Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM1999 -00441
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/04/2000
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: 1 MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 5 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 5 URINALS: GREASE TRAPS:
•
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 0 ft
WATER CLOSETS: WATER LINE: 0 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI. SWR1999 -00269 Fees to be paid prior to issuance.
FEES
Owner:
Type By Date Amount Receipt
TIGARD CORPORATE CENTER LP PRMT BON 01/04/200C $126.50 MANUAL
15400 SW MILLIKAN WAY SPOT BON 01/04/200C $10.12 MANUAL
BEAVERTON, OR 97006
Total $136.62
Phone 1:
Contractor:
MACDONALD- MILLER COMPANY(SEE 1
7717 DETROIT AVE SW
SEATTLE, WA 98106 REQUIRED INSPECTIONS
•
Top -out Insp
Phone 1:
Reg #: LIC 00063593 Final Inspection
PLM 37 -64PB
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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: 6, Ik Q� Permittee Signature: ) (.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan / -�/
13125 SW HALL BLVD. Commercial and Residential Rec'd
TIGARD, O 97223 Date Rec'd /P - )d < /
$39 -4171 _ e3-.• Date to P.E. I� - -99 Print or Type O
(503). ��� o � l � r-i Date toDST 9s'
Incom Incomplete or illegible applications will not be accepted Permit #�c � - �v ��
P 9 PP Related SWR #/ t9f -60X!6?
Called AZ - A - 'T e rf
Name of Development/Project FIXTURES (individual) = , QTY PRICE ::AMT
Job
t ree ;A.R0 Cett,o' *rE gmr Sink S' 11.50 C� �D
Address t Address Suite Lavatory 11.50
Z 1 s'9 )w rA 6 9 Tub or Tub /Shower Comb. 11.50
Bldg # City/State Zip Shower Only 11.50
a T;".. 9iaL3
Name Water Closet/Urinal (Specify) 11.50
.5 f r PRo/'c Dishwasher 11.50
Owner Mailing Address Suite Garbage Disposal f 11.50 11,51:)
/Sfbo SW A"Il drve 1414y Washing Machine/Laundry Tray (Specify) 11.50
City/State Zip Phone Floor Drain/Floor Sink 2" 11.50
lkAtage `re/ OI( V7oo6
Name ,/ //", 3" 11.50
L d1Ures4c.s. H./driecy / c. 4" 11.50
Occupant Mailing Address !! Suite Water Heater 0 conversion 0 like kind 5 - 11.50 b
yy00 J /,J & L 11444 / Gas piping requires a separate mechanical permit. 7 I `'
City/State Zip Phone MFG Home New Water Service 28.00
&hot". OR ?700) 1 ri - 83oo MFG Home New San/Storm Sewer 28.00 _
Name Hose Bibs 11.50
#1 44410 w ►AN-A A7/4
Contractor Mailing Address Suite Rain Drains 11.50
riff Sw //god Drinking Fountain 11.50
Prior to permit CV /Stale , a Zip Phone Other Fixtures (Specify) 15.00
issuance, a copy p# f c../( ere 174,11/ LSa- j l
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if /37 3 ye 4/Z
expired in COT Plumbing Lic. # Exp. Date
database 3 7 6,4 Pa
Name Q Sewer - 1st 100' 3R no
Architect L./(o S '7 - h #e 3 Sewer - each additional 100' 32.00
Or Mailing Address Suite Water Service - 1st 100' -
1 / SW ,At..hs4
Water Service - each additional 200' 32.00
Engineer City/State Zip Phone
Aerff. I Off( 97 Zo N 2?-1 -- lit I Storm & Rain Drain - 1st 100' 38.00
Describe work to be done: Storm & Rain Drain - each additional 100' 32.00
New • Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00
Residential 0 Commercial • Residential Backflow Prevention Device' 19.00
Additional description of work:
Catch Basin 11.50
Insp. of Existing Plumbing 50.00
Are you capping, moving or replacing any fixtures? per/hr
Yes 0 No • Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by per/hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling _ 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application. that the information QUANTITY TOTAL 2..
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
that plans submitted are in compliance with Oregon State Laws. - I
SI ure of Owner /Agery , Date / /f9
*SUBTOTAL 212 5D •
,;1 t LB
t ,' o SURCHARGE 'D{2-
Con ct Person Name Phone
6/4410 Al ere1,0 tr 2 g0- e99/ "'PLAN REVIEW 25% OF SUBTOTAL
OUSE' 1 0 0 a y, Y � +K r "`.p. Required only if fixture is > 9 Y
I.. 7„� TOTAL �s t ��+�s .ts°a eq y' -;„
,es 3f ...._11, ` T`n .•, � n.the Ii a itd , e
,, _ -- t ndl lvater<seU . It : a r
.:a,a� . ; 'Minimum permit fee is $50 + 7% surcharge, except Residential Bacidbw Prevention
u a
t)eviee, which is $25 + 7% surcharge
""A11 New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:tdstsvormslpI mapp.doc 7/19/99
V
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / /(O /N AM PM BLD
Location 122-5 (' / Al ` Suite MEC
Contact Person n Ph S 7 2'Z % a ZZ PLM y'-
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 PART FAIL
F JMBI1 G)
Post & Beam
Under Slab
p Ou
r Service
Sanitary Sewer
Rain Drains
Final
PART FAIL
HANICAL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other p Date (0 n 6 Inspector / Ext 3 /1
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.