Permit CITY OF TIGARD
.,
po,„a, PLUMBING PERMIT # DEVELOPMENT SERVICES PERMIT • PLM96 -0326
..-1,191-1J1. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/01/96
PARCEL: 25110BB -05600
SITE ADDRESS...: 14252 SW 121ST AVE
SUBDIVISION • ARLINGTON RIDGE ZONING: R -3.5
BLOCK • LOT •033
CLASS OF WORK..:NEW 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: backflow device at meter for irrigation — double check
Owner: FEES
WILLIAM PARSONS type amount by date recpt
4050 SW BANCROFT PRIM $ 15.00 JMH 10/30/96 96- 285906
5PCT $ 0.75 JMH 10/30/96 96- 285906
PORTLAND OR 97221
Phone #: 222 -1241
Contract or:
NORTHWEST CENTRAL PLUMBING
19645 SW BLANTON
ALOHA OR 97007
Phone #: 591 -8911 $ 15.75 TOTAL
Reg #..: 72253
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 Inspect ion
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 yore
than 180 days.
Permittee Signature: MAW) 03AFP
Q/n iOCh A
Issued By:
Call for inspection — 639 -4175
:,ITY,OF TIGARD Plumbing Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P E.
(503) 639 -4171 Date to DST
Permit #PLM - O'32_6
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Sink 9.00
Job A.,' is it I? J - d C_ Lavatory 9.00
Address Street Address ¶ Suite
( l '/ Z S Z $• u, / 2 / S Av Tub or Tub /Shower Comb. 9.00
Bldg # ' City/State i Zip Shower Only 9.00
7 f 0 " - CA. Water Closet 9.00
Name Dishwasher 9.00
1-.) 2 I i,G, -. Pc .- 5e-1
Owner Mailing Address Suite Garbage Disposal 9.00
1 r(2 5 i 5 Washing Machine 9.00
City/State pp Zip Phone Floor Drain 2" 9.00
I r 5 ° ` O � / 01-r_. 3" 9.00
Name
LJ . (i c .._, 1 4 v S r l 4" 9.00
Occupant Mailing Address Suite Water Heater 9.00
5 c. Laundry Room Tray 9.00
City /State Zip Phone Urinal 9.00
5 a -L.__ Other Fixtures (Specify) 9.00
Name / /I
n/G f Ve c„4-0G,I ID/ d w b 9.00
Contractor Mailing Address Suite 9.00
9.00
City /State Zip Phone 9.00
Oregon Const. Cont. Board Lic.# Exp. Date 9.00
Attach Copy of 7 2 2 5 3 9.00
Current Plumbing Lic. # Exp. Date Sewer - 1st 100" 30.00
Licenses Sewer - each additional 100' 25.00
COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
( Name Water Service - each additional 200' 25.00
Architect a 1 L G 0 It: i C Storm & Rain Drain - 1st 100' 30.00
0
or
Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space I 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- ' 25.00
Pollution Device r
Describe work New 0 Addition 0 Alteration 0 Repair 0 Residential Backftow Prevention Device' ( 15.000
to be done: Residential 0 Non- residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional descnption of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per /hr
Existing use of Specially Requested Inspections 40.00
per /hr
building or property Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property ,
QUANTITY TOTAL e 7 S
Are you capping , moving or replacing any fixtures? Yes ❑ No ❑ lsometnc or riser diagram is required f Quanity Total is > 9
(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
that plans submitted are in compliance with Oregon State Laws. .
Sign re of Own r/_ •ent Date PLAN REVIEW 25% OF SUBTOTAL
/0 6 / ? � Required only d fixture qty. total is > 9
TOTAL / S 7s
Contact Pe :'' 17��� - Phone
`Minimum permit fee is S25 + 5% surcharge. except Residential Backflow
Prevention Device, which is S15 + 5% surcharge
is \dsts\plmapp.doc 8/96
PLEASE 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)
COMMENTS REGARDING ABOVE:
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Requested G// (7 Q U AM 'L. PM BLD
Location 1 )- 2-- 1 2 W -i'l Suite MEC
Contact Person Ph PLM 96.-Oo
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing FPS
Foundation N OT REQUESTED
Ftg Drain
Crawl Drain I FOUND DURING RESEARCH SGN
Slab NO INSPECTION(S) FOUND IN FILE SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall i( -
Fire Sprinkler / .4(4,e Ard 1 ✓ i' _
Fire Alarm i
Susp'd Ceiling AIOY % ftG.
Roof
Misc:
Final
PASS ART FAIL
UMBI
Post & Beam y
Under Slab �/ C
Top Out (`
Water Service
Sanitary Sewer
Rain Drains 609
, . PART FAIL
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
A
111 pproach /Sidewalk Lif Date (i Inspector E xt �
Other p
Final
PASS PART AIL DO NOT REMOVE this inspection record from the job site.