Permit CITY TIGARD PLUMBING PERMIT
I't DEVELOPMENT SERVICES PERMIT #: PLM1999 -00354
AU �� 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/27/1999
SITE ADDRESS: 12805 SW 77TH PL PARCEL: 2S101 BD -00101
SUBDIVISION: ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
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 2 commercial backflow prevention devices.
FEES
Owner:
Type By Date Amount Receipt
B R + G CO LLC PRMT KJP 10/27/199 $64.00 99- 319391 •
PO BOX 23009 5PCT KJP 10/27/199c. $5.12 99- 319391
TIGARD, OR 97223
Total $69.12
Phone 1:
Contractor:
NORTHWEST LANDSCAPE INDUSTRIES
16075 SW UPPER BOONES FERRY RD
TIGARD, OR 97224 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 684-1450
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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b ines
10/12/99 TUE 15:05 FAX 503 598 1960 CITY OF TIGARD . (7j 002
CITY OF TIGARD . • Plumbing Permit Application Plan Check#
- 13125 ;SWr'HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 \ I) Date Rec'd
(503) 639 -4171 . 1 Date to P.E.
Print or Type Date to DV
Incomplete or illegible applications will not be accepted Permit # ki 199 35
• Related SWR #
Called
Name of Development/Project 'FIXTURES 11ndtvtduai) „; . it QTY . PRiCEi •AMT
.Job sue-- lr•1a..L.o r.. Sink 11.50
Address Street Address Q Suite Lavatory 11.50
I X 905 S L) 7 . `4" f L Tub or Tub /Shower Comb. 11.50
Bldg # City/State Zip Shower Only 11.50
Name n Water Closet/Urinal (Specify) 11.50
•-`a.� 6 1 4 - G L L. e, Dishwasher 11.50
Owner Mailing Address p Suite Urinal 11.50
P a) Ox o2.�0 / _ Garbage Disposal 11.50 .
City /State Zip Phone
ad Laundry Tray 11.50
Name / J " � , Z Washing Machine /Laundry Tray (Specify) 11.50
R ( N n O
ae, 1 C U +I 1; 4 E %t i t D. C. Floor Drain /Floor Sink 2" . 11.50
Occupant Mailing-Address ' Suite 3" • 11.50
I o ; V D S S (_k _ ) `11 P I Q.u.. 4" 11.50
City/State Zip Phone
rg_xid o2 q-7aa3 ( LI Water Heater 0 conversion 0 Tike kind 11.50
Gas piping requires a separate mechanical permit.
Name
��oN4 -fit )j - LMtdSco�x rcdu.1 -2.5 MFG Home New Water Service 32.00
Contractor - Mailing Address , __ Suite MFG Home New San /Storm Sewer 32.00
10015 (A p( ' o .*.3 (=eAll� Hose Bibs 11.50
Prior to permit City/State Zip Phone Roof Drains 11.50
issuance, a copy T- i Cy)," d O tZ ci la.a `l - (.41-4- 1 4-s v Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# cp. Date -
required if neggt. f4 /7630 Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # . p. Date 1
database
Name •
Architect Sewer -1st 100' 38.00
Or Mailing Address ' Suite Sewer- each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City/State Zip Phone
g Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 , .
New ' Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial Commercial Back Flow Prevention Device Gi OJ
Additional description of work: a 32.00
Residential Backflow Prevention Device" 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
1 hereby acknowledge that I have read this application, that the information Isometric or riser diagram is _ «
given is correct, that I am the owner or authorized agent of the owner, and �9 required if Quantity /oral is > 9
that plans submitted are in compliance with Oregon State Laws. SUBTOTAL _ ( co
Signature of Owner /Agent Date 8% SURCHARGE
tgl�c� /49 5.1a
Contact Person Name Phone f r OF SUBTOTAL
C( •k.Q (gY'1 t 0 Required fixture total r s 5% O
"PLAN REVIEW 2
l0 4 i Crs;~. � iii -T _ i . : equi only if re qty. >
��. � ntr,.Y.._� ���:: �:�-r` �.� `���� � - � T
#2 OUs' 25,940. a. X 51 • r (f j •
• xklO.t7SE 285e 0 .h. 1,1: ,_ .*- •- 1 �, - T ,. °a ? ",; fi
• lncIui s 1I;,plu • .3:n. e eIII9
R. n t0 • Minimum permit fee is 850 + 8% surcharge. except Residential 0ackflow Prevention
1 -a , . :z• �1i . s • '� � �.•-:^ �•.. •' , A � i l- . eta :_. ..:..`- �'^^'�. �
00 eo t 01 Gamma a 'er r,rlil'rse r and w t&e !i _,,-,�_; - Device, which Is $25 + 8% surcharge
- _::
"Alf New Commercial Buildings require plans with isometric or riser diagram and
. plan review.
1:ldstsvormslplumapp -doe 1 0/8/99 _ --
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Requested �1(5AM PM BLD
Location j F d .? "7 7)7 Suite MEC
Contact Person k L)(,i, ' kA / uW kitlaseiieh 579 -0 -7 PLM /q l -Dv 3S'
Contractor Ph SWR
_ � nn
BUILDING Tenant/Owner Ra ��c�s%L (,/1 t irk ELC
Retaining Wall ELR
Footing Access:
Foundation e FPS
Ftg Drain
Crawl Drain 1114:31-,roan o ° - l 1c ^ l � CL-Ft./(4t1 SIT
SGT
Slab 6�CJ
Post & Beam tr (tS+ v o'+r'►�� _ / v,u �Jad � -1.0)G
Ext Sheath /Shear 431r -e,G(L D
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Miscf ...t /
Final
PASS ZART FAIL
.C
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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 for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 11(..vq1 I nspector Other / � 9 �%
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.