Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES DATE ISSUED: 4/ 0/99 PLM1999-00115
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10498 SW KENT ST PARCEL: 2S114BB 14500
SUBDIVISION: SWANSONS GLEN NO.2 ZONING: R -12
BLOCK: LOT: 086 JURISDICTION: TIG
CLASS OF WORK: ALT 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: Install a residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
ANN TIDD PRMT GEO 4/20/99 $15.00 99- 314686
10498 SW KENT STREET MISC GEO 4/20/99 $0.75 99- 314686
TIGARD, OR 97224 .
Total $15.75
Phone 1:
Contractor:
CONCEPT LANDSCAPES
PO BOX 1583
BEAVERTON, OR 97075 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 646-5781
Reg #: LIC 11743 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: „,--7z--ete:A
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD RECEIVED Plumbing Permit Application Plan Check #
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD;1R 97223 APR 1 6 1999 Date. Rec'd
(503) 639 -4171 Date to P.E.
COMMUNITY OEVEtOPMENl Print or Type Date to DST
Permit # �A1 �jy" CC //�
Incomplete or illegible applications will not be accepted
Related SWR #
Called
Name of Development/Project ;FIX$ (individual) - r QTY , PRIC 0M-r4
TURESM : E Es
Job Sink 9.00
Address Street Address p �L Suite Lavatory 9.00
10488 9.Y kit+ lJl Tub or Tub /Shower Comb. 9.00
Bldg # S4y /State �yZiipp�,�` r ^ Shower Only 9.00
1 ■Cu� / '" ` Water Closet 9.00
Name
A 7; roc, Dishwasher 9.00
Owner Mailing Address A Suite Garbage Disposal 9.00
1 04 Val Washing Machine 9.00
City /State Zip Phone
A f OZ q -j 044 („.`d 1)- 3 4 Floor Drain /Floor Sink 12" 9.00
Na a "L 3" 9.00
3a 4" 9.00
Occupant Mailing Address 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
Na e
Other Fixtures (Specify) 9.00
Contractor Mailing Address � 2 Suite 9.00
V .O. i `mac] J 9.00
Prior to permit y /Sta`teIn/�.�,^ ). a- Zip Phone Sewer - 1st 100' 30.00
issuance, a copy �1 - `L l(,75 �7Io - 5 8 ( -
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if ! i - v13 (o -Z0-1 Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database _ 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* I 15.00 5
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Y es 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial O _ Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
. per /hr
•
Specially Requested Inspections 40.00
perlhr
Rain Drain, single family dwelling 30.00
Are you capping, moving or replacing any fixtures?
Yes O No O Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL ,�_ '`= " r, e
fixture. FAILURE TO ACCURATELY REPORT FIXTURE isometric or riser diagram is required if Quantity Total is > 9 (010;14§00
WORK COULD RESULT IN INCREASED SEWER.FEES. * SUBTOTAL •�_'r
�,; � . ._...... � -' ( "
. I hereby acknowledge that I have read this application, that the information 4 , ki': �t�; 5 ^
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE ..- . 114064-i
that plans submitted are in compliance with Oregon State Laws. °r;,;. .„ �; :;, ,.. c
Signat a of Owner /A Date * *PLAN REVIEW 25% OF SUBTOTAL iiivarl -0
Required only if fixture qty. total is > 9
TOTAL . �..�,; ,
Contact Person ame Phone = = „',s
5 j 0A4.t c0 / �f' g.i / * Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
(0 Prevention Device, which is $15 + 5% surcharge
* *AII New Commercial Buildings require plans with isometric or riser diagram
and plan review
I: \dsts\plumapp.doc 7/2/98
4 1; )
PLEASE COMPLETE:
P erformed Fixture Type Quantity by Work ..................................................................................................................................................
• . • - New Moved Replaced Remove dlCapped .....
: ....
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2"
3 "
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
•
COMMENTS REGARDING ABOVE:
I:\ dsts \plumapp.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested
,, y -29 - q AM PM BLD
Location 1 b L i q b 9--tF\ S+• Suite MEC
C
Contact Person &.pf � ' Ph (yt'/O g l PLM 19gq- /S
Contractor Ph SWR
BUILDING °x, x °. T,_� Tenant/s /r P AV) y) TI ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: Gr SGN
Slab � tC� i ri ` �I 1 / .CP SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling /� / / ,y
Roof .6/,/6/t l Leo/ /i
Misc:
Final
PAS_ • RT FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Ra' Drains
PART FAIL
ANICAL; ekr °$r
Post & Beam
Rough In
Gas Line nn
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL , wr:`.g - , a
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
Other Date Inspector e Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection re s from the job site.