Permit . , . , .
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM1999 -00371
' DATE ISSUED:
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11304 SW IRONWOOD LP PARCEL: 1S134AB-00300
SUBDIVISION: ENGLEWOOD ZONING: R -4.5
BLOCK: LOT: 002 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: 1 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 new water heater.
FEES
Owner:
Type By Date Amount Receipt
LASCINK, GARTH V AND RUBY E PRMT KJP 11/08/199 $50.00 99- 319631
11304 SW IRONWOOD LOOP 5PCT KJP 11/08/199. $4.00 99- 319631
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
TRI COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97015 REQUIRED INSPECTIONS
Phone 1: 557-2220 Misc. Inspection
Reg #: LIC 72623 Final Inspection
PLM 26 -428PB
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 cop' s of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: A --yvt- Permittee Signature: 'Y17,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW.HALL BLVD.
RECEIVED Commercial and Re Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 Date to P.E.
NOV 0 31999 print or Type Date to DST
Ir t� fgcAl ble applications will not be accepted Permit # pail � - 003 7!
�
Related SWR #
Called
Name of Development/Project '=iF . E
tJ. individual �.,,. ... ZIT! r ±�N ". `.��`"CPRICE � PM
Job � IXT S y:�,.re .��� .� 9.00 ��
Sink
Address Street Address • Suite Lavatory . 9.00
/ /3O'( S J �xn1ardaC' p Tub or Tub /Shower Comb. 9.00
Bldg # City/State Zip ip ,5X4� p 7Z23 Shower Only 9.00
Name, C Water Closet 9.00
6 a r . GaSc%k Dishwasher 9.00
Owner Mailing Address _ Suite Garbage Disposal 9.00
/ C ( SC4 Tlovi nix 1- `r Washing Machine 9.00
City /State Zip Phone
%9 e f7eZe erG_ y.�U? Floor Drain/Floor Sink 12" 9.00.
Name 3" 9.00
�� fQ Sc yiG 4" 9.00
Occupant ailing Address,. Suite
p Mailing � "l � S� .� GO -Or�G Water Heater conversion 0 like kind 9.00 � d v
Gas piping requires a separate mechanical permit. f
City /State A Zip Phone Laundry Room Tray 9.00
77FAL, q7z 3 5 C, ' Urinal 9.00 '
-N el/ li� _ __ a kI Other Fixtures (Specify) 9.00
Contractor Mailing M ailin Addres Suite 9.00
/ i53 S t'lim trwu 0116 fir • 9.00
Prior to permit City /State Zip , Sewer - 1st 100' 30.00 •
issuance, a copy , (� gag - � -220
Sewer - each additional 100' 25.00
of all licenses are Oregon st. Cont. Board Lic.# Exp. Date
required if 72603 4 ,6 _ o lL Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. gate Water Service - each additional 200' 25.00
database '- /2X-r j - 3 )' 2-600 0 ,- Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
Or Mailing Address . Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device* 15.00
• (Irrigation timing devices require a separate
Descri work to be done: restricted energy permit.)
New R pair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Resid n iai Commercial 0 Catch Basin 9.00
Additional d scription of work: Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
per/hr
• Rain Drain, single family dwelling 30.00
Are you capping, moving or replacing any fixtures?
Yes 0 No 0 Grease Traps 9.00
If es, see back of form to indicate work performed b
y p y QUANTITY TOTAL e
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required If Quantity Total is >9 ' ar' ” : - ',,
WORK COULD RESULT IN INCREASED SEWER FEES. _. <;,. lr.. - -,> ,
SUBTOTAL A.:.,� " <- 'i �:,� ,. . -;. ,VI , *
I hereby acknowledge that I have read this application, that the information MAMA ,
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE " 4F'�
that plans submitted are in compliance with Oregon State Laws. ;: , <,a.=;�s „, ` i • Signature of O wner /Agent D to ** , .�6 :...�
7l/ PLAN REVIEW 25 /o OF SUBTOTAL {'' 1 st! z
Required only if fixture qty. total is > 9
TOTAL , 47:21,5 u ; K < , r
Con Person Name Ph n ..
yy�� *Minimum permit fee is $25 + 5% surcharge, except Residential Backflo 26
�.� tCh Prevention Device, which is $15 + 5% surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
t:tdsts■plumapp.doc 7/2/98
•
- PLEASE - COMPLETE: - - - •
New Moved Replaced Removed/Capped
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2"
3 „
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
• •
Bdstskplumapp.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
`lik( X06 / / BUP
d a l ar I;
' Date Re quested it (? /'? AM / PM BLD
Location t( 3 sJ -r t . r - d Suite ® � q q9 _ - . r,
Contact Person ? S / 1� Ph s�� o LM qq c r a 3
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
� \" �AS &A� T FAIL
PLUMBING) _ _
Post & Ie am
Under Slab
Top Out
Water Service
Sanitary Sewer
-' Drains
PART FAIL
MECHANICAL
P ost & as LBInneam
i
Smoke Dampers
' i 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 j ill? Other Date I nspector .�' Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.