Permit CITY TIGARD PLUMBING PERMIT
,0rA' DEVELOPMENT SERVICES PERMIT #: PLM1999 -00410
.,� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/03/1999
SITE ADDRESS: 15775 SW ROYALTY PKWY PARCEL: 2S110CD -03300
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: 002 JURISDICTION: KIN
•
CLASS OF WORK: ALT 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: •
TUB /SHOWERS: SEWER LINE: 0 ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 100 ft or less water service.
FEES
Owner:
Type By Date Amount Receipt
SAUB, C R AND LUCY A PRMT KJP 12/03/199E. $50.00 KING CITY
15775 SW ROYALTY PARKWAY SPOT KJP 12/03/199E. $4.00 KING CITY
KING CITY, OR 97224
Total $54.00
Phone 1:
Contractor:
CROWN PLUMBING
23172 SW STAFFORD RD •
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 771 -9449 Water Line Insp
Reg #: LIC 000042 Final Inspection
PLM 34 -70pb
GINAL
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 rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: - �YIL� G
• Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
DEC -03 -99 FRI 01:41 PM City of King City FAX:503 639 3771 PAGE 2
si r, L.. tr. a a n- sr
CITY OF TIGARD Plumbing Permit Application Plan Check#
t3125 AW HALL BLVD, Commercial and Residential Redd By •
TIGARD, OR 97223 Date Rec'd -
(503) 639 -4171 Date to P.E.
•
Print or Type Dale to DST
Incomplete or illegible applications will not be accepted Permit* kM1449 -00(1/o :
Related SWR #
Called
' Name of Development/Project I''.. :I. , r i ^ ; 1 .
1.4::1:4.... 1 4 11 .._
i
41 44.1 •... t (.. •;'•' -., 4 J .
-4• m- .. .... ........... .44 .......... - , .4N.:,.1 .. -.-.. ll h. 1 ..v:vell. .= •= Pa?t
Job Sink ' 11.50
Address Street Address n utte Lavatory
/5 775 $W Ro 11.50
y Tub or Tub /Shower Comb. 11.50
Bldg # • City /Slate Zip Shower Only 11.50
Name a Water Closet/Urinal (Specify) 11.50
Ise, v v^c� S0.) Dishwasher 11.50
Owner Malting Addis Suite ' Garbage Disposal • 11,50
/5)7s 5 .Roy PK1 , • ' Washing Machine/Laundry Tray •
City/State ! Phone 9 h y (sPedh) 11.50 .
K i w� . o 1Q 9� z 2 y_ 4, - 9 y. D Floor Drain/Floor Sink 2" 11.50 •
Name 3' 11.50
5 A-01 h. 4" 11.50
Occupant Malting Address Suite Water Heater 0 conversion 0 like kind 11.50 - :
Gas piping requires a separate mechanical permit.
City/State Zip Phone MFG Home New Water Service 28.00 '
MFG Home New San/Storm Sewer 28.00
Name
. c.VO .-/..., 9 / r 6 , N../.9 • Hose Bibs 11.50
Contractor Mailing Address Suite Rain Drains 11.50 •
5 56 /%V' -t. Drinking Fountain • 11.50
Prior to permit Gt /State Zip Phone Other Fixtures (Specify) • 15.00 •
Issuance, a copy. Qy } O. 9 7 .0 r, 77/ 9' ° / •
of all licenses are ` Oregon Const. Cont. Board Lie,# xp. Oate •
required if �f oL(v 7 / V Z a
expired in COT Plumbing Uc. # ate
database 3t-?o Po b ;u O p .
Name (((
Sewer -1st 100 38
Architect Sewer -each additional 100' ' 32.00•
-
Or Mailing Address Suite •
Water Service - 1st 100' 38.00 3 o;
•
En Ineer City/State Zip Phone Water Service -each additional 200' 32.00 '
�
9 Storm & Rain Drain - 1st 100' 38.00
Describe work to be done: Storm & Rain Drain - each additional 100' 32.00 •
New cir Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00 •
Residential ' 1 Commercial 0 •
Additional description of work: Residential Beddow Prevention Device* 19.00
. Catch Basin 11.50
.e w 5 ' ' vi c `E.
• Insp. of Existing Plumbing • 50.00 -
Are you capping, moving or replacing any fixtures? per/hr _
Yes 0 No q Specially Requested Inspections .•• 50.00 •
If yes, see back of form to indicate work performed by per /hr
fixture, FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information ' i� I : i � �:s -
given is correct, that I am the owner or authorized agent of the owner, and QU y T otal is 9 9
TOTAL '>:,:_::. r
Isomeuie or riser dlsgrsm is required IF Quantity Total � •`� -' 0 4F "'
that plans submitted are in compliance with Oregon State Laws. "SUBTOTAL ` % ^iy = ,i ;, ! +i uo
Signature o f Owner /Agent Date ',; ; L it i; :.: �D
. - 1 ,), I. .-- 3 -9 SURCHARGE ' :`` %°'":n ;i;r 1l;rF;f0 <,re
Contact Perso Name Phone : :. l i/ Vii'; y
� TN` � 't . 77/ -9 `1 '1 y "PLAN REVIEW 26% OF SUBTOTAL i: M1 � "1+
• �,, , . i
:�! ttop,S. A , _';• '
,, j%1,:. ;? Cvel(1 i @ '4:4,1 'P r • Re quired on lytr fi xturegt y.totalis >g • ..gri • P' ,r Ait,ii -. 2.'1m:1i. ., ‘,f P' , rn o, !•„, .. TOTAL `:
i ._ -4'14 „„..t.'0. ". 4..; . i... iu.. , v :i., • . . -. •
(Th tE•p' "l
,1, y .,, t ' 1
r r r � ta° t �, j, . : , ; ` i ' Device, m permit fee is $50 + 7% surcharge, ercepl Residential Backflow Preverdion
g.: �. h .•...‘ - n b. -:y.. Device, which is 125 + 7% surcharge
"All New Commercial 9uildinga require plans with Isometric or riser diagram and
plan reviiow.
•
r:ltialeVormalptumepp.dot 7/19199
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /014 gl qg AM PM BLD
Location / 5' 1S 2aLica4 Play l- Suite MEC
Contact Person haC.4.. // viyu 1k_PCc ,Sr•, t I'2 (- qctY / PLM tqq 9
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 JUL%
Fire Alarm
Susp'd Ceiling / ,i 4IL!7 . _� /i /_
Roof 7 /
Misc:
Final PART FAIL GOY
'
PLUMBING / /... _Ai� : _� � —
Post & Beam / � / ' i
Under Slab e;■ `' — 4 wr
Top O it -
ater Service
ewer
Rain Drains
Final
PASS B FAIL
MECHANICAL roe
Post & Beam / �C
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
n Reinspection fee of required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Storm Drain [ ] p $ q p y ty
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk D a t e 1 t Inspector J Itor Ext -
1 lll���
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.