Permit w
CITY TIGARD PLUMBING PERMIT
4 , ,,�n. DEVELOPMENT SERVICES PERMIT #: PLM2000 -00328
,.� ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: / / zoo
SITE ADDRESS: 10190 SW VIEW TERR PARCEL: 2S111 BC -01200
SUBDIVISION: GREENBRIER ZONING: R -3.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow device.
FEES
Owner:
Type By Date Amount Receipt
SEARS, ALLEN C PRMT CTR 9/1/00 $50.00 27200000000
c/o WILLIAMS, GRANT + LANA SPOT CTR 9/1/00 $4.00 27200000000
10190 SW VIEW TER
TIGARD, OR 97224 Total $54.00
Phone 1:
Contractor:
JOHN DARBY LANDSCAPE INC
13867 SW BENCHVIEW TERRACE
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone 1: 579 -5298 RP /Backflow Preventer
Reg #: LIC 7110 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other 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 ad • •ted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 - 0010th • , • • • A - • - ' 101 -0080.
You m ' eo•ies of these rules or direct questions to OUN ; , g (503) 246 -1987.
Is ued By: j l i i a/ -,v / // Per ignature: L
Call (503) ;39 -4175 by 7:00 P.M. for an inspection need, n -s day
CITY OF TIGARD .plumbing Permit Application Plan heck#
13125 SW HALL BLVD. Commercial and Residential Rec' By
Date Rec'd F
TIGARD, OR 97223
(503) 639 -4171 Date to P.E.
Date to � �
Permit # CHL9/jry00- q
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (individual)
Job Qty Price Total i
Address Street Address Suite Sink 16.60
Lavatory 16.60
Bldg # City/State Zip Tub or Tub /Shower Comb. 16.60
Shower Only 16.60
Name y G Water Closet 16.60
re) Nrea i ^ LC(vtgi ) t 1 Vitt J Urinal 16.60
Owner Mailing Address Suite
/®/ 9 ' i) pvvice Dishwasher 16.60
City/State ` n Zip Phone Garbage Disposal 16.60
t 1 SMA �\` q7 Laundry Tray 16.60
Name n w1 Washing Machine 16.60
Occupant M Address � P Suite Floor Drain /Floor Sink 2" 16.60
p 3" 16.60
City/State Zip Phone 4" 16.60
Name Water Heater 0 conversion 0 like kind 16.60
Gas piping requires a separate mechanical permit.
Name
R 1 I OS f 4 " '4 er 2 MFG Home New Water Service 46.40
Contractor Maili Address 1 ..1 Sue MEG Home New San /Storm Sewer 46.40
SO C. V o e W _Tell Hose Bibs 16.60
Prior to permit City/ tate Phon
issuance, a copy "Y, �A D' �C7i 3 Roof Drains 16.60
of all licenses are Orego Cons C nt. Board Lic.# Exp. Date Drinking Fountain 16.60
required if )) � // " "i' t)r Other Fixtures (Specify) 21.75
expired in COT Plumbing Lic. # Exp. Date
database
Name
Architect
Or Mailing Address Suite Sewer -1st 100' 55.00
Sewer - each additional 100' 46.40
Engineer City /State Zip Phone Water Service - 1st 100' 55.00
Water Service - each additional 200' 46.40
Describe work to be done:
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - 1st 100' 55.00
Residential 0 Commercial 0 Storm & Rain Drain - each additional 100' 46.40
Additional description of work: Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' / / 27.55
Are you capping, moving or replacing any fixtures? Catch Basin 16.60
Yes 0 No 0 Insp. of Existing Plumbing or Specially Requested 72.50
If yes, see back of form to indicate work performed by Inspections per /hr
fixture. Al URE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 65.25
WOR ' CO LD RESULT IN INCREASED SEWER FEES. Grease Traps 16.60
,� owledge . ham. rPad_this application, that the information QUANTITY TOTAL
* y niita<a:.. - • r authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
_ yF sal' i d a •_• r ' L ! • - . • , State Laws -
*SUBTOTAL o0
-o Person Na : P one 8 /o SURCHARGE
r �p
BATH OUSE $249 0• * *PLAN REVIEW 25% OF SUBTOTAL
1 -
2 BAT OUS 2 00 � ��" `� Required onl if fixture qty total is > 9
3 BAT OUSEf$399 00 tip `, , ; ', * TOTAL
(This fee nc udes al plumbing; fixtures +In the elling and-the:first 4
:100,fee ani . sewer torm ewer and ate `sery Ca , , dt , *Minimum permit fee is $50 + 8 %sur .
**All New Corume W uu n require plans with isometric or riser diagram and plan review.
I \dsts \forms\plumapp_rev doc 8/29/00
A
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
11dstslforms'plumapp_rev doc 8/29/00
Case Activity Listing 11/16/2004
Y g 11:55:10AM
TIDEMARK Case #: PLM2000 -00328
COMPUTER SYSTEMS, INC
Assigned _ Done Updated
I A Description - Date 1 Date 2 ° - Date 3 Hold Disp To 4 By By ;,- _ Noted
PLMA003 Application received 9/1/2000 None DONE DEB 9/1/2000
BLD
PLMA005 Create Permit 9/1/2000 None DONE DEB 9/1/2000
BLD
PLMA750 RP/Backflow 11/30/2000 None PASS TLP 12/4/2000
Preventer TLP
PLMA799 Final Inspection 11/30/2000 None PASS TLP 12/4/2000
TLP
PLMA060 (F) Issue permit 9/1/2000 None DONE DEB 9/1/2000
BLD
PLMA055 (F) Reprint Permit 9/13/2000 None DONE AMS 9/13/2000
AMS
PLMA800 Case Finaled 11/30/2000 None PASS TLP 12/4/2000
TLP
Page 1 of 1 CaseActivity..rpt
CITY OF TIGARD BUILDING INSPECTION DIVISION MST AI
Z4-Hottr Inspection Line: 639 -4175 Business Line: 639 -4171
. . BUP dill
_ ' Date Requested /1— 3 AM - PM BLD (i
1--
Location. / 5 / 'V''- Suite M EC ‘`
�,
ContacYPerson I D I g D 1 Mf Ta Ph •
5 t 73 Z L (i: � -ate 3Z
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
•
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Inf Sheath /Shear '
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ..
Fire Alarm
Susp'd Ceiling .
Roof
Misc: �y
final 0 V
PASS PART FAIL 0
BING
,- eam _
Under Slab
Top Out �l
�/ 5 ,
Water ice
Sanitary S er L
_ Rain Drains \
�� PART FAIL
CHANICAL -
Post & Beam - .
— Rough In
Gas Line . • ; i
Smoke Dampers \ ; 1 ''' ;■ ' ''=
Final
PASS PART FAIL - ' ° ''1 ,, �, .
ELECTRICAL ' .' .
Service
Rough In
UG /Slab i.:'' '
Low Voltage s '///
Fire Alarm j 1%
Final ..-=---- ., ' ,
PASS . PART FAIL
SITE r�
Backfill /Grading
Sanitary Sewer -
Storm Drain [ ] Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin 5
Fire Supply Line [ ] Please call for reinspection RE: - [ ] Unable to inspect - no access -
ADA "•
Approach /Sidewalk •
Other Date d, Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. - -