Permit A .
CITY OF TIGARD
A�� , ,„ DEVELOPMENT SERVICES PLUMBING PERMIT
�' "���� I PERMIT # PLM97 -0502
=:_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: 12/09/97
PARCEL: 251O4CC -00100
SITE ADDRESS...: 13713 SW TRACY PL
SUBDIVISION • HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK LOT °106 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: Installation of residence backflow prevention device for landscaping.
Owner: FEES
WINDWOOD HOMES type amount by date recpt
14076 SW BENCHVIEW TERR PRMT $ 15.00 DRA 12/09/97 97-301571
TIGARD OR 97224 5PCT $ 0.75 DRA 12/09/97 97- 301571
Phone #:
Contractor
CEDAR LANDSCAPE
14375 SW PATRICIA AVE
HILLSBORO OR 97123
Phone #: 503 -628 -3411 $ 15.75 TOTAL
Reg #..: 000058
REQUI RED 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 DAR 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.
Issue By: 01)-4.44L4-4 Permittee Signature: Cs�v -
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
;ITY OF TIGARD Plumbing Application Recd ey -.J)
3125 SW HALL BLVD. Commercial and Residential Date Recd , 9--q - 7
- 1GARl3, OR 97223 Date to P.E.
503) 639 -4171 oats to OF
Permit ill l'' 9 7 05
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Called
Name of Devetopment1Project F3.3cM4§;Qndlvldua)) 011001. :�. 1P 4gMTg
Job /v,y /sh%P - 8sr,4rEs 4r /06 Sink 9.00
Address Street Address Suite Lavatory - 9.00
a 7/,3 Sw TRHy 1�' L Tub or Tub/Shower Comb. 9
Bldg it City /State Zip Shower Only
krf gRRD 0R . 17 2 2 f Water Ooset 9.00
Name. ' / / 9.00
yV ikuDiocre G� � Me5 Dishwasher 9.00
Owner Matting Address Suite Garbage Disposal 9.00
Washing Machine 9.00
City/State Zip Phone - -- Floor Drain Y - 9.00
Name ■ r 9.00
' 4 ' 9.00
Occupant Mailing Address Suds Water Heater 9.00
Laundry Room Tray 9.00
City /State Zip Phone Ual -
rvh 9.00
Name
Other Fixtures (Specify) 9.00 •
CEAAK L..4ivascry -CNC . 9.00
Contractor Melling Address - - suite - 9.00
1.137s- Sui Address, ,4,e
(Prior to issuance 9.00
applicant must � np rp7 / -.31 a 9.00
provide all Oregon Corot Cant. Board Liss Exp. Date 9.00
contractors S e• - 4 7?
9.00
license Plumbing Lk, s Exp. Date Sewer - 1st 100'
30.00
Information / 3.2 s 6-W - Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro it Exp. Date yya Service -1st 100'
database). 30.00
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' • 30.00
or Mailing Address Suite Storm & Rain Drain - each additional 107 25.00
Mobile Home Space 25.00
Engineer City/State LP Phone C Back Flow Prevention Devoe or Anti- 25.00
•
Oescnbe work New /Addition 0 Alteration 0 Repair 0 Residential Beddow Prevention Device' / 15.00 /3 �°
•.o be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of worts
- Catch Basin 9.00
-_ Insp. Insp. of Existing Plumbing 40.00
per/hr
'Existing use of Specialty Requested Inspections 40.00
perihr
:adding or property Rain Drain. single family dwelling 30.00
'Imposed use of Grease Traps 9.00
kidding or property
QUANTITY TOTAL �•f •: -;j'.
7 :.� : � - i A - Ay
'km you capping , moving or replacing any fixtures? Yes Isometric N Isometric c or riser d en diagram am is required Ouanay Total > z :1 ...l 9 :: ,
;If yes see back of form) 'SUBTOTAL - -- r-- , - -• - . K;- crG
..:•; .' " /cam
ckn
i
• hereby acknowledge that I have read this application, that the information -
;rven is correct that I am the owner or authorized agent of the owner. and 5% SURCHARGE _- :::,;.
.hat plans submitted are in compliance with Oregon State Laws.
signature f - Owner/Agent Date PLAN REVIEW 25% OF SUBTOTAL :i
Q� Required only I hours qty. to121 is 2. 9
- �
,c. 4174( /.2 - 9 97 TOTAL - . ,. /5 -3 - __
�. -. ��
antact Person Name Phone - - - ' '�• --
/ 'Minimum permit fee is 525 + 5% surcharge. except Residential Backflow
,ive L✓' /Q 70,E --Zs03 Prevention Device. which is $15 + 5% surcharge
I: \plmapp.doc 12/96 (dst)
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved. or replaced Qty :.
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)
:OMMENTS REGARDING ABOVE:
1: \plmapp.doc 12/96 (dst)
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: C 7 — /0 — q g A.M. 0 X MST: 7 " M SS
Location: 13 7 / 3 S W t4 a. c__L U . ex BUP:
Tenant: Suite: Bldg: MEC:
Contractor: Cy Phone: 703 - J , / -- PLM: 9 7- 0 (53239-2. der: Phone: J ELC:
ELR: 9 7-d 35D
SIT: .
BUILDING LDG on't) PLUMB I ►_ . i ELECTRICAL SITE
Site • os r : earn Po : • :. P os : y. 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
..ipP • rI c_31201....: Approved Approved
Appr /Sdwlk . • ...roved Not oved roved Not Approved Not Approved
I • ' INAL FINAL FINAL
0 0 --e - 2-->liZet— re-t-A---"R 1.4g—v-e-
�.-■■-...n '4-4 JI • Cal mar* ICI st..�. 6..w� c .� 2 ..<
J g - 2- 4 -97
)3 B
O Call for reinspection '� 0 Reinspection fee of $ required before next inspection 0 Unable to inspect
Inspector: :.� i��/ Date: L / /0 ` 7 Page of