Permit CITY OF TIGARD
NG PERMIT
DEVELOPMENT SERVICES PERMIT PLM2000 -00265
"" ' ` ''-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PLUMBING
ISSUED: 7/14/00
SITE ADDRESS: 12446 SW 131ST AVE PARCEL: 2S104AC -08700
SUBDIVISION: MORNING HILL NO. 9 ZONING: R -25
BLOCK: LOT: 230 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
CRAWFORD, SCOTT, M AND PRMT DEB 7/14/00 $25.00 0003730
BROBERG, KAREN L SPOT DEB 7/14/00 $2.00 0003730
12446 SW 131ST AVE
TIGARD, OR 97223 Total $27.00
Phone 1:
Contractor:
MATT SANDERS LANDSCAPING INC
21785 SW TV HWY
ALOHA, OR 97006 REQUIRED INSPECTIONS
Phone 1: RP /Backflow Preventer
•
Reg #: LIC 00005703 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 ma ebtain- opies of these rules or direct questions to OUNC by calling (51 46 -1 • . i p
Issue B y: • .e. 1/111 'Li/4 . ....,4_ Permittee Signature: , r
r - . .
Call (503) 6 -4175 by 7:00 P.M. for an inspection needed the next business day
City of, Tigard PLUMBING PERMIT APPLIC , • • N Planck/Rec. #
1'3125 SW Hall Blvd. „ . Permit #
Tigard, OR 97223
i (503) 639 -4171 .
NIM ► ' `• 5.00 PERMIT FEE + ST. SURCHARGE
Cleveloommt C (� . } ( New Single Family Residences Only
( ( t- ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job ' Zi l � LI (Q 510 f ❑ 3 BATH HOUSE $225.00
Address cnwar. c�}� Fee includes all plumbing fixtures in the dwelling and the first 100 feet
��, i [ eecO of water service, sanitary sewer and storm sewer. See fees below. '
Macho
('a a' E ...) FIXTURES QTY PRICE AMT
C 1Cv 1 \ (L Sink 9.00
wttn redress C5(-0..A.,...)-V-Qrr
y �,at" Lavatory 9.00
Owner 7 I L \(, r) } S � \?)\' 1 AWL Tub or Tub/Shower Comb. 9.00
caw Shower Only 9.00
" y.._ 9 70.3(0 Water Closet 9.00 ,
Name (a °' °iRnia) Dishwasher 9.00
Occupant - 4 ( C \6 r C Garbage Disposal 9.00 huip, � Washing Machine 9.00
\ J' Co j � � 1 s- ' Floor Drain 9.00
_ Water Heater 9.00
k �� i �`Q Laundry Room Tray 9.00
Urinal 9.00
(Wan- a!) L Qu 1C J 2 Th0 . Ot her Fixtures (Specify) 9.00
ream Contractor r C U ( 9.00
It "V V� n h J 9.00
^( &•--- 9700(0 9.00
Sewer 1st 100' 30.00
sous Reyst t a.n No ) City Bus. Tax No. Sewer - ea. Addit. 100' 25.00
5 0 I I (0 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application a t 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
j.„....„-- Back Flow Prevention / 5-: CO
Device or Anti - Pollution Device .9;08 J
awrs rer a gain
a) '
V Data 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 0 non - residential 0 Insp. of Exist. Plumbing 40.00 /hr ,
Specially Requested Inspections 40.00 /hr
Existing use of Rain Drain, single family dwelling 30.00
building or property
Residential backflow prevention
Oe
devices / �9
Proposed use of
building or property
"(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee SUBTOTAL :vim s
PERMITS BECOME VOID IF WORK OR CONSTRUCTION �v
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE v7' • i ■
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 r7 p�
TOTAL
Special Conditions
Date issued by
CITY OF TIGARD BUILDING INSPEgTION DIVISION
24 -Hour Inspection Line: 639 -4175 • Business Line: 639 -4171 MST
BUP
Date Requested 7 -7 AM PM BLD
Location (2.'(9 Sw /3/ . Suite MEC
Contact Person Ph ri ( -1Z /(/ 7 PLM AGO) — OD..G)
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 MAIIP Insulation Drywall Nailing Ale Afr
Firewall
Fire Sprinkler s! .01
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PA§.,S_ ..E RT FAIL
<PLUMBING )
Posm
Under Slab
Top Out
Water Service
Sanitary Sewer
Rai P rains
6q , C f g"
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
I ADA /�
Approach /Sidewalk Date l LY Inspector ►� / Ext 3//
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.