Permit CITY TIGARD PLUMBING PERMIT
. I; DEVELOPMENT SERVICES PERMIT #: PLM1999 -00165
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/21/99
SITE ADDRESS: 14703 SW 109TH AVE B. 1 PARCEL: 2S110AC -00500
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R1 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: Backflow prevention device
FEES
Owner:
Type By Date Amount Receipt
SECURITY CAPITAL PACIFIC TRUST MISC BON 5/21/99 $1.25 99- 315590
330 112TH AVE NE PRMT BON 5/21/99 $25.00 99- 315590
BELLEVUE, WA 98004
Total $26.25
Phone 1:
Contractor:
HIGHRIDGE CORPORATION, THE
21480 NW CORNELL RD
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1:
Reg #: LIC 00006221 Final Inspection
ORIGIN
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: • M lag ✓N__ Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan c
13125 SW HALL BLVD. Commercial and Residential Recr(By >_
TIGARD, OR 97223 Date Rec'd 6 :- (2 -11- 92 .
(503) 639 -4171 Date to P.E. ---
Print or Type Date to D T ---
Incomplete or illegible applications will not be accepted Permit # t,K (499 'ex)l4
Related SWR #
Called
Name of DevelopmenvProject FIXTURES (individual) QTY PRICE AMT
Job 7 /ffl/PLd/ APFS Sink 9.00 -
Address Street Address Suite Lavatory 9.00
/y79 SkY /9 Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip
776 Q,2 97123 Shower Only 9.00
Name / / Water Closet 9.00
eche/, G /DEG �iaclGic, RU S' 1 Dishwasher 9.00
1 Owner Mailing Address Suite Garbage Disposal l 9.00
330 /12- Ave NE Washing Machine 1 9.00 1
City /State Zip Phone
I E- L.Etlue W 1 /A o7aCJ n„ Floor Drain /Floor Sink 2" 9.00
Name l 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
Urinal 9.00
Name
C' C Other Fixtures (Specify)
9.00
t",\ 77 �6wi�' keoe 612,92 Zd*�
1 , _ Contractor Mailing Address Suite 9.00
L. .2 /'/fib N to kyae02aorJ D/L
o 9.00
\ Prior to permit City /State Zip Phone Sewer - 1st 100' 30.00
r, issuance, a copy al ggRa e x 47/244 6z9_0/93 Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if 6 ZZ / Water Service - 1st 100' 30.00
VO expired in COT Plumbing Lic. # ' Exp. Date Water Service - each additional 200' 25.00
database Storm & Rain Drain - 1st 100' 30.00
. � Nam /' .� Storm & Rain Drain - each additional 100' 25.00
Architect 74I ,l4�jQ /D - 6P-P' Mobile Home Space 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device i ��
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 XS Repair 0 Replace ith like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial f Catch Basin 9.00
Additional description of work:
6 ((�� ( -
2t Go Insp. of Existing Plumbing 40.00
u�JJ i'�T �� �►� �� �� 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 O No O Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL & -- '
I hereby acknowledge that I have read this application, that the information
given is corr:. , that I am the owner or authorized agent of the owner, and 5% SURCHARGE - P - S --
that plans ..mined are in compliance with Or -gon State Laws.
Sign : of Owner /Agent Date * *PLAN REVIEW 25% OF SUBTOTAL
/� Required only if fixture total is > 9
equre ony xur qty. oas
- !� %��J " � �/ TOTA �
ontact Person Name • hon- A''
/ _ 2 P �� /6 .62? .79.3 *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
1: \dsts\plumapp.doc 7/2/98
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved 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:
tee.u2cry C'.fo/ L. 2/fcr F c-
P1 Ca- g
I:\dsts\plumapp.doc 7/7/98
/44 /) ITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested (0 AM PM BLD
Location ' 7 1. ( q Suite 6 • I MEC
Contact Person } Ph PLM jq' l 1
Contractor / "` X L t e if rs Ph SWR
BUILDING Tenant/Owner / // AL/ �i ,t ELC
Retaining Wall ■ `f ELR
Footing Access:
Foundation QQ p20 ( FPS
Ftg Drain c�� ' ��� r _
S�S SGT
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam ""
Ext Sheath /Shear e
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL ..97/
<ELUMBING,2
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
R a i , ;; D rains
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 C/V Approach /Sidewalk
Other Date Inspector 1 /.1 Ex
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.