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Permit CITY OF TIGARD _A,,,, DEVELOPMENT PLUMBING PERMIT ,,.,,,,,,„ ~�n�mn�n��n omnn�u�o SERVICES PERMIT # ^ PLM98-00�1 =��i 13�5 SW�ll�»��a�OR 97223 (503)639-4171 DATE ISSUED: 03�16�98 PARCEL: 2S104DB-02400 SITE ADDRESS...: 13147 SW ROCKINGHAM DR SUBDIVISION ^ AMESBURY HEIGHTS ZONING: R-4.5 BLOCK ^ LOT ^024 JURISDICTION: TIG --------------------------------- ------------- ----- -- --- CLASS OF WQRK..:ADD 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 F LAUNDRY TRAYS - 0 SF RAIN DRAINS - B SINKS.. - 0 URINALS... - 0 GREASE TRAPS ^ B 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: Add residential backflow prevention deivce to a new single family dwelling. Owner: ------- — — --- FEES -------------- GREG SIMMONS type amount by date recpt 4214 SW KANAN DR PRMT $ 15.00 GEO 03/16/98 98-304147 PORTLAND OR 97221 5PCT $ 0.75 GEO 03/16/98 98-304147 Phone #: Contractor------------- ----- KOREY WINCHELL 17465 NW CARL CT PORTLAND OR 97229 ------------------------------------ Phone #: 614-0814 $ 15.75 TOTAL Rey #..: 000126 REQUIRED INSPECTIONS ------- This permi is issued subject to the regulations contained in the RP/Back flow 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 952-0631-0810 through OAR 952-00014888. You may _____________________ _____________________. obtain copies of these rules or direct questions to 0UNC by calling ._____________________ ____________________ (503)246-1987. Issued By: ° �� P ermittee Signature: + +++++++++++++++++ ÷+++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Call 639-4175 by 7:00 p.m. for an inspection needed the next business day + +++++++++++++++1-4-++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ CITY OF TIGARD Plumbing Permit Application Rec'd By 13125 SW-HALL BLVD. Commercial and Residential Date Rec'd TIGARD, OR 97223 Date to P.E. Date to DST (503) 639-4171 Permit* ' - ' RN &7/ Print or Type Related SWR # Incomplete or illegible applications will not be accepted Called Name of Development/Project On back Indicate Work Performed by fixture. Job v- e5bv Ae In:t6 FIXTURES (Individual) QTY PRICE AMT Address Street Address Suite Sink 9.00 1314'7 .90 eon i 1 Lavatory 9.00 Bldg # Way/State Zip Tub or Tub/Shower Comb. 9.00 Name Shower Only 9.00 C j 42 ' CC VS MU' ertO "J Water Closet 9.00 Owner Mailing Address Suite Dishwasher 9.00 1-l2 11.4 $W 4.4,04A3 pec Garbage Disposal 9.00 City /State Zip Phone Fp -S I - Q 7221 Washing Machine 9.00 Name Floor Drain 2' 9.00 3 ' 9.00 Occupant Mailing Address Suite 4• 9.00 City /State Zip Phone Water Heater 0 conversion 0 like kind 9.00 Laundry Room Tray 9.00 Name Urinal 9.00 )4.012 >( W 0 -^` eL .- Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 t 7 Kw Ci.# et Prior to permit City /State Zip Phone 9.00 issuance, a copy PO(t(Lka►D c)e CI 7Z.Zq 6 14 -4:51141 4 9.00 of all licenses are Oregon Const.Cont. Board Licit Exp. Date 9.00 required if l 2-66 3 I I f 3C "7 £ Sewer - 1st 100' 30.00 expired in COT Plumbing Lic. # Exp. Date Sewer - each additional 100' 25.00 database Name Water Service - 1st 100' 30.00 Architect Water Service - each additional 200' 25.00 Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00 Storm & Rain Drain - each additional 100' 25.00 Engineer City /State Zip Phone Mobile Home Space 25.00 Commercial Back Flow Prevention Device or Anti- 25.00 Describe work New 0 Addition 0 Alteration 0 Repair 0 Pollution Device to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device' ' 15.00 Additional description of work: Any Trap or Waste Not Connected to a Fixture 9.00 Catch Basin 9.00 Insp. of Existing Plumbing 40.00 per/hr Existing use of Specially Requested Inspections 40.00 building or property per/hr Rain Drain, single family dwelling 30.00 Proposed use of Grease Traps 9.00 building or property I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL �q Isometric or riser diagram is required if Mandy Total is > 9 �� given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL that plans submitted are in compliance with Oregon State Laws. SI nature of Owner /Agent Date 3 -�-�� 5% SURCHARGE _ 'f 1';: ontact arson Name Phone PLAN REVIEW 25% OF SUBTOTAL „; . 1 ` � 4 W ` j re- 61 C 1 `5g Required only if fixture qty. total is > s TOTAL 'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow Prevention Device, which is $15 + 5% surcharge l:tdsts\ptmapp.doc 5/97 PLEASE COMPLETE: Fixture Type : : ::. '.:::;::.:;;: Quantity by Work Performed ;:... New ..: ::.:: :::Moved "` -: Replaced Removed /Capped ;ink _avatory Tub or Tub /Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine =loor Drain 2" 3" 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I kIstMplrnapp .doe 5/97 1/21/00 Activities for Case #: PLM98- 00071 4:51:17 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMA003 Application received 3/16/98 GEO RECD DST 3/16/98 PLMA005 Create Permit 3/16/98 GEO DONE DST 3/16/98 PLMA799 Final Inspection 1/3/00 MRS PASS AKJ 1/3/00 PLMA750 RP /Backflow Preventer 3/16/98 5/1/98 WA FAIL J'H 5/1/98 BACKFLOW DEVICE NOT INSTALLED PLMA050 (F) Issue permit 3/16/98 GEO PASS GEO 3/16/98 PLMA800 Case Finaled 1/3/00 AKJ DONE No Hold AKJ 1/3/00 Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested AM PM BLD Location ��r��_ i�,� ,. _ Suite MEC Contact Person 7,J 1-4 Ph PLM Z — nd Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspe tion Notes: Slab _ SIT Post Beam �� Ext Sheath/Shear eath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL Under Slab Top Out Water Service Sanitary Sewer Rain Drains PS PART FAIL MECHANICAL 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 Other Date Inspector Ext { � Final ' PASS PART FAIL 0 NOT REMOVE this inspection record from the job site. r 3 . CITY OF TIGARD BUILDING INSPECTION DIVISION ` , . -I 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 ` Date Requested: ca ( A.M. P.M. MST Location: 0� .4_ ) ,4 /,i. . iIi . _ BUP: Tenant: /'//// Suite: Bldg: MEC: Q / / / CrC'.) P_ Y -�D /, ' PLM: ! k- I Contractor: d� ! � Phone Owner. liii ' Phone: Og ELC: T 6 .04.4._ 06-iy e ELR: SIT: BUILDING BLDG (con't) UMBING MECHANICAL ELECTRICAL SITE Site Post/Beam 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 c.�� (/l.t. Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt Approved Approved Approved Approved A... • Appr /Sdwlk Not Approved Not A proved Not Approved Not Approved - •' of A y.rov -. FINAL FINAL FINAL FINAL r ' ;E )--C 'e ,L !"/ 4 47zi c-li /4 4 1 pry 7d Jd). ') �11 for reinspectio O Reinspection fee of $ requir before ext inspection Unable to inspect Inspector: `�� • Date: c�I Page of INIP :‘- , - CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 id • Date Requested: '%%' I r. FL' v i ): O "i — Q(f A.M. P.M. MST: 7-0/y 7 Location: 3 �/L _, 041 BUP: Tenant: ..I/ t_ 4M / //.1 , Suite: Bldg: MEC: Contractor. �j / p p :/1 � _ . A�d� Ph one: � � t ' ,57:31A PLM: / O -00 w] Owner Phone: ELC: ELR: SIT: BUILDING : LDG' • I n't) MECHANICAL ELECTRICAL SITE Site Po 7 : eam Post/Beam 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 %, • pprov ... . Approv =.■ Approved Approved Tr . Appr/Sdwlk o • .j.roved 1.1 , 1• .,. . ved Not Approved Not Approved No < _..• . ed FIN • FINAL FLNAL I • • ...---V.,� cyett. -4 p`. ' 5' - 9 " 7- f .7,-14.,-- 7 9 2- .7 - 7 8 O Call for reinspection CI Reinspection fee of $ sp required before next inspection O Unable to inspect Inspector: IY, / Date: 6 ' /' l f Page of