Permit CITY OFTIGARD 4 VELOPMENT SERVICES P LUMP # PERMIT
PERMI : 9 -0073
:=' - ° 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 03 / 17 / PLM9 99
PARCEL: 25111CD -07700
SITE ADDRESS...: 15775 SW SERENA CT
SUBDIVISION KERWOOD ESTATES ZONING: R -4.5
BLOCK LOT -010 JURISDICTION: TIG
CLASS OF WORK..:ALT 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
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0'
SINKS 0 URINALS 0 GREASE TRAPS • 0
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: Residential backflow prevention device
Owner: FEES
CHRETIEN,' JERRY & KATHY type amount by date recpt
15775 SW SERENA CT PRMT $ 15.00 B 03/17/99 99- 313766
TIGARD OR 97224 SPCT $ 0.75 B 03/17/99 99- 313766
•
Phone #: 639 -0809
Contract or
CEDAR LANDSCAPE
14145 SW GALBREATH DRIVE
SHERWOOD OR 97140
Phone #: 625 -3700 $ 15.75 TOTAL
Reg #..: 000058
REQUIRED INSPECTIONS
•
This permit is issued subject to the regulations contained in the RP /Backflow 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 per ®it will expire if work is not started
within 180 days of issuance, or if work is suspended for Dore
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 eay
obtain copies of these rules or direct questions. to OUNC by calling
(5031246 -1987.
Issued By: 6 iviukt� Perm ittee Signature:
++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++.++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # RPM -1 13
- Tiga? J, OR 97223
(503) 639 -4171 •
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
NaAe d Development - New Single Family Residences Only
Address ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job IS 7755 av Se-rer.4L e� ❑ 3 BATH HOUSE $225.00
Address cx zip Fee includes all plumbing fixtures in the dwelling and the first 100 feet
T'i 9 1 0 2 9727_ ti of water service, sanitary sewer and storm sewer. See fees below.
Nark: (et name at Manual FIXTURES QTY PRICE AMT
..1r '''*- Ko4TA7y CA r+C jiei0 Sink 9.00
Maw Address J p^0 / e• Lavatory 9.00
Owner l$ 77,5 5 w She cr G31-og,i Tub or Tub/Shower Comb. 9.00
^ stet• Zits Shower Only 9.00
(+
( C 1 4 ' 7 Z Z `' Water Closet 9.00
Neme (a name of Mammal al Dishwasher 9.00
Occupant 3,e)-1-1-( Garbage Disposal 9.00
"°°°" p"°^° Washing Machine 9.00
Floor Drain 9.00
"^" - Zip Water Heater 9.00
Laundry Room Tray 9.00
NaAe / Urinal 9.00
(2e L
' A "-dic ire .-T/ Other Fixtures (Specify) 9.00
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Contractor U.ag Address (� ZS 370d 9.00
/Y/VS S 6412S DiL
9.00
City/State zb 9.00
J 6'e 1 - 4 - 10 -e e) 02 17/y0 Sewer 1st 100' 30.00
Sta1e R. .radon No. CN Bus. Taa No. Sewer - ea. Addit. 100' 25.00
58 4/3 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
2 Back Flow Prevention
�:` y / // //J � ✓ �7_ Device or Anti- Pollution Device _ 9.00 • ,
5 ¢taeee (owner a agent) / Date Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential (g! non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of Rain Drain, single family dwelling 30.00
building or property
Residential backflow prevention
devices 1 15.00 1,..5 _
Proposed use of
building or property
- (Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL /s %
PERMITS BECOME VOID IF WORK OR CONSTRUCTION ✓
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE ■76-
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
- FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL IJ `��
.7.s
Special Conditions iP/611 i
Date issued I i 7 by R 6O
03/03/2000 • Activities for Case #: PLM99 -00073
8:23:06 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 03/17/1999 B RECD BON 03/17/1999
PLMA005 Create Permit 03/17/1999 B DONE BON 03/17/1999
PLMA799 Final Inspection 02/18/2000 RB PASS AKJ 02/21/2000
PLMA750 RP /Backflow Preventer 03/17/1999 BON 03/17/1999
• PLMA050 (F) Issue permit 03/17/1999 B PASS DST 03/17/1999 •
PLMA800 Case Finaled . 02/21/2000 AKJ DONE No Hold AKJ 02/21/2000
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Page 1 of 1
7
CITY OF TIGARD BUILDING INSPECTION DIVISION . MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
UP
o
Date Requested AM AM PM BLD
Location / s 7 c 5eA ) '&_ Suite ME
Contact Person Ph PL 9�
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing V
Foundation A NOT REQUESTED FPS
Ftg Drain FOUND DURING RESEARCH 1 SGN Wr
Slab
Crawl Drain NO INSPECTION(S,),F_QUND IN FILE eie I kr
Post & Beam ( ,,,� l /: SIT
"�
Ext Sheath /Shear I ` ° V `�' "1 �� /
�"l
Int Sheath /Shear
Framing
Insulation •
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
antl
'•AS PART FAIL
HANICAL
Post & Beam
Rough In \�
Gas Line
Smoke Dampers
r()
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 ./1 �I0 b
Other Date Inspector Ex
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site