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Permit AR CITY OF TIGARD OR1GINAL PLUMB1NGM1T 'uI DEVELOPMENT SERVICES PERMIT #: PLM1999 -00263 '- , -- • 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/13/99 SITE ADDRESS: 11865 SW 91ST AVE OFFICE PARCEL: 1S135DC -02000 SUBDIVISION: VILLA LA PAZ ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: 2 OCCUPANCY GRP: R1 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: 3 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 200 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Additional plumbing work for PLM1999- 00224: additional 200' of water service, 2 commercial backflow prevention devices and 3 catch basins. FEES Owner: Type By Date Amount Receipt VILLA LA PAZ LIMITED PARNERSHI PRMT DEB 8/13/99 $130.50 99- 317638 COMMUNITY PARTNERS /AFFORDABLE 5PCT DEB 8/13/99 $9.14 99- 317638 HOUSING INC, POB 23206 TIGARD, OR 97281 -3206 Total $139.64 Phone 1: Contractor: • APOLLO DRAIN + ROOTER SERVICE 2208 NW BIRDSDALE #8 GRESHAM, OR 97030 REQUIRED INSPECTIONS Phone 1: 239 -8801 Water Service Insp Reg #: LIC 00049418 Misc. Inspection PLM 0004941 RP /Backflow Preventer Final Inspection 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 -01:: You ay obtain c 9 ies of these rules or direct questions to OUNC by call' (50 ) 246 -198 Iss ed By: I Jj • A / 0 4 ) Pe rmittee Signature: / 4 A Call (503) 639 -4175 by 7:00 P.M. for an inspection neededf46 business day i� • 1 CITY OF TIGARD Plumbing Permit Application '°� Plan t31- 25 HALL BLVD. Commercial and Residential OS Y Rec'dib TIGARD, OR 97223 fill Date Rec'd -/3 ,_ (503) 639 -4171 Rtitk. Date to P.E. �j Print or Type Date to D T - Incomplete or illegible applications will not be accepted Permit# L 94 -prJ 3 Related SWR # Called Name evelopmen off UPr ct 'FIXURES individual '" ' -N " Job d l � LA �/4-Z �" .T... � (,. ,�.... ��,� ,:`; .. . ,.. Y�`w t ; ;�'QTY`z .PRICES AMT "( Sink Address • Street A dress r Suite Lavatory 11.50 l! � 5 `�T �"' &- Tub or Tub /Shower Comb. 11.50 Bldg # City /State I Zip Shower Only 11.50 Name --// Z. /�" Water Closet/Urinal (Specify) 11.50 U L // #j- Lm- 67-- Ltb PR-r -q. Dishwasher 11.50 Owner Mailing Address Suite Garbage Disposal 11.50 3 � • Washin Machine /Laund Tra fy) 9 ry y (Speci 11.50 City/State `+ Z Zia, Phone Phone ` Floor Drain /Floor Sink 2" 11.50 Name d am+ 3" 11.50 �I�` 4" 11.50 Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50 Gas piping requires a separate mechanical permit. City /State Zip Phone MFG Home New Water Service 28.00 MFG Home New San /Storm Sewer 28.00 Na / 11.50 . D ! © b v, �i ✓,- Ho Bibs Contractor Mailin Address /� uit Rain Drains 11.50 r4 r 4`'` /3" l r -3 o, i 4- Drinking Fountain 11.50 Prior to permit C y /State Zip c Phone Other Fixtures (Specify) 15.00 issuance, a copy . ✓Q5 yo� a3 / 6� / - of all licenses are Oregon Const. Cont. Board Lic # Exp. Date required if 9C) v/r' I c -C7 ( i expired in COT Plumbing Lic. 3 A Exp. Date - database , n Name / Sewer- 1st 100' 38.00 Architect Sewer - each additional 100' 32.00 Or Mailing Address Suite Water Service - 1st 100' 38.00 Engineer City/State Zip Phone • Water Service - each additional 200' _ / , 32.00 3,4- Storm & Rain Drain - 1st 100' 38.00 Describe work to be done: Storm & Rain Drain - each additional 100' 32.00 D+ New 0 Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00 Z,i --- Residential, 0 Commercial 0 Additional description of work: Residential Backflow Prevention Device* 19.00 Catch Basin 3 11.59 37. C `d Insp. of Existing Plumbing 50.00 Are you capping, moving or replacing any fixtures? per /hr Yes 0 No 0 Specially Requested Inspections 50.00 If yes, see back of form to indicate work performed by per /hr fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00 WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50 I hereby acknowledge that I have re d t s lication, that the information QUANTITY TOTAL � ° :�Y, �. ;' r,, " :t � , ,•� ; �� given is correct, that I am the ner or rap ed age' of the owner, and if ,� � , ""'' =F^ 9 , a x g I sometric or riser diagram is required Quantity Total is > 9 :,« >` > ;; that ,.ar. submitted are in Vi ce with 4 •. " .e Laws. *SUBTOTAL�'� `V °;<' jQ Si. c - rreofOwnEr/ a Date �� 6 A '. 430 Oafi acct t on ame 7% SURCHARGE a 5 1 q /y Phone i `__ ",. `_ `• Mrs,A 4 , &CS 4 * *PLAN REVIEW 25% OF SUBTOTAL ' .` `,°1 BAT HOUSE° $18 OUT s us,���,'" ` '," ` Required only if fixture qty. total is > 9 �`.��u :, -. -. �,� ,�� -'<�c� �_ <o':;'s' .�. :����' &: ;"� w ��' • s n q Y q Y `.; .r` ar•��•rv. ; <..;a. fa -s ,. �. fi <` �:.� ;�:,: s;a _ , s z "' ", k AZri .1.14 $z5o :. r r E T ,.., ,�. .AO`s a; �:,. .�;�, _.,- � TOTAL �� i rhiO3t BATH Et 285 €UO.; "s> F ` , gin:,,._ _. t / 3q eeliocludes ali plug b' ng ,fiztures' and f ist * ermit fee is $5 0 + 7% surchar e, except Residential Backflow Prevention OQ feet san►tary sewer�sinrmsewer and_ ser ° -� : p g - �� =� ^ ^'< Device, which is $25 + 7% surcharge "All New Commercial Buildings require plans with isometric or riser diagram and plan review: - I: \dsts \forms\plumapp.doc 7/19/99 • . . PLEASE COMPLETE: 4 : 4 "'"" - Tao re - TiagriCett 1,F,Wp'0■12:Cti,,,y7ppol;te-: 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: \ dsts Vormskplumapp doc 7/19/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 - Business Line: 639 -4171 BUP Date Requested g ''l - 1. '1 AM PM BLD Location I ( q (OS -1 1 set $ztv1/4-e � Suite Q MEC Contact Person �C u YYL/, ll/L Ph gq � gS� % allep )991 ZZ q Contractor Ph 6VVR I qq q'odzfr/ BUILDING - Tenant/Owner ( A I , L PK,-7__. ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler < _-- Fire Alarm WOMIVA Susp'd Ceiling III 4 Roof ' Misc: / Final • PASS PART FAIL cF MI / Post & eam Under Slab Top Out (` S anity Rain Drains .....1 /� y / f �l -f /g Yg PART FAIL ' �`� _ - C�'� MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab ..,_ 6 (-- Low Voltage Fire Alarm Final PASS PART FAIL B k Grading Sanitary Sewer ry ei S [ ] Reinspection fee of $ required before next inspec,]ion. Pay at City Hall, 13125 SW Hall Blvd tch B ' Fire upp y Line [ ]Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach/Sidewalk I � - ° Other Date Inspector Ext Final � PART FAIL DO NOT REMOVE this inspection record from the job site.