Permit CITY TIGARD PLUMBING PERMIT
o DEVELOPMENT SERVICES PERMIT #: PLM2000 -00112
rl " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/10/2000
SITE ADDRESS: 12506 SW QUAIL CREEK LN PARCEL: 2S104DA -00900
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 046 JURISDICTION: URB
CLASS OF WORK: ALT 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: Install residential backflow prevention device for a new single family dwelling.
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRM4 GEO 04/10/200C $25.00 0001291
4230 GALEWOOD STREET 5PC2 GEO 04/10/200C $2.00 0001291
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
aNsrivAL
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 the e rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: / Permittee Signature; ,
Call ( � ) 639 -4175 by 7:00 P.M. for an inspection needed the next busine ' day
06/08/99 TUE 10:57 FAX 503 598 1960 CITY OF TIGARD p( acr-0o -COII Z 1LI 002
CITY OF TIGARD Plumbing Permit Application Plan Creek
13125 SW HALL BLVD. Commercial and Residential olSO Redd By
TIGARD, OR 97223 10 Da:e Reel
(503) 639 -4171 ^ 'LD Q� P.E.
• Date to P. _
Print or Type Q � 1 �N Date lc :.3+
. Permit 4 ,2GiliAeleo -
In or illegible applications will no a a46tl Relates slrR x
CAMM4N\ Called
Name of Deveiopment/Prajec: L-�7- 4 C {lndivltiiia0 a •' : -: =; °r ° . : ..:-: = ; ' Q7Y" • PRICE ;AMT
Job dlt- ' 41Dtiauj Sink 1/.50
Address t reetAdd ss I Suite Lavatory 11.50
�e �� ' i '� � Tub or TubiShower Comb. ' 11.56
• Bldg d /State Zio Shower Only 11.50
Name Water Closet I 11.50
Z an MM SS G ifrYn S Cist washer i 11.50
Owne Mail;ng Address Suite Garbage Disposal 11.50
�/a3o RV 6 4 /d 1-4- ' 0001 _ Washing Machine 11.50
Gty/S•.ate Zip Phone .
Floor Crain/Floor WFloor Sink 2° 11.50
La KG vSfvcya ol�. 790- by SO
Naze ' 3°
acre 3° 11.50
• 4° 11 50
• Occupant Mailing Ad . ss Suite Water Heater O conversion 0 Ike kind 11.53
Gas piping requires a separate mechanical permit •
City /State Zip Phone Laundry Room Tray 11.53 i
Urinal , 11.53
. OSC° I P e rOe Grass m Lailds Other Fixtures (Specify) 15.00 l
• c
■
Contractor Mating Address Suite •
aq � t S c/a) / rno.1.
Pricr to permit City/State Zip Phone L 0 - Sewer - ist 100' 38.00
Issuance, a copy W/ / ,S-pn DiIk Ok. 97070 1.074) an Sewer - each additional 100' 32.00
of all licenses are Orego Corset. Cont. Board Uc.# Ems. Date
required if �p)3(p C� o Water Service - let 100' 38.00 g/3 aO
expired In COT Plumbing Lit. S I Exp. Date- Water Service - each additional 206' 32.00 .
database t Storm & Rain Drain - 1st 100' 38.00
Name . Storm & Rain Drain - each additional 100' 32.00
Architect Mobile Home Space 32.00
or • Mailing Address Suite Ccmmerclal Back Flory Prevention Device or Anti- 32.00
• • Pollution Device
Engineer I City/State Zip Phone Residential Bacidlow Prevention Device' i 19.00 /9 `
(Irrigatior. timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Rep:aca 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
- peuhr I
Are you capping, moving or replacing any fixtures? Specially Requested Inspections per /i j
er /�r
Yes 0 No 0 Rein Drain, single family dwelling I 45.00
If yes, see back of form to indicate work performed by Grease Traps I 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. - QUANTITY TOTAL : `e, r
I hereby acknowledge that : have read this appOcation. the: the information Isorererie or riser diagram Is required If Quan:lSe Trial is s• 9 ' .
given Is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL . r . `' j ?
that plans submitted are in compliance with Cregon State Laws.
et,,w ant Date ''9, b% SURCHARGE _
Contact Person Naw� Phone "PLAN REVIEW 25% OF SUBTOTAL _ - -
Rev -
uirec only H fixture qty. total Is _ 9 . • - _ -
� _ :_,.� _=,r.� -_ TOTAL :::;,,'.`` f
1-;;t10py•�{�My 88:DRi'P_Ti2- - iAri ,'Z _ c .r ;sl�E : 41 _ r] -"
4` �M Qt -� Z�t =d vF .: ;- ' ; PSC ?l :i-i _
r'_ ;S -�; , , =# - r -: s,f: n _ n 2 'Minimum permit fee is $50 + 5% surcharge, except Residential Backf ow
z s g „ " ° ° °" �• : - ` ' `" " T'� ` • ' �j PrevarrUon Derive. which isJ2$ + 54 surcharge
f :` 'rj1..,: .g�lg itdetrt•P 141 0 jl $ii ki ja v �
_. ° • ° ''-- - •-•-- "'' ` {r_ "3 "All New Commercial Buildings require plans with isometric or riser diagram
;: lOtr ' ot`• BaTti�er�s� vret:sla�i'>karir�•.ari •��' -:'�
-- ' and plan review
l:ldstsL`xmslplumapp.dcc 9/2159
06/06/99 '117E 10:59 FAX 503 598 1960 CITY OF TIGARD Z003
•
•
PLEASE COMPLETE: •
Fixture Type Quantity by Work etn. Od.
• • * ' New Moved • •J,:
Replaced RemovedlCapped
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal •
Washing Machine
Floor Drain/Floor Sink 2"
4" •
Water Heater
Laundry Room Tray •
Urinal •
Other Fixtures (Specify)
4_c/4 fano Pre1—e-4
COMMENTS REGARDING ABOVE:
lAdstmlorffskpurr app. doe 6/2166
. 04/21/2000 Activities for Case #: PLM2000 -00112
8:03:30 AM •
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 04/07/2000 GEO MAIL No Hold GEO 04/10/2000
PLMA005 Create Permit 04/10/2000 GEO DONE No Hold GEO 04/10/2000
PLMA750 RP /Backflow Preventer No Hold GEO 04/10/2000
PLMA799 Final Inspection 04/11/2000 MRS PASS No Hold AKJ 04/11/2000
PLMA050 (F) Issue permit 04/10/2000 GEO DONE No Hold GEO 04/10/2000
PLMA800 Case Finaled 04/11/2000 AKJ DONE No Hold AKJ 04/11/2000
•
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST 2000 _000o9
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Requested (` )! /&) AM PM BLD
12
Location Q 14at (iti.j. Suite MEC
Contact Person ( )'N Ph 2-0q PLM
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
PASS PART FAIL
eB I
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
,�� PART FAIL
i CHANIC7)
Post & Beam
Rough In
Gas Line
Sri •ke Dampers
( • = PART FAIL
LECTRICAL
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 Date Inspector 1 3 / k 1 / Ext
Other p
Final
PASS PART FAIL DO N T REMOVE this inspection record from the job site.