Permit ,k , CITY OF TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM1999 -00227
r � l II 13125 SW Hall Blvd., Tigard, OR 97223 (50 , TE ISSUED: 7/27/99
SITE ADDRESS: 10374 SW PICK'S Y
PARCEL: 2S114BB -09900
W
SUBDIVISION: SWANSONS GLEN ZONING: R -12
BLOCK: LOT: 040 JURISDICTION: TIG
CLASS OF WORK OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of icemaker line.
FEES
Owner:
Type By Date Amount Receipt
JAN SMALL PRMT DEB 7/27/99 $50.00 99- 317163
10374 SW PICK'S WAY 5PCT DEB 7/27/99 $3.50 99- 317163
TIGARD, OR 97224
Total $53.50
Phone 1: 624 -1401
Contractor:
CROWN PLUMBING
23172 SW STAFFORD RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 771 -9449 Top -out Insp
Reg #: LIC 000042 Final Inspection
PLM 34 -70pb
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 obtain c of these rules or direct questions to OUNC by calling (503) 246 -1987.
iss ed By: �� Permittee Signature: X
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan C
13125 SWHALL BLVD. Commercial and Residential Rec'd •
TIGARD, OR 97223 Date Rec'd 7 - 49 - 7 "
(503) 639 -4171 Date to P.E.
Print or Type Date to D T - "
Incomplete or illegible applications will not be accepted Permit # tit C199
Related SWR #
Called
Name of Development/Project FIXTURES- (individual) : . 'QTY? = PRIC ',AMT. '
• Job Sink 9.00
Address Street Address n Suite Lavatory 9.00
Bldg # e 3 7 y 50,1 . P/ c Ks w/*/ Tub or Tub /Shower Comb. 9.00
B dg City/State I Shower Only 9.00
Name Water Closet 9.00
434 5 v -( / Dishwasher 9.00
Owner Mailing Address •/J Suite Garbage Disposal 9.00
Jo3 5w ic- I 5 w"W Washing Machine 9.00
City /State Zip / Phone
• �`( *-� 0i . S _ .2 y_ /ya
Name Floor Drain /Floor Sink 2" 9.00
` " 3" 9.00
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
Name
C j , 5 i ova / d A C Ov/..) Other Fixtures (Specify) Icc U1Ack K .- 9.00 9 c�
Contractor Mailing Address • _Suite , 9.00
2 3 17 a, s w s 4 if ov of . 9.00
Prior to permit City/State Zip Phone • Sewer - 1st 100' 30.00
issuance, a copy tuCia.I+wN. brQ °/> 01 77 1- 999 9
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if y(2- ( 7 ( Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Dale Water Service - each additional 200' 25.00
database 3V-26 (0 13 - ' d - 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' 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New I Repair 0 Replace with like kind: Yes O No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per/hr
P w+-, a., c' tii c .. i_a k. r Specially Requested Inspections 40.00
- per/hr
Are you capping, moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes O No O Grease Traps 9.00
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL
Isometric or riser diagram is required K Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER.FEES. *SUBTOTAL 5
. I hereby acknowledge that I have read this application, that the information ,'3
given is correct, that I am the owner or authorized agent of the owner, and 7 Iwo SURCHARGE . 50
that plans submitted are in compliance with Or on State Laws. 11 �r
Signature"of caner /Age Date * *PLAN REVIEW 25% OF SUBTOTAL . -
/ r "),-- 2 7 Required only if fixture qty. total is > 9
' /
TOTAL ,
Contact Person 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:tdstslplumapp.doc 7/2/98
PLEASE COMPLETE:
Future. :Type Quantity: by: Work Performed
New Moved:... <I - ReplacecVEe Removed /Capped:
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:'dstslplumapp.doc 7/7/98
8/16/99 Activities for Case #: PLM1999 -00227
5:13:58 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 APPlication received 7/27/99 DEB DONE No Hold DEB 7/27/99
PLMA005 Create Permit 7/27/99 DEB DONE No Hold DEB 7/27/99
PLMA725 Top-out lnsp 7/27/99 7/27/99 No Hold DEB 7/27/99
PLMA799 Final Inspection 7/27/99 7/27/99 7/29/99 MS PASS No Hold AKJ 7/29/99
PLMA050 (F) Issue permit 7/27/99 DEB DONE No Hold DEB 7/27/99
PLMA800 Case Finaled 7/29/99 AKJ DONE No Hold AKJ 7/29/99
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Re uested q AM 1` PM BLD
n .
Location 0 Y C Suite MEC
Contact Person I KZ Ph - 7 -- 71-9L1 ( -0 PLM , q - / Gy
— op7
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab ke t SIT Post & Beam / DIIvLJ
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
am
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
/497- PART FAIL
HANICAL
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 Date )-1 ( Ins /` Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•