12165 SW 123RD COURT r
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--- 12165 SW 123TH (:(YJRT --
\ CITY OF TIGARD ,— PLUMBING PERMIT _
DEVELOPMENT SERVICES PERMIT f#: PLM1999-00213
13125 SYJ Hall Blvd., Tigard, OR 97223 �¢j�6���7�� � DATE ISSUED: 7/14/99
SITE ADDRESS: 12165 SW 123RD Cl- r� PARCEL: 2S103BI3-115C0
SUBDIVISION: YE OLDE WINDMILL ZONING: R-4.5
BLOCK: -_ LOT: 034_ JURISDICTION: TIG
Cl.A,S OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME "PACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS- CATCH BASwiS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER F!XTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Rt-..narks: Installation of residential backflow prevention device.
FEES ---- -----
Owner: �—__ _-
GENEVIEV= MELONE Type By _- ` Datz Amount Receipt
12165 SW 123RD CT PRMT DEB 7/14/99 $25.00 99-316846
YARD, OF. 97223 MISC DEB 7/14/99 $1.75 99-316846
Phone 1: —
-- Total! ?q
Contrac.O.or:
PRO LANDSCAPE INC
3045 SE 61 ST CT
HILLSBORO, OR x° '23
REQUIRED INSPECTIONS
Phone 't: 642-5696 RP/Backflow Preventer
Reg M LIC 7013 Final Inspection
FLM 12.174
This permit is Issued subject to the regulations contain id ,n the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. V work gill Le done in accordance with approved plans.
This permit will expire if work is not started vyiihin 180 days of i3-.uunce, 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 arc. set forth in OAR 952-0001-0010 through OAR 952-0(`01-0080.
You may ohtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
C,�lr.�vv`c _ l
Issue By: � t Permittee Signature; � •�
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next butIiness da
City 5 Tigard
25 PBING PERI_TCATION
131S!N Hall Blvd. LUMMAPPLIPlanck/Rec. # — --�---------
Tigard, OR 97223 Permit # 77 rs
(503) 639-4171
MINIMUM $25.00 PERMIT FEE +ST, SURCHARGE
Nvw Sin le Frmi Residencros Only
Job k ! 7 1 BATH HOUSE$140.00
Ads!;eerjowner 'e'r ' )--�L=_��v � � � 2 9ATH HOUSE$195.00
ar. Fee includes all plumbing futures in the dwelling
0
k N Z 3 if water service, sanitary sewer and stOrTn ewe and the first 100 feet
sewer. See feesbelow.
FIXTURES,T^ rr'' QTY PRICE A `des.., V v� Sink .�Yt� R. Lavatory 9.00
/� 9.00Tub or Tub/Shower Comb. 00'/jCC_ C Shower Onty - 9.00
r Myie,�r Water CIO-$~
Dlshwasher� 9.00
Occupant9.00
>r.e,a,,,,,.. Garbage Disposal
Ph� 9�
Washing Mactiinn —
9.00
$,.are. Floor Dain --
�1. 9.00
Water Heater
Laundry Room 9.00 Tray 9.00 -
,>� _ Urinal
9.00
w+q Aar.w v ' Other Fixtures (Specify) 9
Contractor00
9.00
�(. ' `�/ ar 9.00
VL 9.00
crew a.a.r�Ha Sewer 1st 100'
Sewer-ea. Addft. 100' 30.00
25.00 -----
I hereby acknowledge that I have road this apnlicaticne` Water Service 1st 100'
_ 30.00
information given is correct, that I am tl wvner or authonzed agent of Water Service ea. Addit. 200'
It, owner, That plans submitted are In cumpliance with State laws, that 'S
1 cm registered with the Conshlu-Jon Contractors Board, that the 5fo� &Rain Drain 1st 100' r --
30.0
number given Is correct. t xempt from State registration, please Storm & Rain Drain Addit. 100'
giv reasun below.) — 25.G0
Mobile Home Space
25.00
Back Flow Pion
Z Device or Anti-POIlutIon Device 9 r` Ui
°r• 4ny Trap or Waste Not
Desnnbe work new _ Connected to a Fixture
addition (� alteration repair (� 9.00
to be dons rosidential hatch Basin -
n non-residential 90
Insp. of Exist. Plumbing-
_ a�1oomr-
Existing use of Specialty Requested Inspections 40.00lhr
building or property V- Rain Drain, single family dwelling
30.00
Residential backflow prevertlon
Proposed use of devices
---�_.____
budding or property — 1500
Prevention devices)
—__
NOTICE °Mlnimum Fee $25.00 SUBTOTAL
PFRMI f S BECOME VOID IF WORK OR CONS TRUC TION ~— CV
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED WSURCHARGE �-
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED
PLAN REVrFW 281; OF SUBTOTAL.
Special Conditlons
TOTAL '
Date issued by
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -
BUP
Date Requested AM_ Pfvi _ BLD
Location Z- Z, �'l �7 Suite _ M
Contact Person Ph M
Contractor P � S L C C -� Ph (DL12 - .S(L 4 SLUR — ----
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation '/ Lp - � I'PS
Ftg Drain r .� - SGN
Crawl Drain Inspection Notes: -
Slab r �' SIT - --- ---
_ r �I ---
Post 6 Beam -- -----
EA Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm ,
Susp'd Ceiling _ —
Roof
Misc: - - — - _ - - _
Final
PASS ART FAIL ------------------- -.----..____T__
MBI Ci-
r567s &Beam --L�� -
Under Slab �✓4
TopOut --------------------__ -_ - - _ �"' - .-,
Water Service
Sanitary Sewer 771-1
Rain„ rains
PART FAIL
te FIANICAL
Post& Beam
Rough
,. _ - -- -- - - - - --- --------
Rough In
GasLine --- _... --- - - --- - --- ---- _ - ----
Smoke Dampers
Final __--____w ------ -- -
PASS PART FAIL
ELECTRICAL ----- -- --.__..--------_—_--
Service
Rough In _-
UG/Slab
ow Voltage
F1 o Alarm _ _—
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain ( J Relnspectlon fee of; required before next Inspection. Pay at pity Hall, 13125 SW Hall Blvd
Catch Basin ( J Please call for reinspection RE:_ _,-- ( j Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date CJ I ispector — E.
Other ------
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the fob site.