Permit ,�
CITY � TI ��/� � PERMIT
����~�v ��w�uv nu�~.~.~ PERMIT #. .. . . . . : PLM96-0231
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/08/96
1o1csmw Hall Blvd. Tigard, Oregon e7223°81e9 (503) 639-4171
PARCEL: 2S114BB-13300
SITE ADDRESS...: 16382 SW 104TH AVE
SUBDIVISION....: 8WANSONS GLEN NO.2 ZONING: R-12 PD
BLOCK.....,....: LOT .74
_______________
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..03 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: Installing a residential backflow prevention device.
Owner: — — FEES --------------
SHARA SUNDBURG type amount by date recpt
16382 SW 104TH AVE PRMT $ 15.00 CJS 08/08/96 96-282705
5PCT $ 0.75 CJS 08/08/96 96-282705
TIGARD OR 97223
Phone #: 503-620-6056
Contractor: ----- ---------
OWNER
Phone #: $ 15.75 TOTAL
Reg #.
REQUIRED INSPECTIONS -------
This permit is issued subject to the regulations contained io the RP/Back flow Pre
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 permit will expire if work is not started
within Iv: days of issuance, or if work is suspended for more
than 180 days. _
___ ___
Per mittee Signature: MN; i
rL ---- -
L
Issued By: �^�"'o*'' c~�r__ -- _- _---- ----
Call for inspection — 639-4175
•
CITY OF TIGARD Plumbing Application Recd ByCD>
Date Recd g -2 ' 9 ' .
13125 SV HALL BLVD. Commercial and Residential Date to P.E. 1/X
TIGARD, OR 97223 Date to DST 4
(503) 639 -4171 Permit# f Lm Sn-- / D a2 3 (
Print or Type Related SWR # yr'
Incomplete or illegible applications will not be accepted Called n'lCr / /•
e of Devlopment/project rt ' ,, ', Nsw'Slnale Femtly Residences°Onl� � ", . �-
Job I FStU11L. �
ip tpBATH HOUSE�S1gB 00 ' % ci fga TH.HOUSE $1.95:ti0� y •
r x� � «,
Address Street Address Suite P,': a�? ` t 3B4 OU9^E$z2 ^ , 4 t �a� m
I63 g2 . 57..3 / 0 4 -1.1 AVE ^ F fluor eslin the dwelliftalt alai rdif,100 feet�o # City/State Zip wa service sanif s w and \� �' ' `i " .'
Bldg Y P ry a ' ' storm sewerSee b elow: �.
C.MRD 1 CA. 6 ) 7224 :!4.::::,,, . ' ' -_x ' _ , . � W t k � '
Name FIXTURES (individual) QTY PRICE AMT
(/' eiTl es,^L,, Sink
9.00
Owner Mailing Address Suite_ Lavatory 9.00
/ 3 -S J /o4 4d�
Tub or Tub /Shower Comb. 9.00
-C�ity /State /� Zip Phone
I. G.l D DR.. g7Z24 _ 6 Show Only 9.00
Name Water Closet 9.00
ROSS 4 - SM - SuntA3r ` Dishwater 9.00
Occupant Mailing Address /� Suite Garbage Disposal 9.00
(( 332 S k.) /04-t..4 ,4i
4 Washing Machine 9.00
City /State Zip ! Phone Floor Drain 2" 9.00
T )iOA_6)C7ZZ -+- 6zo °c.45
Name
3" 9.00
4" 9.00
Contractor Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City /State Zip Phone Urinal 9.00
Oregon Const. Cont. Board Lic.# Exp. Date Other Fixtures (Specify) 9.00
Attach Copy of 9.00
Current . Plumbing Lic. # Exp. Date • 9.00
License Sewer -1st 100" 9.00
COT Business Tax or Metro # Exp. Date Sewer - each additional 100' 30.00
Name Water Service - 1st 100' 25.00
Water Service - each additional 200' 30.00
Architect Mailing Address Suite Storm & Rain Drain - 1st 100' 25.00
or
Storm & Rain Drain - each additional 100' 30.00
Engineer City /State Zip - Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration 0 Repair O Pollution Device
to be done: Residential Non - residential O .-� Residential Backflow Prevemion Device' 1 15.00 15,001
Additional description of work Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
L.p\vIr' S Pi.l ntk-LT.n�SYST Insp. of Existing Plumbing 40.00
per hr
Existing use of Specially Requested Inspections 40.00
building or property
per hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps
building or property 9
QUANTITY TOTAL l ' ' ,"
Are you capping any fixtures? Yes 0 No
Isometric or, riser diagram is required if Quanity Total is > 9 1 ia , ., , ;r
I hereby acknowledge that I have read this application, that the information „� , . , .
SUBTOTAL , S. 00
given is correct, that I am the owner or authorized agent of the owner, and _ ,
that plans submi -_ :re in compliance with Oregon State Laws. m " "
Sig a of - r /Agent Date 5% SURCHARGE ,
�. r1Au & PLAN REVIEW 25% OF SUBTOTAL '« ';== i
Required only dfudure, N A
j
ontact Pets Name Phone
TOTAL N qty. total is > 9 ` r, . < - `
= ,1-a4:
OAP ‘056 g0:4 IM:144 )
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
i:\dsts \plmapp.doc
Vig
PS
IS Prevention Device, which is $15 + 5% surcharge
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639- 4171_--
BUP
Date Requested ,./5 AM PM BLD
Location I (1) ;q2- /ht-1 A AiX Suite MEC
Contact Person Ph PLM 9 — a- ) 23/
Contractor Ph SWR
BUILDING a w .. ` Tenant/Owner ELC
Retaining Wall ELR
Footing
Foundation NOT REQUESTED FPS
Ftg Drain , FOUND DURING RESEARCH SGN
Crawl Drain NO INSPECTION(S) FOUND IN FILE
Slab SIT
•
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing (� _
Insulation
Drywall Nailing
Firewall
_ Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: - J / �l -rte '
Final �C� y 'T
PASS PART FAIL
EUMBI '. '
Post & Beam
Under Slab / , �/��� �_�`�
Top Out e
Water Service J •
Sanitary Sewer .'
Rain Drains ,
ti r PART FAIL
HANICAL
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 p _51 Approach /Sidewalk /' Z� L--
Other Date ! Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
05/30/2000 Activities for Case #: PLM96 -00231
10:21:18 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA007 Application received 08/08/1996 CJS RECD CJS 08/08/1996
PLMA799 Final Inspection 05/12/2000 MRS PASS AKJ 05/15/2000 sprinkler device had never been
insp
PLMA745 RP /Backflow Preventer 08/08/1996 CJS 08/08/1996
PLMA050 (F) Issue permit 08/08/1996 CJS PASS CJS 08/08/1996
PLMA740 Misc. Inspection 02/22/2000 02/22/2000 02/22/2000 JMT DONE No Hold JMT 02/22/2000 research inspection request
PLMA800 Case Finaled 05/15/2000 AKJ DONE No Hold AKJ 05/15/2000
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