Permit CITY OF TIGARD
k DEVELOPMENT SERVICES PLUMBING PERMIT
���di�,k�l PERMIT #.......: PLM97 -029'
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 07/23/97
PARCEL: 25111BA- 02800
SITE ADDRESS...: 09815 SW JANZEN CT
SUBDIVISION....: MCDONALD ACRES ZONING: R -4.5
BLOCK........... LOT .............:3 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE.....: SF WASHING MACH..... ° : 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP:..:R3 FLOOR DRAINS......: 0 TRAPS..............: 0
STORIES........: 0 WATER HEATERS.....': 0 CATCH BASINS 0
FIXTURES -- • - -- LAUNDRY TRAYS— ..: 0 SF RAIN DRAINS— ..: 0
SINKS....°.. °.: 0 URINALS— ..... °. °: 0 GREASE TRAPS— .... . 0
LAVATORIES— ..: 0 OTHER FIXTURES. °°.: 0
TUB /SHOWERS...: 0 SEWER LINE (ft ). ° °: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)... 0
Remarks: Installing a residential backflow prevention device.
Owner: -- -- -- FEES --
DOUG LARSON type amount by date recpt
9815 SW JANZEN CT PRMT $ 15.00 B 07/23/97 97- 297472
TIGARD OR 97224 5PCT $ 0.75 B 07/23/97 97 297472
Phone #:
Contractor
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN OR 97062 - - - - - -•- --
Phone #: 691 -6166 $ 15.75 TOTAL
Reg #. ° : 000879
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backflow Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect i o n
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 M
adopted by the Oregon Utility Notification Center. Those rules are _•_,_
set forth in OAR 952- 0001 -0010 through OAR 952- 0001 - You may -
obtain copies of these rules or direct questions to OUNC by calling -
(503)246 -1987.
M
Issued By: Permittee
++++++++++++++++++++++++++++++++++++++++++++++++ + + + ++++ + + ++ + + + ++ + + + +-l+ + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + ++ + + +++ + +++ ++ + + + + + + ++ ++ + + + + + ++
CITY _(:)TIGARD Plumbing Application Rec'd By &A"
13125 SW HALL BLVD. Commercial and Residential Date Recd �� 71, - �/�
Date to P.E.
TIGARD, OR 97223 Date to Ds
(503) 6394171 Permit* � �7'0147--" --
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (Individual) • QTY PRICE - AMT
Sink ' 9.00
Job Lavatory 9.00
Address Si e dd ess 1 Suite
I c Zei C 1 Tub or Tub /Shower Comb. 9.00 '
B # Ci State i p1 Zip Shower Only 9.00
<J
f �1 C A Il r 6 )74- ‘ 1 6 )74- ‘ 1 Water Closet 9.00
Name Dishwasher 9.00
a lin$ Address Suite Garbage Disposal 9.00
Owner I I J c - S G� aAlseAn - s
C Washing Machine 9.00
_city/State fi� n( 7 Zip Phone Floor Drain 2' 9.00
d ailf* V F 11 14.0 3" 9.00
Na' 4" 9.00
Ct/1nti �-
Occupant
ailing Address 1 � _ Suite Water Heater 9.00
- 4 . 25 V 5I✓"U Zev l_.I j Laundry Room Tray 9.00
,..9j /Sctta a Zip { Phone Urinal 9.00
"' Dr C t�z L � l Other Fixtures (Specify) 9.00
Na e
C AP -V� p \..L
� vv.\0% t'�Ct 9.00
`
Contractor Mailing Address Suite 9.00
\ \ QC) SI,YZt uti4a.' 9.00
City /State Zip Phone
�i -.1e I v tart_ C ri 0 t.,,1._. l.p CI I. - 14 I l 1, 9.00
Oregon Const. Cont. Board Lic.# Exp. Date 9.00
Attach Copy of 8 (.. l 9.00
Current Plumbing Lic. # Exp. Date Sewer- 1st 100" 30.00
Licenses 3 _ 2 e1'5
Sewer - each additional 100' 25.00
COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
2 4 P Water Service - each additional 200' 25.00
Name
Architect Storm & Rain Drain - 1st 100' • 30.00
Or Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer city /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
� f / Pollution Device
Describe work New 0 Addition 0 Alteration Repair O Residential Backflow Prevention Device' , 15.00 js,°o
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per /hr
Existing use of Specially Requested Inspections • 40.00
per/hr
building or property Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
•
building or property
QUANTITY TOTAL
•
Are you capping , moving or replacing any fixtures? Yes ❑ No ❑ Isometric or riser diagram is required if Quanity Total is > 9
(If yes see back of form) *SUBTOTAL r te , o 3
I hereby acknowledge that I have read this application, that the information i
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE
that plans submitted are in compliance with Oregon State Laws. .
Signature of Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL
\ Required only if fixture qty. total is > 9
�v, 6/L 1 , Y i u 4/-1 TOTAL
1‘
Contact Person Name Phone - )5'
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
�(j V &I/4 Prevention Device. which is $15 + 5% surcharge
i:\dsts\plmapp.doc 8/96
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection.Line: 639 -4175 Business Phone: 639 -4171 "
Date Requested: -- L/ - 7 7 A.M. P.M MST:
Location: cm /, 94 (l BUP:
Tenant: !i�� Suite: : / / Blddg: MEC:
_�G
Contractor: 1/4� j� U GU � A 7 /� Phone: C� ! q7 (p J (! 6 7 PLM: 9 QoC ?�
Owner: 6, q�(',/,//,ip hone: ELC:
cePee-e_121.46-74) 4.12.07`a__. (/ ELR:
' SIT:
BUILDING BLDG (con't) PLUMBING . MECHANICAL ELECTRICAL SITE
Site Post/Beam o earn Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -hi UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect • Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt I _/...,,....., . __
Approved Approved Approved Approved (Apo fed
Appr /Sdwlk Not Approved Not A iproved Not Approved Not Approved Not Approved
FINAL " ' ili cip. FINAL FINAL FINAL
•
•
O Call for ' ctio O Reinspection fe of $ required before next inspection O Unable to inspect
Inspector /% - - - s. ") (f �i-' . ^ - .( ,l�ZDate: fS �' ---(./.- / Page of
CITY OF TIGARD BUILDING INSPECTION DIVISION ' MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 1 2f Z416 / AM PM BLD
Q
Location - 717 5 / 64- Suite MEC I qq 00 SS
Contact Person Ph (020 PLM Z9
Contractor /�� Ph (p ;1.- C7 SWR
BUILDINGa 5.° f v " Tenant/Owner /%`-A 9 ij,/ ELC
Retaining Wall - ELR
Footing Access:
Foundation qrkd?� Z o P -sr r 6F P FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: q
Slab l Cl 2°C) pif or SIT
Post & Beam `4b
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
Post.& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Dns
Drains
PART FAIL
heCHANI ° A
Post & Beam
Rough In S 0ve
c vt®
Smoke Dampers
Final
apiP 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: [ I Unable to inspect - no access
ADA `�
A
-
pproach /Sidewalk
Other 6 D ° Inspector 7 771' Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.