Permit CITY OF TIGARD
«i+ei DEVELOPMENT SERVICES PERMIT PLUMBING PERMIT
a
� hp� ll' I #.......: F'L_M98 -031 �:,
13125 SW Nall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/08/98 .
PARCEL: 2S110AB —HM007
SITE ADDRESS...: 11455 SW JACKIE CT
SUBDIVISION....: HAWK MEADOWS ZONING: R -4.5
BLOCK..........: LOT ....... :007 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:SF WASHING MACH 0 BACKFLOW PREVNTRS..': 0
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....:
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 100
WATER CLOSETS.: 0 WATER LINE (ft)...: 100
DISHWASHERS - 0 RAIN DRAIN (ft)...: 0
Remarks: Reconnect water and hook —up sewer
Owner: - - - - - -- - - - - - -- - -- - FEES
RIVERWOOD DEVELOPMENT LLC type amount by date recpt
. 4035 DOUGLAS WAY PRMT .$ 60.00 JSD 09/08/98 98- 308930
LAKE OSWEGO OR 97035 5PCT $ 3.00 JSD 09/08/98 98- 308930
Phone #:
Contract or- -- - ---
G
& B PLUMBING
PO BOX 1269
HILLSBORO OR '97123-1269 - - - - --
Phone #: 640 -5770 $ 63.00 TOTAL
Reg #..: 000001
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Line Insp
applicable laws. All work will be done in accordance with Final Inspection
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
(503)246 -1987.
�����Zr
Issued By: Rermittee. Signat�_�re:
+ + + + + + + + + + + + + + + + + + ++ ++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + +. + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
CITY OF TIGARD Plumbing Permit Application Plan Check -
13125 S V HALL BLVD. Commercial and Residential Rec'd By n
TIGARD, OR 97223 Date Rec'd 44 - v
(503) 639 -4171 Date to P.E.
ST
Print or Type D ate to D , ,
Incomplete or illegible applications will not be accepted
Permit #�L�� -J3�'3
Related SWR # 9 1�� ��1J�3��
Called
i
Name of Development/Project
id ,- ! . .,
';FIXT;UR tndiv ual `�� Q TY s FRI;CE
., mss�����,Y„�� -.) %,, _ ...�a�:',.�..�:. � ,:�w:,- ,,�= _��AMT
Job f44t,✓ IS MrA- DWS Sink 9.00
Address Street Address r 1 Suite Lavatory 9.00
ll g SS Sk)JACCI Tub or Tub /Shower Comb. 9.00
Bldg # Ci /:: State ZIP Z 3 Shower Only 9.00
Name
' c Water Closet 9.00
RWJEg.wo0D Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
/
S(0 5r o41,44 4 )yl • Washing Machine 9.00
City /State Zip Phone Floor Drain /Floor Sink 2" 9.00
Lome. Dsupy. 't-1 3f 63S - .1b6a
Name 9.00
• (/'� 4" 9.00
Occupant Mailing Ad r�s ! Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name
4- �, ti 1 lg0h - + r ‘1 % r Other Fixtures (Specify) • 9.00
Contractor Mailing AddrAss / � 6 /+t � Suite 9.00
Prior to permit i /State Zip Phone Sewer - 1st 100' / 30.00 3D
issuance, a copy H iL�Sp 9 7(. 6U 140 --5726 !�"v'� � Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Ex D to .
required if if 9 7/ Water Service - 1st 100'
/ 30.00
expired in COT PlumbiingLic. # Exp D Water Service - each additional 200' 25.00
database .3i'- ate, fPij 6 / 9 Storm & Rain Drain - 1st 100' 30.00
Name _ ! Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device* 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes. No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work:
EWA// AA-reg. 4-- Insp: of Existing Plumbing 40.00
cc-- per /hr
.L.V Specially Requested Inspections 40.00
per /hr
Rain Drain, single family dwelling 30.00 •
Are you capping moving or replacing any fixtures?
Yes 0 No • Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL '`i " '; " s :"
f FAILURE TO ACCURATELY REPORT FIXTURE ` `.:, " ' „`
I Isometric or riser diagram is required if Quantity Total is > 9 �,�,;:.:,�: ; ��.;� - "- �;, j
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL +; ;511. ; R-1 J, /
hereby acknowledge that I have read this application, that the information / U /
given agent 5 /o SURCHARGE t� ,
iven is correct, that I am the owner or authorized a ent of the owner, and o �. ; s''�"
that plans submitted are in compliance with Oregon State Laws. In :7 ..V4
Signs ure of Owner/ ent Date * *PLAN REVIEW 25% OF SUBTOTAL °<
thf / T Required only if fixture qty. total is > 9 ' <`s `d
TOTAL / /
Contact Person Name Phone k: "r' - 4':' --;' - ( n
*Minimum permit fee is $25 + 5% surcharge, except Residential BackfloW
Prevention Device, which is $15 + 5% surcharge
• * *All New Commercial Buildings require plans with isometric or riser diagram
���,� />/ -/1 and plan review
I: \dsts\plumapp.doc 7/2/98 r ✓ � cr.---
q,,, ---,,_3c( 2
y 2
PLEASE COMPLETE:
New Moved Replaced Removed/Capped
.......... ............... . .. .. ........................................
.................................................................................. ........... .
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:
e
. . _
1:1dsts1plurnapp.doc 7/7/98
CITY OF TIGARD BUILDING,IS1TIctl DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested (7� AM P - M BLD
c
Location / /I/ 55 '( 9a.aztz, 7 , ME
Contact Person Ph NOW f / �
Contractor Ph 7 )9 77 SW- .71?.c Z3
Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation > AztAh //177*_-, FPS
Ftg Drain ` SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam n n
Ext Sheath /Shear �/ I,e.le '(6ef/c el
Int Sheath /Shear
Framing '% 61-Coe ,6 _5'
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm �-- p
Susp'd Ceiling i ' /� �`' .LQ�.I 00 vet.4) -z , p
Roof f
Misc: _
Final - " D le l' ,
p�,SS PART FAIL �`'e cs- Q -e�� /�
Post & Beam
Under Slab •
Top Out
Rain Drains
Final
ASS ART FAIL
MECHANICAL ;q p ='.
Post '& Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL : "°`, R f= v ?: "a.
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITEa. .>
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
Otheoach /Sidewalk Date 2 � F" Inspector �� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.