Permit CITY TIGARD PLUMBING PERMIT
IA` DEVELOPMENT SERVICES PERMIT #: PLM1999 -00396
13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/22/1999
SITE ADDRESS: 12259 SW 69TH AVE PARCEL: 2S101AA -09100
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 030 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: Install commercial backflow device.
FEES
Owner:
Type By Date Amount Receipt
TIGARD CORPORATE CENTER LP PRMT KJP 11/22/199E $50.00 99- 319966
15400 SW MILLIKAN WAY SPOT KJP 11/22/199£ $4.00 99- 319966
BEAVERTON, OR 97006
Total $54.00
Phone 1:
Contractor:
NORTHWEST LANDSCAPE INDUSTRIES
16075 SW UPPER BOONES FERRY RD
TIGARD, OR 97224 REQUIRED INSPECTIONS
Phone 1: 684 -1450 RP /Backflow Preventer
Reg #: LIC 7030E Final Inspection
ORIGINAL
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
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copie f these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: - � Q_, Permittee Signature: a. i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
RECEIVED fl y w al Cern fad-1064Q -
CITY OF TIGARD 19 1999 Plumbing Permit Plan Check*
13125 SW HALL Commercial and Residential Recd By
TIGARD, OR 97223 Date Recd
• (503) 639 -4171 COMMUNITY OEVEWI)MENT Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted !ff Uo 3 a,
Called
Name of Development/Project 7" i A -i t F . j r•-:..,. - " ¢ [ ' . .. - . u
�1 gG J 1 . 1 `- ..8�I1 . V - : °v� i.' ?f3. �' z' rf" °�'�fi�'f=:��'1�" =r':
Job TI 9 Otri pm ` � J Lavatory 11.50 -
Address 2: 2. 51 . w 6 94 it .
Tub of Tub/Shower Comb. 11.50
• Bldg * • City/State ZIP Shower Orly • 11.50
Tic a d r OR 4 7 Z Z 3 Water i (Spey) 11.50
Name ,
1 q c A.el (� " - pcn w - t e ows �. Qshwasher 11.50 '
Owner M Address � 6�r tk4 11f Sum Urinal 11.50
a -
/State Zip Phone Garbage Disposal 11.50
City/
, d R 91223 Laundry Tray 11.50
Name dd '1 Washing MaddnefLaundry Tray (Specify) 11.50
"T j Q �� (e rr � OI4 L Floor Draln/Fbor Sir* - 2 11.50
Occupant N s 1150
a ddress
( Z Z s f S A b e di' 4• 11.50
CitylState Zip Phone
. t o r O Q 4'72.2.3 Water Heater O conversion 0 lace kind 11.50
Gas piping requires a separate mechanical permit.
Igail i rue l,Uu1 tsca tat Tie 11�LlJ.) MFG Home New water Service 28.50
Contractor 9 Address MFG Home New San Stonn Sewer 28.00
/4D75 SW krr RRd. Hose Bibs • • 11.50
Prior topermit City/State Zip Phone • Roof Drains 11.50 • .
issuance. a copy Ti qa,►d j 6/2 47 22'/ i.94 • 14S0 Fountain 11.50
of ail
required licenses are 4pelat ConsL Cont. Board LIm4 Eim.pate
If 7Ds O I Other Fbltures 15.00
expired in COT Plumbi7 � pp OD
database e ISO P . 't 20/0 0 .
Name [L �� .
Architect L. (.S Aft" Pcr3 Sewer -1st 100' 38.00
or Malting Address Sucre Sewer - each additional 100' • 32.00
ii W SW 10 o Water Service -1st 100' . 38.00
Engineer t OR 9720S" t�ha>e Water Service - each additional 200' • 3x.50
Desa work to be done: Stain 8 Rain Drain -1st 100' 38.00
• New X Repair O Replace with like Idnd: Yes 0 No 0 Storm & Rain Drain- each additional 100' 32.00 •
Residential O lion o ndal
Commcrdai Bade Row Prevention Device .
description of work 3200 36.
//�� 4 � t � ,w�hI �� ,,�� �,�pp c""-01-1 Residential Beddow Prevention Device' 19.00
��res x+h- r•� Catch Basin 11.50
Ate you capping, moving or replacing any fixtures? Insp. of Edsting Plumbing or speaaly Requested 50.00
Yes 0 No if Inspections perrtr
If yes, see back of form to Indicate work performed by Ram Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps ' 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. • .. -
form QUANTITY TOTAL g : -.
' � -+ .-� i is!l' t
I hereby adohowiedge that I have read this application, that the intimation _ _ ::
Isometric or riser diagram is required it Quantity Total is >9 -;r = - * 3 ' `
-
given Is correct, that I am the owner or authorized agent of the owner. and
'SUBTOTAL } ;� iii;' 4=
tlha ens submitted are In compliance with Oregon State taws. = __ .56.0b
Signature - • , 'r /Ag. '',:,:-?•=1",--,....: _ -- • _
_ _5 9 8% SURCHARGE
9 _ - _ - "�_ _
_ 11II , btp
Contact ' - on • . me Phon k '1
f e ,.e -- �in s�yl GS Li - 1 `ISO -PLAN REVIEW 25% OF SUBTOTAL _ _ __ _
...... ` _...... • . - _.._.- -.. -- •m: u natt , Required only if fixture qty. total is > 9 - -
a '� ; � -'T , � :nls - •= . �Hnv rilNJt3 ?H.: iM =ki! ,9 u � - -- •
--" _-a �L TOTA _ � - _ _
• -
a• �• r : r ; - e_ :_ Il f. - - .7.: - _
_ - - -__-
:' i�4 "y ^i . � : : 7 ec 'r ...-.. ' _ .. _ 5. is i::i;?
" � 1- . - "` - ` . _ - r'7' t r, '" •Mlnlmum pennk fee is�50 + 8% su except Residential Baddbw • 111 ( ' ... :: , .._ , 4- , 4, , , ..' ^ .. rL.u_y:::_. _ ._ - J- --- An Device, which Is $25 +8% surcharge
"All New Commercial Buildings require plans will isometric or riser diagram and
plan review.
I:ldstslformslpiumspp.doc 10/1199
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�p BUP
Date Requested L� 6 AM PM BLD
Location 1 2 S 9 Suite ^ • Zs
Contact Person Ph • d E in /611?-60,370
Contractor Ph SWR�/ ! 9? -Ir/ 4 /C,
BUILDING Tenant/Owner I, ELC
Retaining Wall J'
9 ELR
Footing A NOT REQUESTED
Foundation FPS
Ftg Drain FOUND DURING RESEARCH — SGN
Crawl Drain Ir NO INSPECTION(s) IN FILE
Slab — SIT
Post & Beam � , , ` I �
Ext Sheath /Shear I - ... .wav�Q �
Int Sheath /Shear
Framing
Insulation
Drywall Nailing /
f1-661-J � /
Firewall , / �— d 2 76
Fire Sprinkler
Fire Alarm
/
Susp'd Ceiling
Roof i
Misc:
Final
PASS PART FAIL
er)LUMI314G 13
Post & Beam
Under Slab
Top Out � 7W
Water Service /
Sanitary Sewer
Glib B rains ii7ze3WZ-L
5 / g ff 000,6
CFTha
O PART FAIL i i l .c% -
CHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers 9 ) 1 F PASS PART FAIL L ��,�GI" ! l 0 'L e_27.15g-----
ELECTRICAL - ,..z.y.4, y
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 je
Approach /Sidewalk
O
17 " . ...;:k
ther Date 4..,1 , Inspector Ex
Final
PASS PART FAIL DO N «T REMOVE this inspection record from the job site.
N /I