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Permit CITY TIGARD PLUMBING PERMIT ' 1 DEVELOPMENT SERVICES PERMIT PLM2000 - 00251 -- '�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/5/00 SITE ADDRESS: 11865 SW 91ST AVE *** BLDG 3 PARCEL: 1 S135DC 02000 SUBDIVISION: VILLA LA PAZ ZONING: R - BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: 3 OCCUPANCY GRP: R1 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: Installation of three commercial backflow prevention devices, two at water meters and one for landscape irrigation. FEES Owner: Type By Date Amount . Receipt VILLA LA PAZ LIMTED PARTNERSHI PRMT DEB 7/5/00 $96.00 0003461 BY COMMUNITY PARTNERS FOR 5PCT DEB 7/5/00 $7.48 0003461 AFFORDABLE HOUSING INC TIGARD, OR 97281 Total $103.48 Phone 1: Contractor: REQUIRED INSPECTIONS Phone 1: RP /Backflow Preventer Reg #: Final Inspection O k `G 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 ,•03) 24. 1987. / r- / / Issue c: �Permit Signature: 4 . /. r / Call (5 639 -4175 by 7:00 P.M. for an inspection needed th • ne' business day CITY OF TIGARD Plumbing Permit Application Plan C �-�� �-�- 13125 SW HALL BLVD. Commercial and Residential Recd 1 TIGARD, OR 97223 - Date Rec'd 7-5 -dO (503) 639 -4171 - Date to P.E. '___ Print or Type Date to D T Incomplete or illegible applications will not be accepted Permit # . M Peer) -aS Related SWR # • Called Name of Development/Project " FIXT RE lJ S (mtlividual)' '° Q A PR C ABM �. >.._.:� <- ..;..:...:, .. � ..:.,�; _ M , E T ai Job . YOU; A i., A f iAZ Sink 11.50 Address Street Address Suite Lavatory 11.50 i I p(O�J ` J• 9 `5I Tub or Tub /Shower Comb. 11.50 • Bldg # City /State �1 Zip Shower Only 11.50 T n o e, c rIZZ Water Closet 11.50 Name /� Vi 111.1 LA LA / Z 1M'lTee0 P Tki Urinal , 11.50 Owner Mailingi, ddress Suite I Dishwasher 11.50 Z3y ('ommUN; /� 7 I" ciege51.•i' �O Garbage Disposal 11.50 City /State Zip Pon T/ y4-a 972-2-3 ,4 ,4-b/e Laundry Tray 11.50 Nab No vi %NOr //U(', Washing Machine /Laundry Tray 11.50 ( J Floor Drain /Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11.50 4" 11.50 City /State Zip Phone Water Heater 0 conversion 0 like kind 11.50 Gas piping requires'a separate mechanical permit. � ame MFG Home New Water Service 32.00 0110 Dal t lQ S � e u i'ck Contractor M sling Address Suite MFG Home New San /Storm Sewer 32.00 , .27 7 0t NitA) , izosome �S Hose Bibs 11.50 Prior to permit City /State Zip Phone Roof Drains 11.50 issuance, a copy' I ie l-1 t , 99( o Z'-.f - D Drinking Fountain - 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp Date required if s-,' LA 1 % 1 I /15/6) Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. ate database P - 3 I o P 51 I CU Name Architect Sewer- 1st 100' 38.00 or Mailing Address Suite Sewer - each additional 100' 32.00 Engineer City /State Zip Phone Water Service - 1st 100' 38.00 Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commercial O.-' Additional description of work: Commercial Back Flow Prevention Device 3 32.00 96- /%YSTA-!(/ AJA (,v&%Z,Q / - 14ceGlo , ..) a. V 1 ?� S / 0e,¢' Residential Backflow Prevention Device* 19.00 tu IS- f e-'Z. L eni4A10, Catch Basin 11.50 Are you capping, moving br replacing any fixtures? Insp. of Existing Plumbing or Specially Requested' 50.00 Yes 0 No 0 Inspections per /hr If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00 • fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL : .., I hereby acknowledge that I have read this application, that the information � ° '" ��� .-F given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9 n o;; ` R a:,,-:It ' that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL >" ` : 0 . { 9/ (E? .- signature of Owner /Agent to '° `" < �'�' E,-(Z S. t(Y�c 2-Q ?p ' SO O © 8% SURCHARGE r':',0 ',.. 3 C t ct Person Na a Phone ` "` .' `4 - - -, 7 LA-- 5 , � -2 ( 239- SE-0/ * *PLAN REVIEW 25% OF SUBTOTAL .. :-: - �`1 BATH HOUSE $1:Z8`Q0 ' "�° ` ;- - � ' " '�'> " v�K e a :;; ; i Required only if fixture qty. total is > 9 , _ 2 ZAT OUSE $250 O _ TOTAL t U3 p� K - 3 BATH HOUSE X 0. 00 e P a ' / ,( * fEBr 1nClUdes ill p1U ln fiat n the dwe11in 1 d the fir$t, R` `Minimum permit fee is $50 +80/ surcharge, except Residential Backflow Prevention ,100 feetiof s anita ry s .: ,ur8s & nd Wdte iii - o e) - Device, which is $25 + g% surcharge "AII New Commercial Buildings require plans with isometric or riser diagram and /,() ,Q/S /I4- L.4' --�� plan review. 1:1dsts\forms \plumapp.doc 11 /18/99 / d 0 � - .0 y11 • I. \41 PLEASE COMPLETE: New M bv, Aon)PYPCYCPPPct Sink • Lavatory Tub or Tub/Shower Combination Shower Only Water Closet Urinal • Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Floor Sink 2" 3" 4 " Water Heater Other Fixtures (Specify) • COMMENTS REGARDING ABOVE: 1: \dsts \forms \ plumapp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 7C ° AM PM BLD Location / / a 4 L S (.4/ 11 51. Suite 3 MEC Contact Person Ph �] PLM 2°' a C ° .- f ■ Contractor Ph 9'I / f g 0 SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspeon Notes: SGN Inspection Slab p /s /Ge hi4/ - 41 fe �G ✓`'" C SIT Post & Beam Ext Sheath /Shear P6k/ Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Msc:. I-��`� Final I //A PARR PART FAIL (>PLUMBINGY WaffrAPIMW Post& team % , r/ Under Slab Top Out v \ Water Service \ Sanitary Sewer l •1 Drains n 4e �1 , Fina /� PART FAIL � ANICAL Post & Beam f Rough In r / Gas Line Smoke Dampers /7 Final Z„ 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 Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Supply Line ADA 16 Approach /Sidewalk ( `1 Other Date 1 Inspector Yd' ' Ext Final I PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION _ • MST 24 -Hour inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested / AM PM BLD Location /1 1 4'5 5 4,/q/ Suite MEC Contact Person ep ! (, Ph 9V, g( G'7 PLM aopk, ,25.—/ Contractor Ph SWR • BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation I I r p FPS Ftg Drain �f SGN Crawl Drain Inspection Notes: / Slab Of GI( cr SIT Post & Beam Ext Sheath /Shear b7 (41 4 yn•f// 4.7 • oZ - 2 '/ Ina Sheath /Shear ^ / Framing /°' //z 4� n ' -i Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling „ -�/ _ �. I3 Roof Misc: r.- Final ` r P RT FA L PLUMBING . Post & Beam Under Slab Top Out Water Service Sanitary Sewer go, c /c (/c_ Rain Drains Fi al A S PART FAIL HANICAL 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 Approach /Sidewalk Other Date a Inspector Ext 3z,/ Final PASS PART FAIL DO N • T REMOVE this inspection record from the job site.