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Permit CITY OF TIGARD ORI G/ f i , / PLUMBING PERMIT *i tit DEVELOPMENT SERVICES P ERMIT #: PLM1999 -00346 � Il 13125 SW Hall Blvd., Tigard, OR 97223 ( 503 Ti 639 -4171 4ATE ISSUED: 10/22/99 (503) SITE ADDRESS: 11895 SW 91ST AVE BLD PARCEL: 1S135DC - 02000 SUBDIVISION: VILLA LA PAZ ZONING: R - BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: A3 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: 100 ft Remarks: Installation of 100 feet of less of storm & rain drain. FEES Owner: Type By Date Amount Receipt VILLA LA PAZ LIMITED PARNERSHI PRMT DEB 10/22/99 $50.00 99- 319274 COMMUNITY PARTNERS /AFFORDABLE 5PCT DEB 10/22/99 $4.00 99- 319274 HOUSING INC, POB 23206 TIGARD, OR 97281 -3206 Total $54.00 Phone 1: Contractor: APOLLO DRAIN + ROOTER SERVICE 2208 NW BIRDSDALE #8 GRESHAM, OR 97030 REQUIRED INSPECTIONS Phone 1: 239 -8801 Storm Drain Insp Reg #: LIC 00049418 Final Drain Insp PLM 26 -533pb inallnspect ion p 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 N. • cation e -r. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952- 0001 -0081 ou may obtain cop•-s of th- _ - rules or direct questions to OUNC by call' g (503) 246 -1987. 41 ued By: / I :.11 / � /I/ / Permittee Signature: Call (503) 6 4-4175 by 7:00 P.M. for an inspection neede• - e business day CITY OF TIGARD Plumbing Permit Application Plan heck# 1 3125 SW HALL BLVD. Commercial and Residential Rec' �loz TIGARD, OR 97223 • Date Rec'd 4 -7 - ? (503) 639-4171 ls?j Date to P.E. r- • (� �� Print or Type ' Date to DST - Incomplete or illegible applications will not be accepted Permit #01 iq f9 -4cy6 Related SWR # Called Name of Develo nt/Pr FIXTURES< individual)" "3; : '' '`'``' QTY PRICES iffirygg Job : ... ,' / es- f A- Z Sink 11.50 Address Street Addresses - / 5 -f- ( Suite 1 Lavatory 11.50 /. % % Sw / a Tub or Tub /Shower Comb. 11.50 Bldg # 4 City /State j Zip Shower Only 11.50 / r ~ Water Closet/Urinal (Specify) 11.50 Nan . / a 4. k Dishwasher 11.50 • Owner a ing ip Suite Urinal 11.50 "� / 7 O 1' d Garbage Disposal 11.50 . City /State Phone Laundry Tray 11.50 Name Washing Machine /Laundry Tray (Specify) 11.50 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 Name / Gas piping requires aseparate mechanical permit. • / / MEG Home New Water Service • '32.00 J MEG Home New San /Storm Sewer 32.00 Contractor Mailing A T 1'/C) Suite d it/c A j -4D Hose Bibs 11.50 Prior to permit Ci /State Zip Phone Roof Drains 11.50 issuance, a copy (g,/�S r4„, `Y x3$" ° / - D rinking Fountain 11.50 of all licenses are Ore stnt. Board Lic.# Exp. Date Q� • required if Co tQ�. o 1 / /S-/ Other Fixtures (Specify) 15.00 expired in COT PI ��Ing L' . Q Exp. t database pCCP -, /v 4) - -en Name Architect . : � j q -'w - Sewer - '1st 100' 38.00 or Mailing Address Suite Sewer - each additional 100' 32.00 Water Service - 1st 100' 38.00 Engineer City /State Zip Phone g 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 0 Additional description of work: • Commercial Back Flow Prevention Device 32.00 Residential Backflow Prevention Device* 19.00 Catch Basin 11.50 Are you capping, moving or 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 Viii' '...; I hereby acknowledge that I have read this application, that the information ? °> Isometric or riser diagram is required if Quantity Total is > 9 >;, <_ -. ;_.li ' 1 given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL - k: Q that plans submitted are in compliance with Oregon State Laws. SUBTOTAL ° �`- : - surcharge, except Residential Back Si nature of Owner /Agent „ __; /O 8% SURCHARGE ,.1 l- "W;.,` x/,00 f ct Person Name Phone v * *PLAN REVIEW 25% OF SUBTOTAL a = ` fl HOIfSE�$17800:' _, " ' R e q u i re d onl if fixture qt y . tot alis >9 / i h TOTAL , '''W11' , D t 3ATH HOUSE$250 00 x �s MATHt .�", �£ 4 -N = - - ° i s n and the first 9 *Minimum permit fee is $50 + 8% Backflow Prevention ` fee of sanity . , ewe r storm ewer andgwat setv1ce t' Area Device, which is $25 + 8% surcharge .�a "All New Commercial Buildings require plans with isometric or riser diagram and plan review. I:1dsts\forms1 plum app.doc 10/8/99 , -- 533 P6 - -- PLEASE COMPLETE: p b� ; Work Performed - ; �,R F- fixture T, evp .: s Q u an . ,. %:... t ;. r- ICa ed: F�:�- = �.� � Re laced:. �Remo�ecf : .,r "New, Moved:,. -P ,p, �. e. ' Sink Lavatory • Tub or Tub /Shower Combination Shower Only Water Closet • Dishwasher Urinal Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Floor Sink 2" 3" 4 " Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I: \dsts \forms\plumapp.doc 10/8/99 - - - CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 A UP Date Requested /� 'AM PM BLD Location 1/?7, /`-d A-GA-2-__ Suite MEC Contact Person Q'17)1 Ph \ • 79 ES-s?' PLM ' 063 Contractor Ph SWR BUILDING Tenant/Owner _ �� ELC Retaining Wall V ELR Footing Access: Foundation FPS Ftg Drain \ Crawl Drain Inspection Notes: . • Slab SIT Post & Beam Ext Sheath /Shear a S 5 k Int Sheath /Shear v Framing ■ , Insulation , Drywall Nailing 1 Firewall ~) ' 1 Fire Sprinkler `' , Fire Alarm • Susp'd Ceiling ' I. , Roof • \ Misc: Final \ \ PASS PART FAIL PLUMBING \ Post & Beam Under Slab Top Out i Water Service • \� Sanitary Sewer Rain Drains \ Final , PASS PART FAIL MECHANICAL Post & Beam , _..-- Rough In Gas Line Smoke Dampers Final - PASS PART FAIL ` ' ELECTRICAL - .5 5 . Service Rough In 1 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 . • 1 Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. il CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested (p I0 AM PM BLD Location 11 Vic `! I S Suite MEC Contact Person Ph PLM iq lq — 00 3 t Contractor Ph SWR BUILDING Tenant/Owner V h ► a LA_ P & A ELC Retaining Wall ELR Footing Access: • Foundation n� /� ^ FPS - -�-', Ftg Drain V v� `°�-h _ t SGN Slab Crawl Drain Inspection Notes: ✓C4i3Ot reSuA SIT 9 '000/ 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 I(LUMBIN7 Post & Beam Under Slab Top Out • Water Service Sanitary Sewer Rain Drains '_= PART FAIL MECHANICAL 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 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 Z � O i _ Date / ' C ' C) Inspector C/ Ext PART FAIL DO NOT REMOVE this inspection record from the job site.