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Permit CITY TIGARD PLUMBING PERMIT I , DEVELOPMENT SERVICES PERMIT #: PLM1999 -00417 '- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/08/1999 SITE ADDRESS: 12385 SW 106TH DR PARCEL: 2S103AA -01909 SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5 BLOCK: LOT: 012 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 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: 40 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Sewer connection from lateral to within 5' of the dwelling. FEES Owner: Type By Date Amount Receipt JAMES FLATTERS PRMT GEO 12/08/199E. $50.00 99- 320269 12385 SW 106TH DR 5PCT GEO 12/08/199E $4.00 99- 320269 TIGARD, OR 97223 Total $54.00 Phone 1: Contractor: TED MCBEE EXCAVATING INC 11428 NE SCHUYLER PORTLAND, OR 97220 REQUIRED INSPECTIONS Phone 1: 939 -5246 Sewer Inspection Reg #: LIC 110314 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: 4/4 61 ‘ --4- Permittee Signature :�''�‘1:4`/ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi ess day CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIG4RD, 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 #4 ‘ # /�lf -may /f Related SWR # Called Name of Development/Pro ect I FIXTURES (individual) QTY PRICE AMT Job \ t �\ Q c Sink 11.50 Address Street Address__ r Suite Lavatory 11.50 '� 5�"7 ! (�V Tub or Tub /Shower Comb. 11.50 Bldg # Th C ` ity /State Zip Shower Only 11.50 Y lS 1brdr 0 Water Closet/Urinal (Specify) 11.50 Name / /� E O'T✓ " 4 / 1651-1--- � Dishwasher 11.50 Owner Mailing Address Suite Urinal 11.50 Garbage Disposal 11.50 City /State Zip Phone Laundry Tray 11.50 Name Washing Machine /Laundry Tray (Specify) 11.50 Floor Drain /Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11.50 4" 11.50 City /State Zip Phone Water Heater 0 conversion 0 like kind 11.50 � N y� Gas piping requires a separate mechanical permit. / - ame r) / AA n� `C � -'- b..* )N & wife > c MFG Home New Water Service 28.00 Contractor Mailing Address MFG Home New San /Storm Sewer 28.00 I I '4 1.1.• S -M Hose Bibs 11.50 Prior to permit City /State Zip Phone Roof Drains 11.50 issuance, a copy �(),�� oz._ i?c) c 1 "( Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if / 1 © 3 ; ! /A.--05=0 Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date 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 Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New Re it 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Resi Commercial 0 Additional description of work: Commercial Back Flow Prevention Device 32.00 \ Residential Backflow Prevention Device* 19.00 Q _E? C N �.;e� } S C, k C C f w c� Catch Basin 11.50 Are you capping, movi or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 l No 0 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 ' '"" I hereby acknowledge that I have read this application, that the information c5Z 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. *SUBTOTAL ,1 �- Signature of Owner/Agent Date 7 g g 8% SURCHARGE Contut Person Name Rhone ' Jc )1 C 3 - A l� * *PLAN REVIEW 25% OF SUBTOTAL 1 BATH H SE $ 6 00 J Required only if fixture qty. total is > 9 TOTAL - 2 BATH HOUSE $250.00 7 3 BATH HOUSE $285.00 (This fee includes all plumbing fixtures in the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention 100 feet of sanitary sewer storm sewer and water service) Device. which is $25 + 8% surcharge "All New Commercial Buildings require plans with isometric or riser diagram and plan review. i \dsts \ forms \plumapp.doc 10/1/99 -- 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 Urinal Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Floor Sink 2" 3" 4" Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I: \dsts \forms\plumapp.doc 10/1/99 CITY OF TIGARD BUILDING INSPECTION DIVISION .24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 @sip' Date Requested AM 4 �"� BLD Location / 23 $ , 5 w/O G O,. Suite MEC Contact Person S A ' Ph i9f SZ' CPLOA /Q t 9— 009/ 7 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 (� t I 1 Framing ( ` J / * a✓Y1 Ct ✓�r� S Insulation (� L .H. 1 c I 004-i C �� - � S 0 \ Drywall Nailing ) 1 � Firewall b\ S �n �C � G [ Q Q ZS 7 c Fire Sprinkler l `(C— Fire Alarm .�� 5 ` /'_ c/ Susp'd Ceiling Li 1� T � CJ "tj Roof 4174. \�^ r Misc: Final PASS PART AIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS 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 Bac fill /Grading arntary Sew 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 /SidewIk � D ate ` 1 Other 1 -i T`' / j T / 1 Inspector , ` Ext Fin A S ART FAIL DO NOT REMOVE this inspection record from the job site. \... invoice - N., \•, GRIFFS SEPTIC SERVICE, INC. A SEPTIC .--er-- i i e Name Z .•eo )12 A/57 it Zalecia IA Date / 'a — 9 — P9 . Z.. 1 .5 Addr: -"--- '' 6-) i 0 '` Phone 2 4(.1-3 39 7 11111111 City ly/4--02-i) Initial On Acct. State c:312. Zip Code 7, .......,, Price Amount ( ..; ... 4 ■ 7 ,x1 b ) \-- _ /d, 0 A.,...B:iilli: - ■ A n ( 1 ---.0- C 7- 5----14 1 -- a - h" -- / - - 4 / . s i) 1 6 _. , .- , NOT RESPONSIBLE FOR LANDSCAPING A service charge of 1.5% per month will be charged on all past due accounts. Total: S —" Not responsible for attorneys fees. A fee of $25.00 will be charged on all returned checks. Approval By: 34ziol \mg" . Customer Signature glankTou P.O. BOX 1244. • Canby, OR 97013 (503) 263-2087 or (503) 632-6138 CCB# 70548 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested /2- `' BLD Location / 1 5 It /0 G a D r Suite MEC Contact Person Ph PLM /5 4 q --.&y y 1 Contractor Ph SWR /-7/1-7 BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Y Foundation 1, / FPS 1 Ftg Drain SGN Crawl Drain Inspection ks: Slab SIT Post & Beam Ext Sheath /Shear \ Int Sheath/Shear Framing Insulation Drywall Nailing Firewall i, :f Fire Sprinkler IM i r� Fire Alarm / Susp'd Ceiling Roof Misc: Final PASS PART FAIL ' - __■•V11/111111 4(` (V LUMB l j rr ►,zra{ II eam Under Slab Top Out Water Service unitary Sewer Rain b( in Dfains � /,� i T /, F- PART ,ip <' HANICAL i Post & Beam l Rough In /�, Gas Line /2/ v Smoke Dampers C(VX Final PASS PART FAIL ELECTRICAL Service // / / // , ' , / /I& /� / /` Rough In /'e/ _ 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 Other oach /Sidewalk Date i -" i 1 (` ! Inspector /// iy -- ) Ext 3/ Final I/ C 4 r �� i PASS PART FAIL DO NOT REMOVE this inspection record from the job site.