Permit , CITY OF TIGARD PLUMBING PERMIT
4 - 1 DEVELOPMENT SERVICES PERMIT #: P -00073
� �� DATE ISSUED: 03/08/20/08/20 00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
• SITE ADDRESS: 12220 SW QUAIL CREEK LN PARCEL: 2S103CB -10100
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 059 JURISDICTION: URB
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 a residential backflow prevention deivce.
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRM4 GEO 03/08/200C $25.00 0000530
4230 GALEWOOD STREET 5PC2 GEO 03/08/200C $2.00 0000530
SUITE 100
LAKE OSWEGO, OR 97035 Total $27.00
Phone 1: 274 -5223
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 00006136 Final Inspection
PLM 11558
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these ules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: i Permittee Signature:
4„....4e2ge
Call (503 .39 -4175 by 7:00 P.M. for an inspection needed the next business day
06/06/99 TIT. 10:57 FAX 503 598 1960 CITY OF TIGARD 9) 002
CITY OF TIGARD Plumbing Permit Application plan Creck
13125 SW HALL BLVD. Commercial and Residential Redd By
TIGARD, OR 97223 Q � f Date Rec'd
(503) 6394171 V I e Date to P.E.
Print or Type Date to CST
Incomplete or illegible applications will not be accepted Permit 2 PI wt gcoo - 0930 ?'3
Related SWR X
• Called
Name of Oeve:opmenUPra ec =F1x URES (Ind(vldubl) .' ? .'. s ; r- : = QTY" PRICE> ;:f1N17*J
Job (l- A -a-a-- of lato C6 T cq Sink 11.50
Address Street Address_ . I Suite Lavatory 11.50
• Iaa-ao �r0) C am- 1J LC l_a 4&.(. Tub or Tub/Shower Comb. 11.50
Bldg 0 • Ci /State n Zi Shower Only 11 .50 I
Name I �q Q. 1 � � Water Closet I 11.50
pal" (flMY7 S5 odic.. ihrmeS Clst:washer I 11.50
Owner Maling Address Suite - • Garbage Disposal I 11.50
11 SW Galewoad Washing Machine 11.50
City/State Zip Phone Fl Crs WFloor Sink 2° 11.50
L,aec bSWCC/D o1�.. 790- Ce($S{o ' i
• Name 3° 11.50 j •
• 4° 11.50
Occupant Mailing Ad , ss Suite Water Heater 0 conversion 0 lake kind 11.53
Gas piping requires a separate mechanical permit
City/State Zip Phone Laundry Room Tray 11.53
Urinal 11.53
me O ther Fbdxues (Specify) 15.x7
• U-t ia Zap_ Pro 6ra-S L s aid sc c, t p • -
Contractor Mailing Address S uite l
aq q S gw kinsman
Prier to permit City/State Zip Phone /,?.2 - Sewer - ist 100' 38.00
Issuance. a copy W/) Sim oak oR 47o10 1,04, ar7 Sewer - each additional 100' - 32.00
of all licenses are Oregon Coset. Cont. Board Lie.* Exp. Date
required if ( J3(o • S/3 /)aor, o Water Service -1st 100' 38.00 -
expired In COT Plumbing LIC. S Exp. Date' Water Service - each additional 200 32.00 .
database I Storm & Rain Drain - 1st 100' 38.00 I
rrre Storm & Rain Drain - each additional 100' 32.00 r •
Architect Mobile Home Space 32.00
or Mallet Tess Suit Commercial Bade Flow Prevention Device or Antl- 32.00
• Pollution Device
• Engineer I C fty/State Zip Phone Residential Backflow Prevention Device' 19.00 /9 11:_' (Irtigatior. timing devices require a separate 1
Describe work to be done: . restricted energy permit.)
Naw 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 11.50
Residential 0 Commercial 0 Catch Basin 11.50
Additional description of work:. . -
Insp. of Existing Plumbing 50.00
per/hr
you capping, movin or replacin any fixtures? Specially Requested Inspections • 50.00
Are j
Y � replacing Y ped�r
Yes 0 No 0 Rain Drain, single family dwelling 45.00
If yes, see back of form to indicate work performed by Grease Traps 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL. f/ccTT '.1; `/.`
a
I hereby acknowledge that i have read this appficat rr
on, that the information Isoe'rle a riser diagram Is required if Cluan'ly Total is s• 9 1 . 4 J ' r
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL - • •
tt:at plans submitted are in compliance with Cregon State Laws. j-4,-.:4•::-.1:::: ate
S Ietaro"ef,Qw • ent Date V9, E°%, SURCHARGE •
Contact Person Phone * *PLAN REVIEW 25% OF SUBTOTAL -
Requree mil H future qty. total Is > 9 11 - 5.,
::_..s- _��•:_....- t1, =�=. •�° ; I
_ �r._
°7T11?�l���US�'i�Z8�f1 : -__ == _: �- `rraE.- ,�:.�" ,; y� ° � - r7 ..
rte; ��:7 � z..:Ligil _- ,
: :: ` •:
u E_ 1 �d: -r.. , . a t . - :r c » .e - - c'a ..:_ -,
ter ._ � ss0 �.: _ - : i l=4 'Minimum permit fee is $50 + 5% surcharge, except Residential Baok
2 ftow
is <F: Y �.Y.,4,r.`. 5�`l�''a n,.° ° ans� : .w := s � v 1, -r. n_...r � s surcharge
� �g p�P Prevention Device, which is $25 + 5%
r:- , .. - .._ dt�1FP�!�.1 .__: _...�� a1ie;�r.�11 p:1@���.r's
;-• ' l - a --' , e ;gi-{r "A11 New Commercial Buildings require plans with isometric or riser diagram
'104 ti `s�tti�ss9vret.si�srt'se�v�tid v
"�°"' - -' ' -' and plan review
I: Ids :s:`xmslplumaee.dcc sr /9
03/27/2000 Activities for Case #: PLM2000 -00073
7:59:29 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 03/08/2000 GEO MAIL No Hold GEO 03/08/2000
PLMA005 Create Permit 03/08/2000 GEO DONE No Hold GEO 03/08/2000
PLMA750 RP /Backflow Preventer No Hold GEO 03/08/2000
PLMA799 Final Inspection 03/21/2000 MRS PASS No Hold AKJ 03/21/2000
PLMA050 (F) Issue permit • 03/08/2000 GEO DONE No Hold GEO 03/08/2000
PLMA800 Case Finaled 03/21/2000 AKJ DONE No Hold AKJ 03/21/2000
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Page 1 of 1 •
CITY OF TIGARD BUILDING INSPECTION DIVISION �pqq ��
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST _1_r<_L! �bQ y
W2A/C)° BUP
Date Requested AM PM BLD
Location ` 21() kI4 A { OU. P A( Suite MEC
Contact Person 'f nVA, Ph 2D9-La'?/
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
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PAS PART FAIL
UM
Post & Beam
Under Slab
Top Out
Water we
Sanitary Sewer
ain Drains
cr PART FAIL
Post & Beam
Rough In
Gas Line
Smoke Dampers
S ASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I 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 2 f /ij( Inspector ) �/ Ext 43) Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.