Found Dr Heat Pump Low Volt
Approved A rp, • Approved Approved Approved
• Appr /Sdwlk Not Approved of Apov -. Not Approved Not Approved Not Approved
FINAL 1 I AL FINAL FINAL FINAL
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all, .
-^ -ai S I GEff illi ffi r ar A .da
1 .- - i / // i. -
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al / ,
Call for . - . • o
• R% I :' Lion fee of $ required before next inspection D Unable to inspect i 7 Inspector: .l' /
Inspec % ;! _, , I , D ate: 2 � S Page of
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
/ (5_
Date Requested: S a" \ 1 l 1 A.M. 1/ P.M. MST:
Location: 1 D T-k- Aij`e BUP:
Tenant: Suite: Bldg: MEC: /
Contractor. Phone: F q -77i PLM: 56 o 3 cZ
Owner: Phone: ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing op Gas Line Rough -In UG Sprinkler
Foundation Insulation wer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved _ Approved Approved Approved
Appr /Sdwlk Not Approved of Approved Not Approved Not Approved Not Approved
FINAL F t` 1 FINAL FINAL FINAL
fi° .-----
7 I c) .ie s t
i
C all for re - ) - IIP O Reinspection fee of $ required fore ex inspection O Unable to inspect
Inspector: Date: 2 / l Page of
•
( 222‹,t) ehjee: 6,--1-- ,
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing ain D 'R Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk � Reins.
Other: ?G� �� l / i" `
Date:
�/d- ^
815 1 A. M. Entry: ` 41`1, I '
Address: 1 , -5 7 v ( 'v
Tenant: Ste: MST:
BUP:
Con /Own: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
ha st11. AI h0 o4 — bc`i -f,0 ,76-
/vete 1,r7r 1, (9/( poe_de- ec
Pat Vk IVa 11/1 0w 5d u f 4 - 14/Ct OI<
Inspector: �f /�.r' Date: ..2 - 29 1 17
XAPPROVED DISAPPROVED /CALL FOR REINSP. CF CO