Permit CITY OFTIGARD
ia,>,, o DEVELOPMENT SERVICES PLUMBING PERMIT
- IL 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 05/12/98 -0
PARCEL: 251O2AA -00602
SITE ADDRESS...: 11960 SW PACIFIC HWY
SUBDIVISION • TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK LOT •010 JURISDICTION: TIG
CLASS OF WORK..:ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:M 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: Install a commercial back flow prevention device for a commercial bldg.
Owner: FEES
HOME & CASTLE type amount by date recpt
11960 SW PACIFIC HWY PRMT $ 25.00 GEO 05/12/98 98- 305704
TIGARD OR 97223 5PCT $ 1.25 GEO 05/12/98 98- 305704
Phone #:
Contractor
CLASSIC GARDEN CREATIONS
6637 SW MILES COURT
PORTLAND OR 97223
Phone #: 414 -4155 $ 26.25 TOTAL
Reg #.. 000069
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 188 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 - 9981-0010 through OAR 952-1091-9980. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
R
Issued B • L ' -r. mittee Signature• /Le —
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Check#
131 25 SW. FALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# P 9$
Related SWR #
Called
Name of Development/Project On back indicate Work Performed by fixture.
Job ri,v 1 C4-1e FIXTURES (Individual) QTY. PRICE AMT_
Address Street Address Suite Sink 9.00
l 9 6 p W ?ar: ftc- / - Lavatory 9.00
Bldg # City/State 17 Zip Tub or Tub/Shower Comb. 9.00
Name 7 ✓ 4 r" a- 13 Shower Only 9.00
/ a yNCI, ,4 Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
..Sirvv„ Garbage Disposal 9.00
City/State Zip Phone Washing Machine 9.00
Name ,.._,r /� Floor Drain 2' 9.00
1 flrn Aeelk 3' 9.00
Occupant Mailing Address Suite 4' 9.00
S G frig Water Heater 0 conversion 0 like kind 9.00
City /State Zip Phone
Laundry Room Tray . 9.00
Name / �-+ /� I Urinal 9.00
.51 C!4 c C7 RCi7'Rt C 5 Other Fixtures (Specify) ' 9.00
Contractor Mailing Address Suite
6637 S k,'. hides C1„ 9.00
Prior to permit C' /State e ip Phone 9.00
issuance, a copy HopLA d i ff7, . 3 Y /l/- y/53 Sewer - 1st 100' 30.00
of all licenses are Oregon Const. Cont. Board Uc.# Exp. Date Sewer - each additional 100' 25.00
required if 4r E 447 3 v -3)- fk Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database
Name Storm & Rain Drain - 1st 100' 30.00
A rc h itect Storm & Rain Drain - each additional 100' 25.00
Or Mailing Address Suite Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- • 25.00 ,,�
City/State �/
Engineer ty fate Zip Phone Pollution Device
Residential Backflow Prevention Device* ...._____1.5.00 AwgSt
Describe work New 0 Addition 0 Alteration 0 Repair 0 Any Trap or Waste Not Connected to a Fixture 9.00
to be done: Residential 0 Non - residential 0 Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
• per/hr
Rain Drain, single family dwelling 30.00
Existing use of
building or property Grease Traps 9.00
Proposed use of QUANTITY TOTA
building or property Isometric or riser diagram is required if Quanity Total Is > 9
* SUBTOTAL
I hereby acknowledge that I have read this application, that the information 5 SURCHARGE
given is correct, that I am the owner or authorized agent of the owner, and ,
that plans submitted are in compliance with Oregon State Laws.
Signatu of Owner /Agent Date . "'PLAN REVIEW 25% OF SUBTOTAL _ • . z-:-',.. ' -'-
Requred only if fixture qty. total b > 9 . .
✓✓"`` c �- - y TOTAL
Con arson Name Phone
*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
and plan review
I:tdatstplumbapp.doc 515198
PLEASE COMPLETE:
Fixture Type Quanti <ty.:b y Work::P:erformed:
New. > :Moved:: .. : •Replaced :: . Removed /Cap ed
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:��alumb8pp .doc 5/srae
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location 1 O _ �•a - ite MEC
Q
Contact Person h PLM ?n —0 (33
Contractor Ph SWR
BUILDING 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 � q Drywall Nailing e Fire Spll (e? 1" �°'1 T
Fire Sprinkler 7!�/� (5 ( (/ 2 //
Fire Alarm
Ceiling ,4SSOe (0 4./ // 4 q'(f �Za < <
Roof
Misc:
Final
P;I . FAIL
ING
Post Seam
Under Slab •
Top Out
Water Servic:
- Sanitary Sewer
_ Rain Drains
'Gob
� J SS - ART FAIL
(,11A 1 ICAL
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
Approach /Sidewalk
Other Date A:9/pp Inspect° Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection ord from the job site.