Permit CITY OF TIGARD
PLUMPING PERMIT
/4 ; DEVELOPMENT SERVICES DATE I ICES ISSUED: O7i2P -024` 97223 1.11 - 11. 13125 SW Hall Blvd., Tigard,
PARCEL: 2S1O3BD -06800
SITE ADDRESS...: 12548 SW 116TH AVE
SUBDIVISION • HUNTER'S GLEN ZONING: R -4.5 PD
BLOCK • LOT •024 JURISDICTION: TIG
CLASS OF WORK..:OTR 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: Installation of residential back flow prevention device. Restricted
energy electrical permit required for landscape irrigation control.
Owner: FEES
CONRAD BRETTSCHNEIDER type amount by date recpt
12548 SW 116TH AVE PRMT $ 15.00 DLH 07/22/98 98- 307574
TIGARD OR 97223 5PCT $ O.75. 07/22/98 98- 307574
Phone #: 590 -6097
Contractor
OWNER
Phone #: $ 15.75 TOTAL
Reg #...
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 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:i�.�'
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Recd By ;-
TIGARD, OR 97223 Date Recd %� /q'
(503) 639 -4171 Date to P.E.
Print or Type / Date to DST
Incomplete or illegible applications will not be accepted I Permit # /AGM 94 -6,2 ya.
g pp Related SWR #
Called
52-29 S -a/F?
Name of Development/Project
iFIXTURES' individual `' °' :" <4QTY.` = P RIC E AMT°
yr, :�: �. )s'...�,�r , ".:: ,� .� - � ��. �� �� _x:: ..
Job 7-7 6c C /,LJ Sink 9.00
Address Street Address -.e/- Suite Lavatory 9.00
5 VS' 5 mot). ,'/ ' ,¢.26 Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip
r/6 2 oe p7Z 2 Shower Only 9.00
Name Water Closet 9.00
(0,04i10 �X c=-% Tf C#4f,J(3' /D c_--: Dishwasher 9.00
Owner Mailing Address - Suite Garbage Disposal 9.00
/GS . tc."- / 70 J 4 2 Washing Machine 9.00
City /State Zip Phone Floor Drain /Floor Sink 2" 9.00
Ti‘ a 97 5 Sb --6o9
Name 3" 9.00
(&c4L7 3g67 Jc 4" 9.00
Occupant Mailing Address _ Suite Water Heater 0 conversion 0 like kind 9.00
/ Z..SY 5 / /4 ?' ,/rJC Gas piping requires a separate mechanical permit.
City/State Zip Phone Laundry Room Tray 9.00
7 % j ' F ?E.?? S90 -6af7 Urinal 9.00
Name
t v/k), /4- 7 e- JC y,,J e - > 2 Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
/ Z7 z/d'' fcRJ , /G 9.00
Prior to permit City /State Zip Phone Sewer - 1st 100' 30.00
issuance, a copy ?"----//"( a' 97F u 5 9 -6 P
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database Storm & Rain Drain - 1st 100' 30.00
Name 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
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.) r ' S
New ,ef Repair 0 Replace with like kind: Yes O No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential . Commercial O. Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per /hr
Specially Requested Inspections 40.00
per /hr
Rain Drain, single family dwelling 30.00
Are you capping, moving or replacing any fixtures?
Yes 0 No ft Grease Traps 9.00
If yes, see back of form to indicate work performed by
•
QUANTITY TOTAL e d _ <.
fixture. FAILURE TO ACCURATELY REPORT FIXTURE -° � ., , : . - -
Isometric or riser diagram is required if Quantity Total is > 9 ; Z :,_ , •,,,,. _ �4' '
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL '__,� `t°' 'I ; . /4:2 . 0%
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 ' '" � A" '
that plans submitted are in compliance with Oregon State Laws. `` " I
P P 9 pV , -, ; - rte =
Signature of O ner /Agent Date * *PLAN REVIEW 25% OF SUBTOTAL �..:k a - '�'
7:9•1..--.V G r L,G �G �� -/ 7 Z Required only if fixture qty. total is > 9 . =: , .
� TOTAL , t i5 7S
Contact Person Name Phone , i , : ` 'x »j�;,
G `Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
( 7 j /%1 J/%1 .9 r i<?C i ���� ' 2 c /gE S/ v G C W Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I: \dstslptumapp.doc 7/2/98
X7,75
PLEASE COMPLETE:
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:
I:ldstsl plum app.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639-4171
BUP
Date Re uested �1" /�,, ,� AM PM BLD
Location /2 g / / I l( )YV� Suite MEC
Contact P rson Ph PLM 9f -(y)?�'
�"
Cont a or eo o_6 Ere c AA-e- r d e&- Ph g16 09'7 SWR
BUILDING Tenant/Owner ELC (� Cj
Retaining Wall ELR 9 b -0 ( /
Footing Access:
Foundation � J^ FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation OM Drywall Nailing 9 P- 7 O z
Firewall
Fire Sprinkler gA)
Fire Alarm E L /� 9f -0 D �ry q
Susp'd Ceiling �` 9f �`j
Roof
Misc:
Final a
PASS PART FAIL
PI�111Bi
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
PART FAIL
HANICAL
Post & Beam
Rough In - -
Gas Line
Smoke Dampers
Final
•
PASS PART FAIL
CLLECTRrC
Se ce
Rough In
UG /Slab
Low Voltage
Fir- larm
40
PART FAIL •
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
Other D ate Z Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•
05/30/2000 Activities for Case #: PLM98- 00242
10:29:34 AM
Y
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 07/22/1998 DLH RECD DLH 07/22/1998
PLMA005 Create Permit 07/22/1998 DLH DONE DLH 07/22/1998
PLMA799 Final Inspection 05/12/2000 CD PASS AKJ 05/15/2000
PLMA750 RP /Backflow Preventer 07/22/1998 DLH 07/22/1998
PLMA050 (F) Issue permit 07/22/1998 DLH DONE DLH 07/22/1998
PLMA845 Request inspection research 03/27/2000 JMT DONE No Hold JMT 03/27/2000
PLMA800 Case Finaled 05/15/2000 AKJ DONE No Hold AKJ 05/15/2000
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