Permit iu,.,.r, „�, • DEVELOPMENT, SERVICES • � ' PLLJ RTNG 'ER i�`IIl
. _• ' I! , 13 125 S W Hall. Tigard; OR 97223, (503)"639 -4171 PERMIT . k ° ° . a •'� PL1M9 C 1 7 '
• DATE ISbUED i E,- ,/'c'i�/ X32 r
'. -
' . ` � . PARCEL ; 2S 1 ` 1:-DB7 -041 `0 , '
SI Tr ,•ADDRC,SS.... 1:1;13 .511 'WE!_L `L i° PI_ _
SUBDI.V'ISION�. n -.. ; Wh1ES;3URY HE'IGI -ITS . ZONIi\I a 'R-- 4. -5_, '
' BLOCK ;, , • .. LOT'...... z-.'.. n .', `0 -+1 JUR "SDICTI'f')N - TI :G' • -•
CLi=itS OF };o . ALLT -- GAR ACE DISPOSALS ' 0' - _ 1 :CLE IIQIY9, '41= ''flc "E'So �,,. •
.'TYPE OF US[E,. ... . ;SF ' ' • 'InPSHING MAC1-1'; ... ,' ▪ - V1'' . .BI' C ,FLOW, r"'RE6,4,T,RS: 1,,; '
• :OCCUPANCY G,RP. _ ; R3' , Fl..3Or3•'�DRR:[f‘�"_i. .•. ; ' ' 9..1' _ IRral= 'S:,.a . 'I. .•0.
EJ �� O R TES. a . '0�, , WATER HEATF.P.;7 . , 0 OfgTC:H " 1 G S,I h1s. i. ' el rr, F xT,URES -' -. -- _ _�_-- -�.,_- Lf �UMD,RY TF • . „, 0 ° S Rai •w, DIN ' n'� l e' ° „a.;,
S 'NKS., e ... .. , el' k ' . UR :ilNAL'.S. ...' _'; . rzi� GREASE • TFi PE. . . ,. , fl
L.AVATORIES.'. ,0 „ ; ',OTHER IXTIa� .E ,-.. 0 ; , „ ,' ,
•
TUB i SHOWERS' .' .. ' 0 SEWER LINE ( -ft •r .', 0. -
' WATER ' C ., . LOSETS , G'-I' . WATER L. CNE (ft i .1Z1 D:,51i'AS¢iERS . t l�' RA IN, DFif�Ti�#''if!:) . !?i
f emar'l-isi (Acid resident ial •backf1o4, pr °eventia'n - device.
.
. _ __ •
O=11;_ KNOLL CONSTRUCT ION INC , t.� , • -amount .by' date r;recpt•�' .'
4x035 514 DOUGLAS, WAY ' ' PRMT, $ ' 15'00 GEO IDS /,2P 9.8.7'308438 \
J S i 7 5- ' v T r,. r_ � . .'
LAKE QJL`.L❑ C7 r, �.��JJ ' F�G�. t 1L. 7,J CEiJ �c1�; /,�`I ':J8- ,��.�rrJ,\
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Pi RTL.AM1) OR 974_29, ' - - -- - -- - � _.:.L
Phone #2. C14-- 0E1ti'. , $ ' :15.75 ,TOTAL
, . - - -- - - - REOU1 RED INSPECT IONS - ' --
Tnis per ;it i, issued subject to' the regulations contained in th, .RP /Backflow Pre, : . ,
, , I,4,ard' Municipal Code State of Ore. ' Specialty Codes and ell other F i ri al 'Os pt c: t ion — _
applicable laws, - All work hill' be done in. accordance with, ° _ ^;� � ,.
onro•ved plans. This perait will eerir,e if work is not started ,. ' . - '
' .:iithin IN days - „ of -i Ssuance`: 'or if or 'is suspended for °ere, ' - - ' ,
'than 18ri, revs: ATTENTION: Oregon ,law r: ;quires you to fglloW rules _
adopted by the C en ,Utility Notification Center. Those rule:, are' - „ . • � , •
• set' or"thi, in 'OAR 35-I-1 ��, through OAR X5'2- �zzvi -a+ o, : . Yo - eat �, - - - ` • ' ” ' - , 'i '
abta these_rti1Es'or dir quest .. ions :to GJ'C`'byy.'ca i n�3 ' -; ,'_ r ' ° - �1'' '
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6, -4175 by 7 00 . in. C,cr, 'rn i'nsp'et.1 i;a•;i needed i,I°►e ne'xt,- vs i. Cal -
✓ +- 9-- F- F- F- t• i- ++.4,- r- ' ±-F- t-+- F - ;-4- 1- + +=F- r +•h- F+,+= :--1- -F - +- i. + -F-[ -- •,t + + -F f -il i•-.1-'.4--1- -/- • i- -F + +- Ir +++-1-++ + '- ++=F-'! —i -; i - -i =-1 - - 1-- 1- -F•f=,F ' .
CITY OF TIGARD Plumbing Permit Application Plan Check#
/ 13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 ' Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# 19cr7g -o/F-y
Related SWR #
°�� Called
Name of Development/Project GETS On back indicate Work Performed by fixture.
Job / indivi ... . ......,. _ .,. M
M 2 Y f f pQ1,(� � s �{ Q FU(TURES rl . �: . . .' :QTIf�� ;'PRIG , nA T -�
. .F 7
Address Street Address Suite Sink 9.00
131 ci Sw we-I-_I'a N Lavatory 9.00
Bldg # City /State Zip Tub or Tub /Shower Comb.
T `f -a1 8� 9.00
Name I Shower Only
9.00
C3 '4. LL ( 'p N s T Water Closet 9.00
Owner Mailing Addrreeeks Suite Dishwasher 9.00
¥1'35' vbe/ 4-c/5L / 5 P Garbage Disposal 9.00
City/State Zip Phone
Z/t�-- i .' l�io`� " �, Gl 7 s Washing Machine 9.00
Name " Floor Drain 2" 9.00
3 " 9.00
Occupant Mailing Address Suite 4" 9.00
City /State Zip Phone Water Heater 0 conversion 0 like kind 9.00
Laundry Room Tray 9.00
N me Urinal 9.00
- - - ._ . - __ -_ -- -- O.Qt ( _vJ CI- ( .._-- - - -:__ _- =Other-Fixtures - -- -
Contractor Mailing Address Suite _ - -- - =9:00 - � __
°
17 165 hfw C/Vet_ Ct 9.00
Prior to permit City/State Zip Phone 9.00
issuance, a copy f t , (Z11.4./• p i o 1 7 2 29 6 I y.- (<< Sewer - 1st 100' 30.00 '
of all licenses are Oreion Const. Cont. Board Lic.# Exp. Date Sewer - each additional 100' 25.00
required if 12,‘C" (1/9 3 Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. it Exp. Date
database Water Service - each additional 200' 25.00
Name Storm & Rain Drain - 1st 100' 30.00
Architect Storm & Rain Drain - each additional 100' 25.00
Or Mailing Address Suite Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Engineer City/State Zip Phone Pollution Device
Residential Backflow Prevention Device* t 15.00 15 CA
i
Describe work New Addition Alteration 0 Repair O Any Trap or Waste Not Connected to a Fixture 9.00
to be done: Residenti Non- residential 0 Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
per/hr
Existing use of
Rain Drain, single family dwelling 30.00
building or property Grease Traps 9.00
Proposed use of QUANTITY TOTAL .! :`••riz= :: e ; :�: �.':�: -i c :/
building or property Isometric or riser diagram is required if Manny Total Is > 9 _ x° ::".::::::M.:4::9 : >
,
'SUBTOTAL - .r :`4;.;.4
• I hereby acknowledge that I have read this application, that the information :. = � ...<,: , I,F,:.:: L':
given is correct. that I am the owner or authorized agent of the owner, and
5% SURCHARGE z ` "' = =r r ':: ' ;_..
that plans submitted are in compliance with Oregon State Laws. + r �. A ° rraA = °::.J
Signature of Owner /Agent Date "PLAN REVIEW 25% OF SUBTOTAL °" .. ` ' "° "'" V: •'t'"-'°:'L:
Required only rf fbdure qty. total is > 9 >...Ca: ,;,; c.. -c '
r (� l O TOTAL : :. K - ,. �: _3
r2 ^T'S t i
Conta arson Name Phone " " °" r" 7
,�,�{,
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
b r-6 t wl , JCcf� -L 61(-1- ( 'l' Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
and plan review
lidstatpiumbapp.doe 5/5/98
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
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
stslplumbapp.doe 5/5/98
(c CITY OF TIGARD BUILDING INSPECTION DIVISION
. 24 -H ur Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP
A LA - krg Requested ) D /�/ AM C-..---6 PM BLD
Location 1 3 3 � i � � v∎ e-- .Suite MEC n � ?
Contact Person ' Y -V--2. \ 1 0 S (c Ph - 7 d / - C1 G ) ¢ PL M '1 b - 0 0 k °-.
Contractor • Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab 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 P4`RT FAIL
cc M )
Post & Beam
Under Slab ()A-
/
Top Out � �
Water Service (pf3
Sanitary Sewer /
Rain ains ��(( ,
na
AS J PART FAIL
MECFIANICAL
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
i/ '
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 1 Y1 Inspector tk Ext I 5-
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .