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Permit CITY TIGARD PLUMBING PERMIT 1Ii DEVELOPMENT SERVICES PERMIT #: PLM1999 -00226 • 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 DATE ISSUED: 7/26/99 SITE ADDRESS: 11430 SW JACKIE CT PARCEL: 2S110AB -05700 SUBDIVISION: HAWK MEADOWS ZONING: R -4.5 BLOCK: LOT: 010 JURISDICTION: TIG CLASS OF WORK: OTR 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: Installation of residential backflow prevention device. • . FEES Owner: Type By Date Amount Receipt FOUR D CONSTRUCTION PRMT DEB 7/26/99 $25.00 99- 317154 PO BOX 1577 5PCT DEB 7/26/99 $1.75 99- 317154 BEAVERTON, OR 97075 Total $26.75 Phone 1: Contractor: G + B PLUMBING PO BOX 1269 HILLSBORO, OR 97123 -1269 REQUIRED INSPECTIONS Phone 1: 640 -5770 Final Inspection e940/4 /% /IJ tc77 MJ Reg #: LIC 00000199 PLM 34 -44PB 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 - uter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You m. obtain conies of these rules or direct questions to OUNC by calling (50 ) 246 -19 ;7. Issued =y: - , ��� Permittee Signature: i f / Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n %/ business • CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIGARD; OR 97223 /1.4, 7'9e _ d ��, Date Recd - 7- ,(0 -9 (503) 639 -4171 Date to P.E. • Print or Type Date to D T Incomplete or illegible applications will not be accepted Permit# 1. # oo h, Related SWR # Called Name of Development/Pro '' FIXSTURES,: ;;(ir' diyi001W' ' ,'- ;f i t QT ( = PRIC l' AMT y Job u k It eo.0 .u. S Sink .. ;° ` 11.50 Address tr eetAddress Suite Lavatory 11.50 1, `1 S, (is. ,siAcKt6 Tub or Tub /Shower Comb. 11.50 Bldg # City /State Zip Shower Only 11.50 Name Water Closet/Urinal (Specify) 11.50 ■Up, 't 6N57 Id Dishwasher 11.50 Owner r t0 aili Address Suite Garbage Disposal 11.50 BOX O X l S - 2 -) Washing Machine /Laundry Tray (Specify) 11.50 City /State Zip Phone Floor Drain /Floor Sink 2" 11.50 Name 3" 11.50 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 Name ?Lf- lM0 /N� Hose Bibs 11.50 Contractor ailing Address Suite Rain Drains • 11.50 P t -0, 0100‹ 10- G7 Drinking Fountain 11.50 Prior to permit /?yate Zip Phone Other Fixtures (Specify) 15.00 issuance, a copy Riti 721 2 3 s(ed _5270 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if o q 9 ©-7 expired in COT Plumbing Lic. # Exp. Date database 3 y- c� fvf,,gj Name Sewer - 1st 100' 38.00 Architect Sewer - each additional 100' 32.00 or Mailing Address Suite Water Service - 1st 100' 38.00 • En ineer City /State Zip Phone Water Service - each additional 200' 32.00 g Storm & Rain Drain - 1st 100' 38.00 Describe work to be done: Storm & Rain Drain - each additional 100' 32.00 New Rir 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00 Residential l t I Commercial 0 Residential Backflow Prevention Device* 19.00 �'' Additional d scription of work: Catch Basin 11.50 z � ���cE Insp. of Existing Plumbing 50.00 Are you capping, moving or re I ing any fixtures? per /hr Yes 0 No j Specially Requested Inspections 50.00 If yes, see back of form to indi a e 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 read this application, that the information ,,. ,. _: ° :;.; . _ QUANTITY TOTAL �,> .,�... iven.is ct + at I am the • ner or authorized agent of the owner, and ,,. f i �`•`: `.. >" g g Isometric or riser diagram is required if Quantity Total is > 9 �; � „�„ , <, . -.,- �;, that p I'M f it -d Alin '•a - pliance with Oregon State Laws. . Si. / Dat= *SUBTOTAL � S „a 2 b 0. 7 / ° SURCHARGE 5 o ntaci'-rson Name / Phone s ir,. " , i `'' F ' : _ l **PLAN REVIEW 25% OF SUBTOTAL =~.- }°` ` A"' $ Required is >9 , ' ' �w;1I3MI Pli.. E$17$A0;`s '°:''._": q only if fixture qty. total , ,::% ., : ° ; a,., ,., t 2tBATNiNOCi E 2 0100" .:, ' 1 TOTAL _ , 4 r S A " - "3 ' B ATM; H O�USE Ycs 285 N r ' ' / ^ ,40 t "(Thts. inclu 12, iia plumbing:P4,0 s iOle•dwelling a'6OOP,f *' , ",' f: s "Mi permit fee is $50 + 7% surcharge, except Residential Backflow Prevention 100feetaf sanitary sewer sewer adwater service) V 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: '1:Yik1P"eli vf.,• t 44=A rt ,, - lr 111411E14U. M oe d pj ace d , i:IRemove C pe„f „ 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: \ dsts \forms \plumapp doc 7/19/99 CITY OF TIGARD BUILDING. INSPECTION DIVISION" MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171' � BUP Date Requested ��Z'7 C / c7 AM PM BLD Location I I l q ?O. ; ] 'etCn4, „pp Suite' MEC Contact Person 04/4/e- Ph -- 72-0 -j-- ) WS' PLM Contractor Ph SWR BUILDING:' ° ' Tenant/Owner 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 y Susp'd Ceiling Ae Roof d • O ' Misc: - ” Final PASS PART FAIL (PLUM1§ Post & Beam �' Under Slab l � /. �i ✓,� i / / lis�f Top Out / Water Service / AW,/ Sanitary Sewer ai Drains Ajar PART FAIL tr:CHANICAL 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. (k(■■1 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 I (1 /4, Inspector y� Ext a >f Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.