Permit CITY TIGARD PLUMBING PERMIT
I, DEVELOPMENT SERVICES PERMIT #: PLM1999 -00328
�� c al II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 ni 1 �t NE ISSUED: 10/12/1999
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SITE ADDRESS: 09057 SW WESTLUND CT PARCEL: 2S111AD -16400
SUBDIVISION: MALLARD LAKES ZONING: R -4.5
BLOCK: LOT: 030 JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace existing poly water pipe with CPVC.
FEES
Owner:
Type By Date Amount Receipt
TODD GARCIA 5PCT DST 10/12/199E. $4.00 99- 319017
9057 SW WESTLUND CT PRMT DST 10/12/199E $50.00 99- 319017
TIGARD, OR 97224
Total $54.00
Phone 1: 684 -8219
Contractor:
PLUMBING CONNECTION
PO BOX 7460
BEAVERTON, OR 97007 REQUIRED INSPECTIONS
Phone 1: 245 -8021 Water Line Insp
Reg #: LIC 00064111 Final Inspection
PLM 34 -304PB
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 adopted by the Oregon Utility
Noti • enter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
Y.0 may obtain opies of these rules or direct questions to OUNC b c !ling (503) 246 -1987.
I ued
By: _ � q 7 i . �.
y /� • s 4 ,l i Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day ) Y p Y
CITY OF TIGARD Plumbing Permit Application Plan eck#
13125 SW HALL BLVD. Commercial and Residential Rec'. By 'i-
TIGAR[3, OR 97223 Date Recd P /, ' - d 1
(5113) 639 -4171 Date to P.E.
Print or Type Date to DS
Incomplete or illegible applications will not be accepted Permit# v-, 1% -003;.?
Related SWR #
Called
Name of Development/Project I FIXTURES (individual) • QTY PRICE AMT
Job Sink 11.50
Address Street Ad re Suite Lavatory 11.50
° f WrV � (_L».Xl7 - . Tub or Tub /Shower Comb. 11 50
Bldg # City /State Zia Shower Only 11.50
Name / I iz Water Closet/Urinal (Specify) 11.50
1 o ta ! 9 (� a Dishwasher 11.50
Owner Mailing Ad ss "� Suite Urinal 11.50
° )051 c.LY41D 6- 1 '0 • Garbage Disposal 11.50
� Ci /Stat Zip Phone q 11.50
tCII1F -��• °l - r 22 I GaS4 el- ) Laundry Tray
Name 1 `� Washing Machine /Laundry Tray (Specify) 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
( akE:?4-A-3(°1611 pM MFG Home New Water Service 32 00
Contractor Mailing Address C. � Suit? MFG Home New San /Storm Sewer 32.00
4� , V , / 5 i . /..(, � • Hose Bibs 11.50
Prior to permit CV /State Zip Phone Roof Drains 11.50
issuance, a copy )p -,�Pl 91303 SSI - SS 5 5
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. +
t. Board Lic.# E � 2 Exp. Dat
required if (.041 i \ TI DM? Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp Da e 4 -36-0,
database 1
Name 1 34
Architect Sewer -1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City/State Zip Phone
Water Service - each additional 200' 32.00
Describe work to be doe: Storm & Rain Drain - 1st 100' 38.00
New 0 Rep with like kind: YesX 0 Storm & Rain Drain - each additional 100' 32.00
Residentia Commercial 0
Commercial Back Flow Prevention Device 32.00
Additional description of work:
I Residential Backflow Prevention Device* 19.00
G� �,L. CIIZICP- )12�1� �/ G� t V(...■ Catch Basin 11.50
A you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 fj 0
Yes 0 No 0 Inspections j per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45 00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if QUANTITY
Total is > 9
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL,
t plans submitted are in co liance with Oregon State Laws. ...
Lure of r e Dat
i0112\� 8% SURCHARGE 1 (, GO
Contact Person Na e SSl. S
**PLAN REVIEW 25% OF SUBTOTAL
BA�TH ; . �^` a r j
AT Required only if fixture qty. total Is > 9
B H 0 ,4 E $250 00 s TOTAL �j/ OU
BATHH $2135 00 �: i - . •/�
This Includes- II plumbing xtures n the'. elling and the first, *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
ooYeet sal sevuer s>:ormsewer and yil a mice) _ Device, which is $25 + 8 % surcharge
**All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I Wstslformstplumapp doc 10/8/99 - - -
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I Wsts \forms\plumapp doc 10/8/99 — -
CITY OF TIGARD BUILDING INSPECTION DIVISION •
MST
24 -Hour Inspection Line: 639 -4175. Business_ Line: 639 -4171
IQ c , BUP
(9 6 ► Date Requested 10/ IS (( 1 AM PM , BLD
1
Location 0S-7 -54 tik SH-0. / 4 C Suite MEC
Contact Person x6 PLIAMC61 eO)l ALCh DX. Ph 8Vl — ASS PLM ( 'P 'P 9 -67 3c
Contractor Ph SWR
BUILDING Tenant/Owner eli3 d 2 a /&a - L8'- 8 -/ ELC
Retaining Wall ELR
Footing Access: J g� FPS
Foundation /
Ftg Drain
Crawl Drain Inspect Notes: n SGN
i n
Slab r � � SIT
Post & Beam
Ext Sheath /Shear / • ' �
Int Sheath /Shear /
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling � /�i _ _� / /L %� ` 1i _f �i
Roof `
Misc:
Final
PASS PART FAIL 'd 'L -
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer /
Drains
PART FAIL
MECHANICAL
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
Approach/Sidewalk /0/ /J Oth roach /Sidewalk Date [ Inspector ?��/ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.