Permit . lb
CITY T I GARD `VIII PLUMBING PERMIT
I DEVELOPMENT SERVICES �'� PERMIT #: PLM2000-00143
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 5/4/00
4 `
SITE ADDRESS: 12456 SW KING GEORGE DR PARCEL: 2S110CC 18000
40
SUBDIVISION: KING CITY NO. 5IN■ ZONING:
BLOCK: LOT: 057 JURISDICTION: KIN
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
CHAVE, P FRANKLIN PRMT DEB 5/4/00 $25.00 KING CITY
12456 SW KING GEORGE DR 5PCT DEB 5/4/00 $2.00 KING CITY
KING CITY, OR 97224
Total $27.00
Phone 1:
Contractor:
JAMES R. DENNY
PO BOX 160
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 590 -1945 RP /Backflow Preventer
Reg #: LIC 11804 PLUS BACKFLOW Final Inspection
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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 • -' • • copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Iss ed By: / _ �./ . // / d Permittee Signature:l�� 61 „ �p�,
Call (503) 6 • -4175 by 7:00 P.M. for an inspection needed the next b iness day
MAY - -03H) WED 03.03 PM City of King City FAX:503 639 3771 PAGE 2
;,ITY OF TIGARD Plumbing Permit Applica Plan Che
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13125 SW HALL BLVD.
Commercial and Residential Recd By R -3
Date Recd $ � 3 -
TIGARD, OR 97223 � / 1 � (� Date to P.1=.
(503) 639 -4171 ` Date to DST S - -
Print or Type Pena # PLMla000- -00/93
Incomplete or illegible applications will not be accepted Related $WR#
Called ,
' t ,,.• I C' T; i «(1:7��.�J.� 'tt lA 1 Y r::�: l l, 5� 1' �"Mr�.r
. ;; l :IJ,RES. (itid 1)
Name of DevelopmenUProyed 11.rn
Job K / M G C t`4- Sink _
Y
Address Street Address � Lavatory 11 50
Suite 1130
2 5 ‹5 11.1 ►�r� Tub or Tub/ShoWer Comb.
Bldg 8 City/State lI ip Shower Only 11.50
K C 1 4 "y 9 2, / Water Clo (Specify) 11.50
We�� Dishwasher 11 -50
� _, Urinal 11.50
M ailing Address Suite
Owner w K .. Gar bage Disposal 11.50
City /4tate zip IP Phone Laundry Tray 1 11.50
(3 �''�" �j , q'7 a 2.- 5T8` 4 ?��
Name ame V Washing Machine/Laundry Tray (Specify) 11.50
*7-- Floor Drain /Floor Sink 2" 11.50
Occupant Mailir 3•
Suite 11.50
CCCCCCJJJJJJ 3" 11.50
City/State Zip Phone Water Heater 0 conversion 0 tike kind- 11.50
Gas plains re•uires a se•arate mechanical .ermit- 28.00
Name 1 MFG Home New Water Service
_�M�S +'��� MFG Home New San /Storm Sewer 28 -00
Mailing Address / Suite - 11 `
Contractor 0 g°1G /Gd Hose Bibs
ains 11.50 Roof Drains r
Prior to permit City/Nate /tale Z P hone 11.50
Issuance. a 4.,0py Li1 ap 1.1 /0 594' eg Drinking Fountain
of all licenses are Oregon Const. Cont. Board Lic.# EXp. D ` O , Other Fixtures (Specify) 15.00
required If (7 q td- .J / / gkg _ .
expired in COT Plumbing Lic. 0 Grp. Date „
database _ ,
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Architect
32.00
S -1st 100' 38,00
Cr Mailing Address Suite Sewer - each additional 100'
Water Service - 1st 100' 38.00
5ngineer
City /State Zip Phone W ater Service - each additional 200' • 32:00
• Describ
S torm & Rain Drain - 1st 100' 38.00
e to be done:
New Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 32.00
_ Residential 0 Commercial 0 Commercial Back Flow Prevention Device
Additional descrlption of work= Residential Backflow Prevention Device' t 18•Q0 •
L -- k g ON o - 5 g-vYL Catch Basin 11.50
} Insp. of Existing Plumbing or Spedally Requested 50.00
Are you capping, moving or re ing any fixtures? per/hr _
Yes 0 No � 45.00 Ra in Drain, single family dwelling If yes, see back of form to ind . Inspections i d a work performed by 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE crease Traps s
Ai
WORK COULD RESULT IN INCREASED SEWER FEES. ^,. "'
QUANTITY TOTAL , �� .�
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required. It Quantity Total Is > 9 «,„ �
given is correct, that I am the owner or authorized agent of the owner, and
* SUBTOTAL 1' , 5,d.;;;;: }PlF� *
that plans submitte P , o 1 i:�'. ,�, :
d am In compliance with Oregon State laws. , ' - i' ,;;
Dt ,ice 8% SURCHAR rAjgj "Iw y ( ,. �
31 nature of Onerl rtt _ /1
`L N Phone i tt
1 person Name * REVIEW 25% OF SUBTOTAL ' `" ':
sea - � q e!� Re4uired only a flxturo qry- blal i > s .�
i > ' ,,,,,. � , v, , '.., '' SC: y, 7,, 1 0 . ,.;t-- :,3)ff„^' TOTAL
;,�, try '� , 9: G..- 2 :� 1 .,. ' It • :, ' L;.,1' }�1'! :.'it'� "�`.tk! ,�; , •
'' . Si %,0', r Y - t1' ,.5 (+�;!Ytt.,. '�j, : Prevenrlcn
T ,.. u 1` f ' , ,: +,1 t • .ti,t � +ri" ac ri • e% surcha except Resi a
.',.. ' ackl ow
•�� - I' � � ��. Yt�'MM , ��'" x 1 • � ftl� E' p t�r' -minimum lee � S �o de B '�
}+. v y . AL 2`4Yf ... j ,} t. 01 'dr $ i P , �I, � • n�
, �1�'�C }g , 4 �4' „ }• a vi r o IId -" [rM ';A7� f . �F1G.N Sl r�Z: K 0l'- J•• �• r YICL�. which Is •SZS �' BlV surcharge 2 ' C .�y,,y Wa I� �S'''' ' isometric or riser diagram and
"All 1 :6,0#(yt t � ! E;Il i -' !t0.1u+ , "'N""ix"� Devi New Commercial Buildings require plans with Isornet 9
plan review.
bdstetformslphxnapp.ex 1O/1199
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested s /r7 '� 0 AM PM BLD
Location I `2, LA S(p a/9 (9Q €_, suite MEC
Contact Person J ,) ,D Ph S'10—f9(-/S PLM Z.DO -QO/ t. 3
Contractor Ph 9y6-14-(Sc) SWR
BUILDING'° w Ty 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
Susp'd Ceiling -1.�� / 1 1
Roof / TJ1/�� OW /
Misc: _
Final <
PASS PART FAIL
fietnVIBT N�,j
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
*op PART FAIL
ANICAL
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
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 Xt
Approach /Sidewalk Date Il Inspector E" r'
Other ` ��%
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Final
PASS PART FAIL DO NOT EMOVE this inspection record from the job site.