Permit .
•
" A CITY OF TIGARD
��� DEVELOPMENT SERVICES PLUMBING PERMIT 1
!+L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT ' ° ° ° ° ° ° ° �. `' " - `�'' ��' `*
DATE ISSUED: 02/04/99 S
PARCEL: 251 1 0CD- 0 11.14
SITE ADDRESS...; 11755 SW QUEEN ELIZABETH ST
SUBDIVISION. . ; KING CITY NO. 2 ZONING:
BLOCK........... LOT ° ° °, ° ° ° ° °. ° °° ° JURISDICTION° KIN
CLASS OF WORK.. e OTR GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES. O
TYPE OF USE.... :COM WASHING MACH......; 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..oB FLOOR DRAINS......: 0 TRAPS..............: 0
STORIES........: 0 WATER HEATERS...... 0 CATCH BASINS.... , ... 0
FIXTURES-------- __.---- _.. -_— LAUNDRY TRAYS.....: 0 SF RAIN DRAINS - ID
SINKS.........: 0 URINALS............ 0 GREASE TRAPS . 121
LAVATORIES--; 0 OTHER FIXTURES....: 01
TUB/SHOWERS...: 0 SEWER LINE (ft) ...: 0
WATER CLOSETS.: I?I WATER LINE (ft) ... : vl
DISHWASHERS....: 0 RAIN DRAIN (ft) .. ,.: 17+ • .
Remarks: Installation of commercial backflOw prevention device.
Owner:
MOOKI DENTAL LAB type amount by date recpt
1 1 [470 SW KING j(MF9 PLACE PPMT <1; 25.00 DEB 02/04/99 KING CITY
KING CITY OR 97224 5PCT $ 1.25 DEB 02/04/99 KING CITY
Phone fly
Contractor— ---------------- -
ANCTIL PLUMBING INC
169010 SW MERLO RD
BEA V E RTON OR 97008 ------------------------------------
Pho n e $ : 5103 - -642 -.7323 $ 26.25 TOTAL.
Reo tl. . o 0061302
------- _ REQUIRED INSPECTIONS ---- - -. - -.
This permit is issued subject to the regulations contained in the • RP /Backfl.ow Prev _______ ____
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 Dore _____. _ __,__
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 9 -00 01 -0010 through OAR 952 -0001 -0080. You nay _ _ _ _ ___ _�._
obtain copies of these rules or direct questions to OUNC by calling _
{503)246-1987. .
I s suec Bye L _ . . / `_6-NV � ) 4 P e r m i t t e e S i gnat u r e: Jfi (C, Z.. -- _,_..�
+ +++++++-++++++++++++• i-- f-- I-+++++++++++- I-+±+ +-I- ±+ +±-1- + +-I- + + +- I•-F +•I-•I• - +-I- + ++± ++ + + + ++± ++ ++ +-I-±
Call 639 -°4175 by 7 :110 p.m. for an inspection needed the next business day
+• +- + + + +-I-•h + +-I- + + + + +++• ++ +++ i-+++++- 1-++++++++++++++++++•- I-+• +++ + +-I-.}. + + + + +- ++++ +- ++• +-••I +-I- + ++ ++
•
' F B 04 -' 99 THU 14:10 I D: FAX NO : 1110? P02
CITY OF 'TIGARD Plumbing Permit Application
Plan Check egc
Commercial and Residential Recd By R. 4
13125 SW HALL BLVD.
TIGARD, OR 97223
(503) 639 -4171 Date Recd arL-1 - 44
Date to P.E.
Print or Type Date to D� a.- 4 I
Incomplete or illegible applications will not be accepted Permit, rL-Mqq
Related SWR a
-- r t)_ a P 9 p 0 1 6 Called
Name of DevelopmenuPro ct " -r
Job / /G d d 4 ��'�--/`f / / 7 'C_ ( ! g Sink c f'1� lit � -
�'; { 7 9 �1 ? ,c r
9.00
Address Street Address , Lavatory
9.00
1 / T � s - �� 7 b56 r Tub or Tub/Shower Comb. # City/State 9.00
4 Sh Only ci b 9.00
Wat
Name er Closet 9.00
Dishwasher
Owner Mailing Address Suite Garbage Disposal 9.00
9.00
City/State Zip Phone Washing Machine 9b0
Floor Drain/Floor Sink 2" 9.00
Name 3"
9.00
4 ' 9.00
Occupant MaiItng Address Suite Water Heater 0 conversion 0 Pike kind 9.0o
City /State Zip Phone Gas piping requires a separate mechanical permit.
Laundry Room Tray 9.00
Name Urinal
A /075 t fi v,79 t6! ,./- Other Fixtures (Specify) 9.00
Contractor /a'9,'°jd6 SIAJ / jam, 9.00
`7 9.00
Prior to permit CI1y /tale Zip Phone Sewer -1st 100'
issuance, a copy g EA 900 to ( '!Z- ?3 25.00
Sewer
of all licenses are Oregon Const. Cont. Boara tic.* Date
each additional 100' 25 00
required If 2. y, ?y '7 t -cr7 • Water Service - 1st 100' 30.00
expired in COT Plumbing c. �� z P� E,m,Q Water Service • each additional 200' 25.00
database 6 r / Storm & Rain Drain - 1st 100'
30.00
Name
Storm & Raln Drain - each additional 100' 25,00
Architect - Mobile Home Space 25.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25,00 o• al Pollution Device
Engineer city/swte �P Phone
9 Residential Backflow Prevention Device* 15
(Irrigation liming devices require a separate [•� �'
Describe work to be done: restricted energy permit.)
New Or Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a.Ftxture 9.00
Residential 0 Commercial4r7 Catch Basin
Additional description of work! 9.00
)4 cL" F /Ot✓ nevi CE 14/� Insp. of Existing Plumbing 40.00
Specially Requested Inspections 40,00
/1 r! 6� /r~9`) /JAI ,S'c f,Se j 40.00
per/hr
Are you capping, moving or replacing any fixtures? �ln Drain, single family dwelling 30.00
Yes O No O Grease Traps 9.00 •
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL .'-': ; .1 .-= ; "-`
WORK COULD RESULT IN INCREASED SEWER FEES.
Is° rn` In`° re °erataQre"'1�'eQ"ir'd'd +'''` ` ' ')
Quantity Total is s 9 h r'L ' ;
I hereby a- rm
edge that I have read this application, that the information 'SUBTOTAL i :� 7.---,p5., ,r I � 1
given Is wrr , that I am the owner or au • ed agent of the owner, and ' ' . -
that plans brr are In oompllan r n State Laws. 6% SURCHARGE x� . <
• Signatu • of Owner/Agent . i. " C r r 1i
• � " �� ''PLAN REVIEW 2 OF SUBTOTAL s ' ~ ` � < ' ` " r
Re • het an d future • t a r ;
ontact Person Name Phone TOTAL i Y y t ` f „ fir
/67AJ -- . %,(/Z --7 - Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
c Prevention Device, which Is $15 + 5% surcharge
"Ali New commercial BUildings require plans with isometric or riser diagram
and plan review
la stMilturn ODA eoc 7298
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
C / , r BUP
> ` /` / -70 , Date Requested r7 /ff AM X PM BLD
Location //75:5 cm,2
_ Suite MEC
Contact Person Ph PLM f OCb-V
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: / t��
Slab (0`Z� SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
�p LUMBIN
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain
1 '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 • r reinsction RE [ ] Unable to inspect - no access
ADA
ea,
Approach /Sidewalk Date (� I E x t Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.