Permit CITY OF T PLUMBING PERMIT
..-A �� � DEVELOPMENT R SERV SERVICES DATE 11/:4/98 -0433
PARCEL: 2S101AD -02600
SITE ADDRESS...: 12625 SW 69TH AVE
SUBDIVISION : WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK • LOT •031 JURISDICTION: TIG
CLASS OF WORK..:ALT 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 0 CATCH BASINS : 0
FIXTURES LAUNDRY TRAYS : 0 SF RAIN DRAINS • 0
SINKS 0 URINALS 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES . 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS : 0 RAIN DRAIN (ft)...: 0
Remarks: Installation of commercial backflow prevention device.
Owner: FEES
JOHN MCCROSKEY type amount by date recpt
14125 SW FARMINGTON PRMT $ 25.00 DLH 11/24/98 98- 311060
BEAVERTON OR 97005 5PCT $ 1.25 DLH 11 /24/98 98- 311060
Phone #:
Contract or
PRO LANDSCAPE INC
3045 SE 61ST CT
HILLSBORO OR 97123
Phone #: 642 -5696 $ 26.25 TOTAL
Reg #..: 7013
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Back f 1 ow Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This persit 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
(593)246 -1987.
Issued By:
.16.ry lei Permittee Signature: OT/ /7 PdoL/e47i i0N
/y/1-/ - e_- /
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
RECEI►/r-
CITY OF TIGARD Plumbing Permit Application Plan Check # ••*---
1314 SW HALL BLVD. Nov 2 A 1998 Commercial and Residential Rec'd By .2:: c-f,4 /i/9/ I-
TI6ARD, OR 97223 Date Rec'd //2y/?1
(503) 639 -4171 COC",Il9U;',ITY Lk'!.-. Date to P.E.
Print or Type �� Date to DST
Incomplete or illegible applications will not be accepted Permit # pa-0 y33
Related SWR # 3'i)R 9? -03Z
a /XI ° 9 7- 05 ,...... ,... . Called
Name of Development/Project ,, I 7 FIXTURES (Individual) _ QTY. . PRICE AMT
I r �-+
Job cl'o5
K j� \�f✓J 1 Sink 900
Address Street A ss Suite Lavatory 9.00
- -(y-f4 3L) � Tub or Tub /Shower Comb. 9.00
2 , Bldg # City/State Zip Shower Only 9.00
I " Water Closet • 9.00
Name'
Dishwasher 9.00
Owner Mailing Address I Suite Garbage Disposal 9.00
Washing Machine - - 9.00 --
City/State Zip I Phone
1 1 Floor Drain/Floor Sink 2" 9.00
Name 3" 9.00
4° 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City/State Zip Phone - Laundry Room Tray 9.00
Sr Y , . --#...-_:- Urinal 9.00
Narrw �/� )
� c A "� yr /T � Other Fixtures (Specify) 9.00
,,� _ •-._� ti"'Z= `1`_i%.- 9.00
Contractor Mailin dress Ad Suite
5S (p(� 9.00
Prior to permit City/State Zip Phone Sewer - 1st 100' 30.00
issuance, a copy 1 61SborZ 0 0 1723 - (0 4' cS 1co
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
r[
required if O 1 \ I i Gj e7 Water Service - 1st 100' 30.00
expired in COT Plumbing Uc. # Exp. Date � Water Service - each additional 200' 25.00
database 1 ZI -I Li t ,
IN )) G ,p Storm & Rain Drain - 1st 100' 30.00
Name 1 I Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device Z�
Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New Repair 0 Replace with like kind: Yes O No 0 Any Trap or Waste Not Connected to a Fixture 9.00
- - Residential" 0 Commercial 0 - - - -" Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
6� S per/hr
Specially Requested Inspections 40.00
per/hr
Are you capping, moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes 0 No O---- Grease Traps 9.00
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL
Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL r
I hereby acknowledge that I have read this application, that the information 25
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE
that plans submitted are in compliance with Oregon State Laws. I" Z
Signature of Owner /Agent Date i **PLAN REVIEW 25% OF SUBTOTAL
1 ) o1 I (b Required only if fixture qty. total is > 9
! f I `// TOTAL V) ,
Contact Person Name Pho a �`'
/� /� (� G247:509 (,, *Minim permit fee is $25 +1 5% surcharge, except Residential Backflow
► v a IN JCS I �v A- o Prevent De vice, which is $15 + 5% surcharge
'*All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:tdststplumapp.doc 7/2/98
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
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1:ldstslplumapp.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST 3
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /2 '/ ' AM ir PM BLD
Location /4a %15 5 C' J W.* * Suite MEC
Contact Person Ph PLM 98 - d V33
Contractor Ph SWR
BUILDING Tenant/Owner 0 ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath/Shear RA CO ' /O( ./2,�a/C e` 2/;-./ v A itl
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall (Q
Fire Sprinkler (�
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
P
FAIL
AVEIP Po Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
emu
-. PART FAIL
MECFIANICAL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA ��
Approach /Sidewalk Date Z / 7 Inspector l !. Ext
Other /
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•