Permit CITY T I G A R D PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM1999 -00309
.4111- DATE ISSUED: 09/24/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14207 SW 116TH TERR PARCEL: 2S110BA -08900
SUBDIVISION: EVERGREEN SPRINGS ZONING: R -4.5
BLOCK: LOT: 014 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: Residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
RENAISSANCE CUSTOM HOMES PRMT KJP 09/24/199E $25.00 99- 318604
1672 SW WILLAMETTE FALLS DR 5PCT KJP 09/24/199 $1.75 99- 318604
WEST LINN, OR 97068
Total $26.75
Phone 1: 557 -8000
Contractor:
MOODY ENTERPRISE INC
PO BOX 98
ESTACADA, OR 97023 REQUIRED INSPECTIONS
Phone 1: 631 -2918 RP /Backflow Preventer
Reg #: LIC 00005973 Final Inspection
PLM 11717
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: dx - 7,7 &aloej
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
iTY OF TIGARD Plumbing Application Recd By ( t° °
3125 SW.HALL BLVD. Commercial and Residential Oats Recd /zz y y
!GARD, OR 97223 Date to P.E.
703) 639 -4171 Date to DST
Print or Type Permit * A411 1 it yg - 00 3 c
Related SWR le
Incomplete or illegible applications will not be accepted Called
Name of Development/Protect FIXTURES. ($ndlvldusI) ,t ;) �0 P CE;
Job �! /� '
Sink
tom-.T
Elie ' U� /ZYt v�r Syr cc 9.00 1
Address Street A ss S Lavatory
l `/ ZC7 S" I , //6 f / Tub or Tub/Shower Comb. 9.00
h �C'illfa'7C -P, T 9.00
Bldg S City/State zi Shower Only ` , cat" ` O� ` 7z a ? Water Closet 9.00
/�/� 9.00
AM /S.S q c CLSiOtt //j t'1' Dishwasher 9.00
Owner �A�dr�as // B #i / Suite
Garbage Disposal 9.00
�/� w 44 ht l c � , Wasting Machine 9.00
/State Zip Phone - Floor Drain
?S+ 1, 1 ' v�/ 0A 77OOSJ 33-7 -rya(0 2' 9.00
Name 3' 9.00
9.00
Occupant Mailing Address Suite Water Heater
9.00
City /State
Zip Phone Lary Room Tray 9.00
Urinal
9.00
Name y Other Fixtures (Specify) 9.00
M QI C�/ ! �'�t.pni.3 el' / 9.00
Contractor Melling A ddFsss S
e
�• ats 7R 9.00
(Prior to issuance Q
applicant must 4 «Ic Phone
a d 1 7Q23 6-71 7 I /il 9.00
r-
provide all Oregon Coast Cont Board Liss E Date 9.00
contractors // 7/ 7 Lan / ' yo /e
9.00
license information Plumbing s 4ry / gy p D tie Sewer - 1st 100'
for COT COT Business Tax or Metros �Exx�� Sewer - each additional 100' 25.00
database). L O / / 2U 7 � U W Service - isi 100'
•
U v` 30.00
Name Water Service - each additional 200'
25.00
Architect Storm & Rain Drain - 1st 100' • 3000
Storm & Rain Drain - each additional 100' 25.00
Of Hieing Address Suite
Molide Home Space
Engineer City /State Zip Phone Commercial Back Flow Device low Prevention De or Anti- 25.00
`/
Pollution Device 25.00
:escnbe work New W Add)on 0 Alteration 0 Repair 0 Residential Baddfow Prevention Device'
3 be done: Residential � Non- residential O 15.00
additional description of work Any Trap or Waste Not Connected to a Fixture 9.00 I
Catch Basin 9.00
5 /0/b; A) le/e, C1,0 k ni/ insp. of Existing Plumbing 40.00
/UN fr Specially Requested Inspections per/hr
_asting use of 40.00
Iii Of property per/hr
Rain Drain, single family dwelling 30.00
use of Grease Traps
9.00
iding or property
QUANTITY TOTAL
-:e you capping , moving or replacing any fixtures? Yes 0 No ❑ Is«netric or riser diagram is re R 3: = F'i '~
"f yes see back of form) a'a^'h Tom > 9 ; :4,47
sreby acknowledge that I have read this application, that the information 'SUBTOTAL = "s
on is correct. that I am e owner or authorized agent of the owner. and 5% SURCHARGE J
th
:plans submitted are in compliance with Oregon State Laws. �'
.0 of A,ent Date PLAN REVIEW 25% OF SUBTOTAL _ .. `
/ 7 w // / Repined any (fixture Qty. total is > 9 ' e
:ntaet Person Name � TOTAL - _
Phone
! / (` N Z i C31-2913/ P Residential
' _ i Qc c y - P i revention Device, which is S15 «�5% surcharge
except Resrdentrat t3ar�ctfow
/
1:\ - -- lma .d oc 12/96 (dst)
P PP
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 Hour Inspection Line: 639 -4175 Business Line: 639 -4171
J' BUP
Date Requested L( �I on AM PM BLD
Location 1L-10-1 // llf' ` ) e,i(Y Suite MEC
Contact Person -- 17a k) I S Ph 5') 2 2 /SCD IMO " - CO 6°
Contractor Ph SWR Atm
BUILDING Tenant/Owner ELC 41/ 4 /
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Note • SGN
Slab
Post & Beam
Ext Sheath /Shear
Ina Framing O n f n Q n , t 1 u '^ ' a „ A
Framing l � V t �/ UJ 1 .t' I. �/�/
Drywall 5 V • � L S i owe '� b „ „ l o , e �0 4e
Firewall
Drywall Nailing Y a vV�. eX.!' ` ��� /L
y /
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof N b • 1111111111
Misc: �•
Final
PASS PART FAIL '
FUMBI `1'5
Post & Beam
Under Slab p
Top Out �►
Water Service
Sanitary Sewer
Rain Drains
anal _
PASS PART FAI
�ECHANIGA1)
Poste Beam
Rough In
Gas Line
Smoke Dampers
tom'
PASS PART
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
SS PART FAIL
I
Backfill /Grading d
Sanitary Sewer A \
Storm Drain /4 n [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( •r cR`7
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
A ro ch /Sid alk 4 (� 3
of e ta Date Inspector �� Ext
Fi
PART FAIL DO NOT REMOVE this inspection record from the job site.
4/26/00 Activities for Case #: PLM1999 -00309
2:21:38 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 9/22/99 GEO RECD No Hold KJP 9/23/99
PLMA005 Create Permit 9/23/99 KJP DONE No Hold KJP 9/23/99
PLMA750 RP /Backflow Preventer 9/23/99 9/23/99 No Hold KJP 9/23/99
PLMA799 Final Inspection 9/23/99 9/23/99 4/4/00 RB PASS No Hold AKJ 4/4/00
PLMA050 (F) Issue permit 9/24/99 KJP DONE No Hold KJP 9/24/99
PLMA845 Request inspection research 3/27/00 JMT DONE No Hold JMT 3/27/00
PLMA800 Case Finaled 4/4/00 AKJ DONE No Hold AKJ 4/4/00
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