Permit ``~ CITY OF TIGARD PLUMBING PERMIT
48 'el DEVELOPMENT SERVICES PERMIT #: PLM2000 -00215
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/14/2000
SITE ADDRESS: 12810 SW 135TH AVE PARCEL: 2S104AC 13100
SUBDIVISION: PP1997 - 031 ZONING: R -
BLOCK: LOT: 002 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: Install a residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
SHEARER, THOMAS M + CHERIE M PRMT GEO 06/14/200C • $25.00 0002952
12810 SW 135TH AVE 5PCT GEO 06/14/200C $2.00 0002952
TIGARD, OR 97223
Total $27.00
Phone 1:
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 00006136 Final Inspection
PLM 11558
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. ■ile
Issued By: �� - Permittee Signature: Y g /iii ". /
Call (503) 63 by 7:00 P.M. for an inspection needed the next business day
06/ TUE 10:57 FAX 503 598 1960 CITY OF TIGARD ij00
F,
CITY OF TIGARD Plumbing Permit Application ec, Plan Cneck Y
13125 S!"�'• BLVD. Commercial and ResidenCC
Redd By
TIGARD, OR 97223 Date Recd
(503) 639-4171 Sati 12, ® ?u Date to P.E.
Print or Type �O Permitit '4 '40/RCM
incomplete or illegible applications will �l ig �pted
Related SWR ft
Called
Name of Deveiopment/Project ._Fl)fTLIRES.(ldivial) : ?- r:;' Q ° ?; .4RIsEtAi1gT
Job Sink 11.50
Address Streete`ddress .i"1"lj Suite Lavatory 11.50
dip I ! Tub or Tub /Shower Comb. ' 11.5C
Bldg it C' /State Zip .
Shower Only 11.50
77 gcvtd . oR ��
Water Closet 11 :50
Name -c'h 6.t_/L,Q._4_, Dishwasher I 11.50
Owner Maifng Address Suite Garbage Disposal • f 11.50
SLa f 1')C. QS � - bD- Washing Machine 11.50
City /Sate Zip Phone Floor Crain/Floor Sink 2° 11.50
•
Nacre 3" 11.50 ' •
4' 11.50
Occupant mailing toss Suite ' Water Heater 0 conversion 0 like kind 11.50
' Gas piping requires a separate mechanical permit.
City /Slate Zip Phone Laundry Room Tray 11.50
Urinal 11.
Name O ther Fixtures (Specify) 16.03 50
Pro�rc� ss Lar)c��ca� e, i
Contractor Mailing Address '
,,,„/,8.,./s. tc3 K nSrnan r lZ0 .
Priicr to permit City!Siate Zip Phorle� - l�oip Sewer - 1st 100' 38.00
Issuance, a copy Wi I i S6rl U Inc, OK. �17O 6 too )< I'•1 Sewer - each additional 100' 32.00
of all licenses are Oregon Guist. Cont. Board Lic.# Dat
required if 1 P 3 f 3 � OG Water Service -1st 100' 38.00
expired in COT Plumbing Lie. ;r Exp. Da.e Water Service - each adcltlonal 200' 32.00
database t - Storm & Rain Drain - 1st 100' 38.00 1
Name Storm & Rain Drain - each additional 100' 32.00
Architect Mobile Home Space . 1 32.00 I
or - Mailing Address Suite Commercial Back Flow Prevention Devise or Anti- 32.00
• Pollution Device
Engineer I
I City/State Zip Phone Residential Backflow Prevention Device' 19.00 (/
(Irrigation. timing devices require a separate
Des ribe work to be done: . restricted energy permit) 1
New Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 11 .50
Reside O Commercial 0 Oaten Basin 11.50
Additional description of work: 1_ Insp. of Existing Plumbirg 50.00
B flow /�i�( J ` / 4 J / Specially Requested Inspections • 50A0 j
- Are you capping, moving or replacing any fixtures? I per /nr
Yes .0 N o Q Rain Drain. single family dwelling 45.00
If yes, see back of form to indicate work performed by Grease Traps i 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL I:
I hereby acknowledge that i have read this application, that the information Isdrr. or riser diagram is required if Qusn:ityTcral is > s : ::'` -_ t'
given is correct, that I am the owner or authorized agent of Lhe owner, and `SUBTOTAL. #: _ _ -
that plans submitted are in compilance with Oregon State Laws.
Sign ur of Owner! Ont 4� `� &CHARGE
' . - j % SURCHARGE
7 CD l
Contac Person Name Phone 'PLAN REVIEW 25% OF SUBTOTAL = "'-
Requires o it fixers qty. total i3 > 9
___ r == y;< =._ .4 TOTAL = =
:'. #i : - - per =:::: � _=:
Y_.. ' -- -z" -- _ � 1 1 - -i .-1 i Sri:tifEV,. r
, : _....... , :
r -
A i1D[ Z5t1 '` �..r_ ,s a <. acv,.
....: ._ . : , - T . _......:
Vi z - iaT _�.._ -_ : _ �_: 1;1 'Minimum permit fee is 850 5% surcharge, except Residential Backflow
' 4P "`"'`�- " - ""� `- �. - - ^" z ' -'� ° _ i Device, whi :h is 2 , 5.S surcharge
, - Fi t -- ' da ?1tAfn•,. i ixtutes e` 40 6k 't := - 3 Prevention De
�'lOtft` 6 Kati$ar sevtetViiffa. :*ijt<g? sgffrr =�� > a`- ;, "All New Commercial Bu11 ngs require plans with isometric or riser diagram
i z._ -.-,. ,._ and plan review
i:lds:s''.forrnslpiumapp.dcc SPAS
06/06/99 TUE 10 : 59 FAX 503 598 1960 CITY OF TIG.kRD 0003
*1- t7
•
PLEASE COMPLETE: Quanttty by Work Performed
Fixture Type •
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"
4"
Water Heater
Laundry Room Tray
Urinal
Otherfixtures (Specify)
8 ia-ae,-ho Prevoiody, atA),
COMMENTS REGARDING ABOVE:
lAthts,forms'ip.urr. app. doc 6/2/fig
CITY OF TIGARD BUILDING INSPECTION DIVISION _ MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /36 AM PM BLD
Location / .F /0 h Suite MEC
Contact Person /el/0724.o Ph 6 6 6 7 PLM c ?-_co 06.11S
Contractor Ph X
SWR
BUILDING Tenant/Owner ELC
Retaining Wall 'f ; ELR 2 0 0/5 1 4
Footing cces • FPS
Foundation
tn / r 3 �) - m SGN
Crawl wl l Drain Inspection No es: CJ v
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service 6 ' L r
Sanitary Sewer
Raid I rains
PART FAIL
HANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
rm
Fina
ASS 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 1 Inspector 924, Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.