Permit CITY OFT1GARD PLUMBING PERMIT
DEVELOPMENT w=�~�=~n�~~n o�.�~.� . ~�n�nxnn~~u�"� PERMIT # ^ PLM97-0262
Aolvityii.. �
13125 SVK Hall 8Avd., Tigard, OR97223 (53) 639-4171 DATE ISSUED: 697/08/97
PARCEL: 15133DD-05300
SITE ADDRESS...: 11546 SW LAKEVIEW TERR
SUBDIVISION - VILLAGE AT SUMMER LAKE PARK 3 ZONING: R-4.5
BLOCK..........: LOT ^92 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: N • 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 ^ 8} URINALS • 0 GREASE TRAPS 0
LAVATORIES ^ 8) OTHER FIXTURES....: 0
TUB/SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS ~ 0 RAIN DRAIN (ft)...: 0
Remarks: Installation of residential backflow prevention device.
Owner: FEES
DOUGLAS JACKSON type amount by date recpt
11546 SW LAKEVIEW PRMT $ 15.00DRA 07/08/97 97-296884
TIGARD OR 97223 5PCT $ 0.75 DRA 07/08/97 97-296884
Phone #:
Contractor • —
NATURAL TOUCH LANDSCAPING INC
22505 BENTS RD NE
AURORA OR 97002
Phone #: 503-678-1328 $ 15.75 TOTAL
Reg if..: 6811
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 Inspection
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 953-M1-0010 through OAR 952-0001-0080. You may
obtain copies of these rules or direct questions to. GUM by calling •
(503)246-1987.
Issued B ^ ^ / I / Permittee Signature
__________
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
' ' ' ' • ' - - -- ' _ ' ' '- '
TY OF TIGARD Plumbing Application Rec'd By
:4125 SW.HALL BLVD. Commercial and Residential Date Read -
3ARD; OR 97223 • Date to P.E.
)3) 639 -4171 Date to DST
Perrnit e Pi-440'7 y
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Caned. f -
•
Name of Development/Project _ :F,tX1URE$ (tttdivldwl) i � : Q C Q
Job l / 1-C, S R' L 4 Kz. U 1 •e Kr suit 9.00 --
Address Street Address Suite L - 8.00
Tub or Tub/Shower Comb. 800
• Bldg * City /State Zip Shower Only
/ 1 614 0 9 ") 22'3 9.00
Wat er Closet 8.00
D u y �A 5 (A c KSan
Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
/ / C 4 (, SGv GAKeOpe k✓ - Washing Machine 9.00
City /State Zip . 0 3 Phone - -- Floor Drain - - r • - 9
TIb /4r 02 _S29 -4ag 3' " 9.00
Name
4- 9.00
Occupant Meng Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal
9.00
Name Other Fixtures (Specify) - 9.00 -
ILf* 'uRH c Toicty- 6 9 k 01 (4 P yr ` 9.00
.yontractor Meiling Address Suite -__. - - -. - , __ .
2aS vs g M r r� > Rif - - 9.00
- nior to issuance City/State Zip S o3 Phone
applicant must 7 4) A o toll q-> c o z (rw 1 27 9.00
provide all Oregon Const. Cont. Board Lice Exp. Dat - 9.00
contractors Ze $ 1 l q 3 8.00
license Plumbing Lk.* E.. to Sewer - 1st 100" 30.00
information - Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro • Exp. Date Water Service - 1st 100' 30.00
database).
Name
Water Service - each additional 200' 25.00
•
Architect Storm & Rain Drain - 1st 100' • 30.00
Or Malang Address i 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
. .... _. _ . - - Pollution Device - - -- - - . ' -. .
.esuibe work New 0 Addition 0 Alteration 0 Repair 0 Residential Beddow Prevention Device* [ 15.00 / J ld
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
'LSting use of Specially Requested Inspections 40.00
calling or property pet h r
Rain Drain, single family dwelling 30.00
r 3posed use of . .. . Grease Traps - - - - - .- • . .. 9.00 .
jaiiding or property .
QUANTITY TOTAL ...;� :a-: - 4. , - .,;
Are you capping , moving or replacing any fixtures? Yes ❑ No o
Isomeric or riser diagram is required it Quality Tatar is > 9 t - Zii?z: s s ? • ;
(If yes see back of form) *SUBTOTAL : . -- ±'?;"% i co ,
f hereby acknowledge that I have read this application, that the information - 3 " '
;iven is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE ':,.::-.7:::";;,-.: 7
.hat plans submitted are in ce with Oregon State L
mpliance witraws. - --
rlgnatu f Owner/A e pate PLAN REVIEW 25% OF SUBTOTAL
1---124 - -- _ P/22 - -- -
Required don fixture my. total is 9 - TOTAL .%:.n;:.;- _ - -
:u Person Name P one' " I ►
'Minimum permit fee is 525 + 5% surcharge, except Residential Backflow
•
Prevention Device, which is 515 * 5% surcharge
I I:\pimapp.doc 12196 (dst)
'LEASE 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:
•
l: \plmapp.doc 12196 (dst)
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 7 -/Q -9 7 A.M. 1/ P.M. MST:
Location: /1 c i /7/ li( a� BUP: .
Tenant: Suite: Bldg: . MEC:
Contractor: _ ' .. I— 41- _ .,'" ,1, NIA Phone: 9 PLM: 7 na.6a
Owner: w L/..f/ /` � _ L . A . ://1101r, _ 1 `' 1 o • = ,, _ 111 • /F /.7 I ELC:
ELR:
SIT:
BUILDING BLDG (coal) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -hi Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In 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 i f
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt j " _ . _ii*
Approved A. • •ved Approved Approved �Ir•e!ed
Appr /Sdwlk Not Approved o.;i • • oved No A • 'roved Not Approved of • pproved
FINAL INAL /Z j j FINAL FINAL
CI-Call-for-re' 1 spec nor O R -:s ` I tion fee -o $— required before next inspection - CI Unable to inspect -
-/4111111111M i
Inspector: �. • Date: 7 .--/ 0 ° 7 Page of