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Permit .- CITY OF TIGARD PLUMBING PERMIT M . I, DEVELOPMENT SERVICES PERMIT #: PLM1999 -00179 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/11/99 SITE ADDRESS: 10560 SW KENT ST PARCEL: 2S115AA 02300 SUBDIVISION: DOVER LANDING NO.2 ZONING: R -4.5 BLOCK: LOT: 062 JURISDICTION: TIG CLASS OF WORK: ALT 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: Add residential backflow prevention device. • FEES Owner: Type By Date Amount Receipt CARTER, SHARON L PRMT GEO 6/11/99 $25.00 99- 316059 10560 SW KENT ST MISC GEO 6/11/99 $1.25 99- 316059 TIGARD, OR 97224 Total $26.25 Phone 1: Contractor: / REQUIRED INSPECTIONS Phone 1: RP /Backflow Preventer Reg #: 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. lJ � Issued By : / Permittee Signature " g L-.._ Call (503) • • • -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 S SW HALL BLVD. Commercial and Residential Rec'd By • TIGARD, OR 97223 Date Rec'd (56 639 -4171 Date to P.E. Print or Type �� Date to DST Permit # / f ff -66/ 7 f Incomplete or illegible applications will not be accepted Related SWR # Called Name of Development/Project =RIXTURESi (indivitlual `fPRICE' ,;, � - .,.. 1 - ;;.. ,W, ,,,, � ,,`,� QTY �,.: ;AMT .d- .S'�Y.:,..?�F.. .:- 'Y < <..,,.F � > �'ii,�:'> � -s ;- x':,: e;?�'� :.;s"fr..� J�:: ",- e , Job 0-011rk-sz- - Sink 11.50 Address Street Address Suite Lavatory 11.50 I ©S G O S w V12- v- -S'F Tub or Tub /Shower Comb. 11.50 Bldg # City/State e Zip -- Shower Only - 11.50 1-1� et,Y D g 9 - 7 Z Name r Water Closet • 11.50 s ' C 4-2-ir- Dishwasher 11.50 Owner Mailing Address � - �1 c1 Suite Garbage Disposal 11.50 O (0 O St- �"' Washing Machine 11.50 City State Zip Phone I r d .-- 0, G '? 2. (0-7"? _VCS Floor Drain /Floor Sink 2" 11.50 Nam l �� 3" 11.50 CIS a- b o.,--1-._ 4" 11.50 Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50 Gas piping requires a separate mechanical permit. City /State Zip Phone Laundry Room Tray 11.50 Urinal 11.50 Name Other Fixtures (Specify) 15.00 Contractor Mailing Address Suite Prior to permit City /State Zip Phone Sewer - 1st 100' 38.00 issuance, a copy Sewer - each additional 100' 32.00 of all licenses are Oregon Const. Cont. Board Lic# Exp. Date required if Water Service - 1st 100' 38.00 expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 32.00 database Storm & Rain Drain - 1st 100' 38.00 Name Storm & Rain Drain - each additional 100' 32.00 Architect Mobile Home Space 32.00 Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 32.00 Pollution Device • Engineer City /State Zip Phone Residential Backflow Prevention Device" i 19.00 (Irrigation timing devices require a separate Describe work to be done: restricted energy permit.) New 0 Repair 0 Replace with like kind: Yes O No 0 Any Trap or Waste Not Connected to a Fixture 11.50 Residential : Commercial 0 Catch Basin 11.50 Additional description of work: j insp. of Existing Plumbing 50.00 Sp r i /l L l-2 d' S 1 S 1 `4' \". per /hr 50.00 Are you capping, moving or replacing any fixtures? Specially Requested Inspections perm O' 45.00 Yes 0 No�, Rain Drain, single family dwelling 45.00 If yes, see back of form to indicate work performed by Grease Traps 11.50 fixture. FAILURE TO ACCURATELY REPORT FIXTURE WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL ''' ' "; - °% I hereby acknowledge that I have read this application, that the information "Y` ° in `f. ";,41,,i, Y 9 P Isometric or riser diagram is required if Quantity Total is > 9 ,�w`° ,.N<y�a given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL ' ,,r r ,% =,E .; that plans submitted are in compliance with Oregon State Laws. ,_, is ,, -y �t:. ;.-:z os ' Signe re of Owner /Agent Date C 5% SURCHARGE , � 3 "° & _-f -� Q � 6" /I- ! / alt .l ntact Person Name Phone ' �FH.�, * *PLAN REVIE 25% OF SUBTOTA I '` '' ` Q z>.. z i Required only if fixture qty. total is > 9 pc �' . e ` p BA.TIO10, ` E' 1 ri` enH -; < 1 = TOTAL •: ' `e OUSE , , t v - k � *Minimum permit fee is $50 + 5% surcharge, except Residential Backflow ' i i 4 . i Pre vention Device, which is $25 + 5% surcharge itcl` id 1 tambin f iitt a Iwet f g and ttie rst„ - 9 f eet of ff eWe Stom1 :$0W f er e nr ic e k - * *All New Commercial Buildings require plans with isometric or riser diagram and plan review I:\dstsvorrns\plumapp.doc 6/2/99 • Fixture Type Quantity by Work Performed 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: lAdsts1formskplumapp.doc 6/2/99 CITY OF TIGARD BUILDING INSPECTION DIVISION Ai 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST C9* �'`�q BUP .r Date Requested ) L AM PM BLD Location /05(00 tP. :3� Suite MEC �+ q Contact Person Ph PLM F1q / /c0I I Contractor Ph SWR BUILDINGa: °;, Tenant/a? 51(10140-y\ C (�/�. � -P/�., ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Not : n , � � Slab ViYll (� SIT Post & Beam .� Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling * Roof CA— , ,r' Misc: f� , /� �Z Final PASS PART FAIL �-- Post & Beam Under Slab Top Out _ Water Service Sanitary Sewer Rain Drains A ir 4 #11k PART FAIL ANICA; Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL n`° , .y,R 344 Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL 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 6 7 7 f Y ( F i( 49 Other Date Inspector Ar Ext Final PASS PART FAIL DO NOT. REMOVE this inspection record from the job site.