Permit r CITY OF TIGARD
,,, DEVELO SERVICES P LUMBING PERMIT
�i����i 13125 SWHa11Blvd ., Tigard, OR97223(503)639.4171 DATE ISSUED: 06/11 -0221
PARCEL: 28103BD —HG016
SITE ADDRESS...: 12716 SW 116TH AVE
SUBDIVISION • HUNTER'S GLEN ZONING: R -4.5 PD
BLOCK • LOT •016 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:R3 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: Install residential backflow prevention device
Owner: FEES
LEGEND HOMES type amount by date recpt
6900 SW HAINES SPCT $ 0.75 JSD 06/11/97 97- 295733
TIGARD OR 97223 PRMT $ 15.00 JSD 06/11/97 97- 295733
Phone #:
Contractor
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
NORTH PLAINS OR 97113
Phone #: 647 -5567 $ 15.75 TOTAL
Reg #..: 000057
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backflow 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 permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
than 188 days.
Permittee Signa
Issued "�
Call for inspection — 639 -4175
"ATY OF TIGARD Plumbing Application Recd By
1125 SW HALL BLVD. Commercial and Residential Date Recd / y
pp .GARD, OR 97223
Date to P E.
1. 1.303) 639 -4171
P ate Dto DST
• / ��
9 o
Print or Type Related SWR C
Incomplete or illegible applications will not be accepted Called
Name of OevetopmentlPro 2 • F §A h iailk ± QT ` k CE , :Aga
a
Job 'ZS� JeL� 6 / L ° 9.00
Address Street Adr s F Suite
_„I Lavatory 9.00
' � j w /�6 , /( Tub or Tub/Shower Comb. 9.00
s
I Clty/Siate l 't:. v Zip Shower Only 9.00
l' ti hl ? .
�_` Water Closet 9.00
Nance
V
L e real--.,"0 t c Jw` a ---.. Oishwa'her 9.00
Owner Mailing L � Suits s o� 9.00
Washing Machine 9.00
CityState n Zip Phone Floor Drain 2 9.00
/ 1 ,�fi � +-- £ 7 772.x_ 3' 9.00
Na 4' 9.00
Occupant Address Suite Water Heater 9
Laundry Room Tray 9.00
City/State Zip Phone Urinal 9.00
1 C Other Factures (Speafy) 9.00
Nernst,✓! r V �-. f� 9.00
:�ntractor U ^� ' .3 O � suns 9'00
'nor to issuance )) Zip Phi
9.00
applicant must n L 4 /' 4,...s. 0 !r ca 9.00
provide all on Const. Cont. Board Licit Exp. Date 9
contractors // � it � 3( contractors S 9.00
license Plumbing Lk. 5
E4s. o a -
- ,u,00- 30.00
information .57 z) () '1 �'j Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro S .oats _,.../-- water Service -1st 100'
database). , 30.00
Name Water Service - each additional 200' 25.00
Architect storm & Rain Drain -1st 100' • 30.00
or Mailing Address Suite Storm & Rain Or - each additional 100' 25.00
Moons Home Space 25.00
Engineer CtY /State Lp Phone Commercial Bads Flow Prevention Device or Anti- 25.00
Poludon Device
Describe work New 0 Addition 0 Alteration 0 Repair 0 Residential Backtiow Prevention Device' 15.00
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9 -00
Additional description of work
Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40.00
pedhr
lwiding or property
Rain Drain. single family dwelling 30.00
- oposed use of Grease Traps 9.00
_Raiding or property
QUANTITY TOTAL
I =•rr Are you capping . mo rig y ❑ ❑ some or ris er d j 3 ^ " wing or replaci an fixtures? Yes NO 1 i9ra m rm vu�e R �uamdy Total a 9 ae ; (If yes see back of form) 'SUBTOTAL ;;+' +. . �.
I hereby acknowledge that I have read this application, that the information - -- -
given is correct that I am the owner or authorized agent of the owner, and 5% SURCHARGE > :,W,.
Mat plans submitted are in compliance with Oregon State Laws. • - -: .•r fi
Signature of Owner>A ��+'" �V � - i ;m ' .
_A / 1 n 4 R orb r fixture Dry. total is > 9
[ TOTAL : - ; .,r:,a_ � cc'? ,
Contact P Marna Phone 7
'Minimum permit fee is 525 + 5% surcharge. except Residential Backflow
Prevention Device. which is $15 + 5% surcharge
I: \plmapp.doc 12196 (dst)
'LEASE 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:
l:\plmapp.doc 12'96 (dst)
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested CN O AM PM BLD
Location I --)/ #1 Suite MEC
Contact Person Ph 2"
/ , >•' 7 -002,2A
Contractor PUAY 1 S&i'1 S Ph (p L/ 7-S5 C� SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation it Sta 6)- - FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear ' *- / l \ � \
Framing W` ` Cy
Insulation C_J"�-12—
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
MBtNG�
Pos eam
Under Slab
Top Out
Water Service
Sanitary Sewer
Drains
42Pet
•ART FAIL 1
HANICAL
1( 3
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS T 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
Approach /Sidewalk Date V C+ �
Other 0/60 Inspector t
L/� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.