Permit CITY OF TIGARD
DEVELOPMENT PLUMBING PERMIT
��~~�=~m~~~. nmom�n�x SERVICES PERMIT # ^ PLM97-0421
13125 SW Hall 8��Ti��C�9���0G��/�
Tigard, ' DATE ISSUED: 10/20/97
PARCEL: 1S134CD-03700
SITE ADDRESS...: 11960 SW 121ST AVE
SUBDIVISION ^ LERON HEIGHTS NO.3 ZONING: R-4.5
BLOCK..........: LOT ....... ......:071 JURISDICTION: TIG
CLASS OF WORK..:ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP.. :A1 FLOOR DRAINS..... . : 0 TRAPS.. ... .... . . ... : 0
STORIES ^ 0 WATER HEATERS.....: 0 CATCH BASINS.......: 0
FIXTURES LAUNDRY TRAYS - 0 SF RAIN DRAINS.....: 0
SINKS ^ 0 URINALS...........: 0 GREASE TRAPS.......: 0
LAVATORIES....: 0 OTHER FIXTURES ^ 0
TUB/SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0
Remarks: I instal l back flow prevention device or anti—pollution device to an
existing single family dwelling.
Owner: -- --- FEES ----
BARBARA DURRETT type amount by date recpt
11960 SW 121ST PRMT $ 15.00 GEO 10/20/97 97-300192
TIGARD OR 97223 5PCT $ 0.75 GEO 10/20/97 97-300192
Phone #:
•
Contract or
RICHARD HANSEN
25540 SW GRAHAMS FERRY RD
SHERWOOD OR 97140
Phone #: 503-682-4157 $ 15.75 TOTAL
Reg #..: 000103
REQUIRED INSPECTIONS --
This permit is issued subject to the regulations contained in the Misc. Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other RP/Backflow Prey
applicable laws. All work will be done in accordance with Final Inspection
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 reqVires 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 OUNrhy calling
(503)246-1987.
Issued By: _410 Permittee Signature:
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # Q01 97 -614
Tigard, OR 97223
•
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development New Single Family Residences Only
' tea.. ❑ 1 BATH HOUSE $140.00 CI 2 BATH HOUSE $195.00
Job //940 SC /A/ ❑ 3 BATH HOUSE $225.00
Address Cry/State Zip Fee includes all plumbing fixtures in the dwelling and the first 100 feet
7//j9 ?2 02- 9 7,2,03 of water service, sanitary sewer and storm sewer. See fees below.
Name (or name of Bus /ess) FIXTURES QTY PRICE AMT
B AR - DuP- r Sink 9.00
Mating Address Phone Lavatory 9.00
Sf
Owner //946 93 /a/ 59D-567.3 Tub or Tub /Shower Comb. 9.00
CitY/Sfate Zip Shower Only 9.00
7/2/ 9 . 7 z f q Water Closet 9.00
Name (or name of boneless) Dishwasher 9.00
Garbage Disposal 9.00
Occupant Mating Address Phone Washing Machine 9.00
Floor Drain 9.00
City/State Zip Water Heater 9.00
Laundry Room Tray 9.00
Nano Urinal 9.00
/ 'rC 74/90-1-c6Ni Other Fixtures (Specify) 9.00
Mating Address Phone 9.00
Contractor
o Sri Cagth 5 kesaf 21 9.00
City/State Zip 9.00
/',� /�
. ' /7 ..4 XD C+� `77/yl) Sewer 1st 100' 30.00
State Registration No. CV Boo. Tao No. Sewer - ea. Addit. 100' 25.00
/038.2 00 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service-ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
7- -e-e.--/
Back Flow Prevention
/ f� / t� Device or Anti - Pollution Device / 9.00 9.ver
'env mer or agent) Date Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential,' non - residential 0 Insp. of Exist. Plumbing 40.00 /hr
Specially Requested Inspections 40.00 /hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
- Residential backflow prevention - - - -
devices 15.00
Proposed use of
building or property
`(Except residential backflow
prevention devices)
NOTICE °Minimum Fee $25.00 SUBTOTAL 9eir'
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 4i
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL /
TOTAL 9. tii1
Special Conditions
Date issued by
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested S _3-O0 AM PM BLD
• Location 119600 ) USt ,A l J Suite ME
Contact Person Ph . I
6' ? - 06
Contractor [ C41614i SZV Ph cPUZ `' /' / S SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation r r i r _ FPS
Ftg Drain �1 � ..
Crawl Drain Inspection Notes: SGN
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
PASRT FAIL
UMBINGl.,)
Pos eam
Under Slab n }pi/
Top Out '
Water Service
Sanitary Sewer
,, Rain Drains
Pk 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 ��� Inspector ExtJ‘Ci
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.