Permit . IlY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT DEREIT S PLM96 -0097
DATE ISSUED: 05/02/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 1S134CD -07100
SITE ADDRESS...: 11760 SW TIGARD DR
SUBDIVISION BURLWOOD NO.3 ZONING: R -4.5
BLOCK • LOT •31
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:A1 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: Installing one residential backflow prevention device.
Owner: FEES
DONNA STEVENS type amount by date recpt
11760 SW TIGARD ST PRMT $ 15.00 CJS 05/02/96 96- 278913
SPCT $ 0.75 CJS 05/02/96 96- 278913
TIGARD OR 97223
Phone #:
Contractor:
OWNER
Phone #: $ 15.75 TOTAL
Reg #.. .
REQUIRED INSPECTIONS
This peroit 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 persit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
than 180 days.
p ef
Permittee Signature: LW/Me /A N •
Issued By: C/►orley ,Cky., €,-
Call for inspection — 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 96-D 7R
1i25 SW Hall Blvd. Permit # 1/7)96
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of D nm New Single Family Residences Only
A eu ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job (L 7 S� � � 71 � & i' ❑ 3 BATH HOUSE $225.00
Address CO zo • Fee includes all plumbing fixtures in the dwelling and the first 100 feet
Z/ b47� � -7 7i 3 of water service, sanitary sewer and storm sewer. See fees below.
u (« name or Bum FIXTURES QTY PRICE AMT
/Cr /( ( /
/ (/ 7 --- Sink 9.00
Mating Aotreu P'0 Lavatory 9.00
Owner 1(7 /0 ea- /�
(4 il Os . Tub or Tub /Shower Comb. 9.00
c°,"s•t• ro Shower Only 9.00
/LP �j ` Water Closet 9.00
Name (cc name of tagneu) Dishwasher 9.00
p H. , � L � /��� Garbage Disposal 9.00
Occupant Washing Machine 9.00
6y 1r71l Floor Drain 9.00
City /sate Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
1 ,� �� Other Fixtures (Specify) 9.00
Mang AOtreu Rhone 9.00
Contractor
9.00
Cay /State 4 9
Sewer 1st 100' 30.00
State Repatratan No Ca' Bus. Tax No. Sewer - ea. Addit. 100' 25 00
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 Contractors Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason bet. .) / Mobile Home Space 25.00
Back Flow Prevention
�� ���' - Device or Anti - Pollution Device 9.00
• a e (owner or agent) Date Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new A addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 00 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00 /hr
Existing use of /�
building or property /" /P'' Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices / 15.00 7..----
Proposed use of
building or property to , /
'(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION /
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE ,!
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 I.5 7
Special Conditions �1
Date issued --C a- 06 by C T .S
4/21/00 Activities for Case #: PLM96 -00097
4:44:26 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA007 Application received 5/2/96 CJS RECD CJS 5/2/96
PLMA799 Final Inspection 4/10/00 MRS PASS AKJ 4/10/00
PLMA745 RP /Backflow Preventer 5/2/96 9/9/98 GS NOTE J *H 9/15/98 Contact only, left
message /report at site.
PLMA050 (F) Issue permit 5/2/96 CJS PASS CJS 5/2/96
PLMA055 (F) Reprint Permit 5/2/96 BON 5/2/96
PLMA800 Case Finaled 4/10/00 AKJ DONE No Hold AKJ 4/10/00
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 4 f /( 46 AM PM BLD
Location 11 )& Tl, cvi sli__ Suite MEC ' 60 tOO 9 7
Contact Person Ph gr r '
Contractor 1-16. _ SWR
NOT REQUESTED ELC
BUILDING Ti FOUND DURING RESEARCH
Retaining Wall NO INSPECTION(S) FOUND IN FILE ELR
Footing
Foundation 1 FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: .6f 0
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall '��m �� /
Fire Sprinkler i � �L� / ' _
Fire Alarm -
Susp'd Ceiling _ _ ✓ _ •'t�� AV < , C
Roof
Misc: ../J/7/� ,
. ,- ' /
Final
PASS PART FAIL
Post & Beam -
Under Slab = s � �--
Top Out
Water Service
Sanitary Sewer
Rain Drains
einat)
PASS PART FAIL 4/ MECHANICAL °--Y---
Post & Beam
Rough In
Gas Line 47 0 / G
Smoke Dampers x , ..441‘
Final �,�� . .
PASS PART FAIL a‘ %•� Vi i.
ELECTRICAL !'' IJ'
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 3„,,.....__ Other Date I Inspector / 7,24 Ext
Final
PASS PART FAIL DO OT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
1 BUP
Date Requested AM PM BLD
Location 1 17 ( � ( Suite MEC
Contact Person Ph PLM — 00 ? 7
Contractor Ph SWR
BUILDING Tenant/%0 T9 — 333/ ELC
Retaining Wall ELR
Footing Access:1
Foundation FPS
Ftg Drain • i J `° _ SGN
Crawl Drain Insp-ction I. otes:
Slab �.� �� - — ' • • —�� SIT
Post & Beam /
Ext Sheath /Shear
Int Sheath /Shear
Framing
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling �" L
Roof
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service t) P
Sanitary Sewer
Rain Drains
PART FAIL
M HANICAL
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 _
Other oach /Sidewalk Date 0 ( / � Inspector ) / J v 'r Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.