Permit r
>~ CITY OF TIGARD
4, ,,� DEVELOPMENT SERVICES PLUMBING PERMIT
�! . .- 13 125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE I ISSUED: 04/10/98 8 -0093
PARCEL: 2S114BB— 12300
SITE ADDRESS...: 10436 SW TITAN LN
SUBDIVISION • SWANSONS GLEN NO.2 ZONING: R -12 PD
BLOCK LOT •064 JURISDICTION: TIG
CLASS OF WORK..:OTR 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: Installation of residential backflow prevention device.
Owner: FEES
JOSHUA GERTH type amount by date recpt
10436 SW TITAN LAND PRMT $ 15.00 DEB 04/10/98 98- 304862
TIGARD OR 97224 5PCT $ 0.75 DEB 04/10/98 98- 304862
Phone #:
Contract or
OWNER
Phone #: $ 15.75 TOTAL
Reg #...
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP/Backf low 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- % '.1-0010 through OAR 952 - 0001-0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued B • , Permittee Signature• _ _ —, i` —
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next.business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
. . , . - - -
CIT ' OP''IGARD Plumbing Application Recd By �-�J•
13125 SW HALL BLVD. Commercial and Residential Date Recd il -/o
TIGARD, OR 97223 Date to P.E. '-
Date to DsK ,--
(503) 6394171 Permit# YLM4S( -oo93
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. I
Job FIXTURES (Individual) - • - QTY PRICE AMT
Address Street Address Suite Sink 9 00
Lavatory 9
Bldg # City /State Zip ' Tub or Tub /Shower Comb. 9.00
Name Shower Only 9.00
775,4/ o A /-i G /-2 7;9- Water Closet 9.00
Owner Mailing Address mss- Suite Dishwasher 9.00
/O i/36 56 , 1s-TM/✓/ Garbage Disposal 9.00
City /State Zip Phone Washing Machine 9.00
Nam A72p ` S / Az53) 9 b %-919 -Floor Drain 2' 9.00
3" 9.00
Occupant Mailing Address Suite 4" 9.00
Water Heater 0 conversion 0 like kind 9.00
City /State Zip Phone
Laundry Room Tray 9.00
Nam J Urinal 9
x ' �, v �� Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
Prior to permit City/State Zip Phone 9.00
issuance, a copy 9.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date _ 9.00
required if 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 NI, Addition 0 Alteration 0 Repair 0 Pollution Device
to be done: Residential X, Non - residential 0 Residential Backflow Prevention Device* 3 15.00 S /6�
Additional description of work: Any Trap or Waste Not Connected to a Fixture 9.00
ADD TT LOA) OA A Ss 2 iit /c 1 - i& Catch Basin .. 9.00
S >'STfpi Insp. of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40.00
building or property h I _ per /hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property //O 7"7 p'
QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Chanty • Total is > 9 '
given is correct, that I am the owner or authonzed agent of the owner, and *SUBTOTAL "
that plans submitted are in compliance with Oregon State Laws. 2
Signature o ner /Agent Date 5% SURCHARGE
"Zzta • 71
ct rson Name /� 6 PLAN REVIEW 25% OF SUBTOTAL '
Required only if fixture qty. total is > 9
' TOTAL � .
'Minimum permit tee is $25 + 5% surcharge, except Residential Backflow •�s
Prevention Device, which is $15 + 5% surcharge AY
i ldststpimaop doc 5/97
PLEASE COMPLETE: �.
_ Fixture T Quantity by Words.d?erformed -`
P � tY Y'
- �
New Moved Replaced � = Removed/Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower_Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3 „
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
l3 /aC /e r.! p/z c t ,fivr raa ,r)fvx-c
•
3OMMENTS REGARDING ABOVE:
I;ldstslplmapp doe 5/97
.- -- -CI.TY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour, Inspection Line: 639 -4175 Business Line: 639 -417
• /d g- BUP
r . I 1 Date Requested ���` 9 AM PM BLD
Location /0 i�.r 40—• Suite tir 9 7— 4
Contact Person .v ✓� Ph ‘/..3.4020 ,PL 9/ — �09�
Contractor Ph SWR
•
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: li
Slab ��. `' u-/G SIT
Post & Beam
Ext Sheath/Shear — �
Ina She
In th /Shear , _ / . y�C'✓�( —
Framing
Insulation
l.N v �—
sulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS P RT FAIL
PLUMB
Post & Beam Under Slab G
Top Out 1– Q bt
Water Service Ciej
Sanitary Sewer
Rain Drains
Fina
F • ' RT FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
irta
S ART FAIL
CTRICAL
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 Date v� 6 Inspector \/ (_j LJ Ext • J
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.