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Permit _A,. CITY OF TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT PERMIT # • PLM97 -0391 I 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: 09/30/97 PARCEL: 25114BB -16000 SITE ADDRESS...: 10241 SW PICK'S CT SUBDIVISION • RIVERVIEW ESTATES ZONING: R -7 PD BLOCK • LOT •006 JURISDICTION: TIG CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 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 • 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: Installing residential backflow prevention device Owner: FEES BOB STEPHENSON type amount by date recpt 10241 SW PICK'S CT PRMT $ 15.00 B 09/30/97 97- 299641 TIGARD OR 97224 5PCT $ 0.75 B 09/30/97 97- 299641 Phone #: Contract or CROWN PLUMBING 23172 SW STAFFORD RD TUALATIN OR 97062 Phone #: 771 -9449 $ 15.75 TOTAL Reg #..: 004267 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the RP /Backf low 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 952 - 0001-0010 through OAR 952 - 000180. You may obtain copies of these rules or direct questions to OJNC by calling (503) 246 -1987. Issued By: Permittee Signature: Alc- +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day +++++++++++++++++++++++++++++++++++++++++++++++ + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + ++ CITY OF TIGARD Plumbing Application Recd By 13125 -SW BALL BLVD. Commercial and Residential Date Recd Rf Date to P.E. TIGARD, OR 97223 Date to j DST (503) 639 -4171 Permits ` 0P7 - ,W11 Print or Type Related SWR s Incomplete or illegible applications will not be accepted Called e of Develo ment/Pro C Job '11 X VI cd,“ j .FUCTURES'(Indlyldual) - ,., - ,=,.,..7, : .... .1 „ 'QTY,,. ; PRICE • 'AMT r. Address Street Address Suite Sink 9.00 ° /cep/ - y Lavatory 9.00 Bldg * City /State Zip Tub or Tub/Shower Comb. 9.00 h 4,-.1-- Shower Only 9.00 P C (,',e5 "`---- Water Closet 9.00 - Owner Mailing Address Suite Dishwasher 9.00 (' 11 .3ti.) R .--7 Garbage Disposal 9.00 C �tat� Zip Phone Washing Machine 9.00 Name Floor Drain 2' 9.00 3' 9.00 Occupant Mailing Address Suite 4' 9.00 Water Heater 0 conversion 0 like kind 9.00 City /State Zip Phone Laundry Room Tray 9.00 fyame, / , /. Urinal 9.00 �/� �`- `/ L• � Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 (Prior to issuance City/State Zip Phone 9.00 applicant must ____ eir,o,,( 4j7eW 9 ,/WS 7 9.00 provide all O an Const. Cont. Board Lic.0 p Date 9.00 !J contractors a 7 e , J2 - yr - 9.00 license Plumbing Lic. * Exp. Date . information if Sewer - 1st 100 30.00 expired 3/ 7 © p _ '/7T �! ' c) Sewer - each additional 100' 25.00 in COT COT Business Tax or Metro * Exp. Date Water Service - 1st 100' 30.00 - database). / 1 -2 1.- 3/ / - / ` 7 Water Service - each additional 200' • 25.00 Name Architect Storm & Rain Drain - 1st 100' 30.00 Storm & Rain Drain - each additional 100' 25.00 Or Mailing Address Suite Mobile Home Space 25.00 Engineer City /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device / Residential Backflow Prevention Device' ( 15.00 Describe work New 0 Addition 0 Alteratio0 Repair 0 to be done: Residential 0 Non - residential 0 My 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 . Specially Requested Inspections 40.00 Existing use of . 6 per/hr building or property_ Rain Drain, single family dwelling 30.00 Proposed use of Grease Traps 9.00 building or property QUANTITY TOTAL Isometric or riser diagram is required if Quanity Total is > 9 ' ,. Are you capping , moving or replacing any fixtures? Yes 0 No ❑ (If yes see back of form) '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 ns submitted are in compliance with Oregon State Laws. SI a re o ner/ gent Da te / QI/ /. PLAN REVIEW 25% OF SUBTOTAL / Required only if fixture qty. total is > 9 �� TOTAL Contact Person Name Phone ' *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow 0,6,e f ( [ / c LI ? "" Prevention Device, which is 515 + 5% surcharge 1:ltlststplmapp.doc 5/97 PLEASE 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: • t:ldstslpunapp.doc 5197 6/1/99 Activities for Case #: PLM97 -00391 2:39:34 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMA003 Application received 9/30/97 B RECD DST 9/30/97 PLMA005 Create Permit 9/30/97 B PASS DST 9/30/97 PLMA799 Final Inspection 10/2/97 MS PASS MRS 10/2/97 PLMA750 RP /Backflow Preventer 9/30/97 DST 9/30/97 PLMA057 Issue plumbing signature form 11/21/97 SW RECD S'W 11/25/97 sent this as landscape architect took out permit. PLMA050 (F) Issue permit 9/30/97 B PASS DST 9/30/97 PLMA800 Case Finaled 10/2/97 MS PASS MRS 10/2/97 Page 1 of 1 • • 4 3° — 5, �r� k2I�( l o , i � CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 Date Requested: / /O _rQ– 71 A.M. P.M. MST: Location: /0, 4 , . , / �`� BUP: Tenant: Suite: Bldg: MEC: p Contractor: ,[ Phone: PLM: 97 03`7) ) Owner: J Phone: ELC: ELR: SIT: BUILDING BLDG (con't) LUMBING MECHANICAL ELECTRICAL SITE Site Post/Beam • : .:.s:i . Post/Beam Cover /Service Sewer /Storm Footing Roof UndFl/Slab Rough -In 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 Shear /Sheath Fire Spklr /Alm Crawl/Found Dr • Heat Pump Low Volt Approved y.. :1► Approved Approved Appro Appr /Sdwlk Not Approved No L oved Not Approved Not Approved Not Approved FINAL N L FINAL FINAL FINAL • A / / i 4 ,- - .7,..z.z O Call for reinspection O Reinspection fee of $ required before next inspection CI Unable to inspect Inspector: Date: 1 6/ 02/171- ` Page L. of 2