Permit CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
44- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT 1$.......: PLM99 -0019
DATE ISSUED: 02/01/99
PARCEL: 2811OC8- •80012
SITE ADDRESS...: 12110 SW KING ARTHUR AVE
SUBDIVISION....: ZONING:
BLOCK....,.....: L.OT .............. JURISDICTION: KIN •
CLASS OF WORK. :OTR GARBAGE DISPOSALS.: 0 MOBIL.' HOME SPACES.: 0
TYPE OF USE.... :SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY G R3 FLOOR DRAINS....... 0 TRAPS..............; 0
STORIES........: 0 WATER HEATERS.....: 1 CATCH BASINS.......: 0
FIXTURES___- __- ________ LAUNDRY TRAYS.....: 0 SF RAIN DRAINS.....: 0
SINKS.......... 0 UR 11•fA!_.S............ 0 GREASE l RAl- 'S....... 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: Replace water heater with like kind.
Owner: -- - FEES ---------
LINDA HALLET type amount by date recpt
12110 SW KING ARTHUR PRMT $ 25.00 DEB 02/01/99 KING CITY
KING CITY OR 97224 5PCT $ 1.25 DEB 02/01/99 KING CITY
Phone #:
Contractor
RESCUE ROOTER
PO BOX 1728
WILSONVILLE OR 97070 -. _.._. --------
Phone #: 243- 1172 $ 26.25 TOTAL
Reg #..: 127325
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 Final Inspection
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- 91001 -0010 through OAR 952- 0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503) 246 -1987. ..
IssuLd By � t Perm ittee Sic+.nature : ✓1Z? _ .
•
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + +± + + + + + + + + + + + + + ++
Call 639-4175 by 7 :00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + ++ ++ + + + + + + + + + + + + + + ++ + + + + ++ + + ++
FEB- 01 —'99 MON 10:06 ID: FAX N0: #091 PO2
CITY OF TIGARD Plumbing Permit Application ' _—
13125 SW HALL BLVD. Commercial and Residential Plan Check
TIGARD, OR 97223 Recd By
(503) 639 -4171 Date Reed _ l _ Qy
Data to P.E.
Print or Type Date to osr 2 - 1
Incomplete or illegible applications will not be accepted Perrriitt P�
Related SWR d
Called
Name of Development/Project c
Job J .,kr: q� Sr)k ( 44`(„, t J/ ' e r rr r� ° a r r °j 4 rr- / M. F
Sink , : kf t. , J. n1y f - ' °1 4 l
,: L ,x,1'
Address . treat d ree: j, Site 9.00
(s/ Lavatory
.,,/,' Bldg d City /State 21 Tub or Tub/Shower Comb. 9.00 IMIN 9.00
' r'i C� q
p
1 2Z
Shower Only
ame 8
� I
i CA Water Closet
44 I„ �� 9.00
Dishwasher
Owner M ling dress Suite Garbage Disposal 9.00
_
' 9.00
City /Slate Zip Phone Washing Machine 9.00
Floor Drain/Floor Sink 2"
Name @.00
3" 9.00
Occupant Mailing Address Suite tl 4' 9.00
O conversion Ike kind 8.00
City/State ' zip Phone as • 'r • re • wires a se • ardte mechanical !emit.
Laundry Room Tray 9.00
P ma Urinal 9,00
ew Lit 0 -DOT - CZ Other Fixtures (Specify) 9.00
Contractor g Address Suite
, If 11Zg 9.00
Pnor to permit City/ ate / Zi 9.00
suance. a Dopy WtlSOLIo fe Q? Q t -C1a50 sewer - 1s! 104'
30.00
is
of all licenses are Oregon Consl. Cont. Board Lie.* sewer -each etlditlonal 1100'
required if �. �� 25.00
12 3 Z S Water Service - 1st 100' NM 30.00
aspired in COT Numbing tic.* PE
Exp. Date Water Service - each additional 200'
database �j` �t-.f� -. 02 25.00
Name Stern & Rain Drain - 1st 100' 30.00
Architect Storm & Rain Drain - each additional 100' 25.00
Or Mailing Address Mobile Home Space 25.00
Suite Cofnmercial Back Flow Prevention Device or Anti -
Polluti0n Device 25.00
Engineer Cib/8tate Zip Phone Residential Bedrflow Prevention Device -
(irl1galion liming devices require a separate 15.00
kisaibe work to be done: restricted ems
hew 0 Repair 0 Replace wike kind: Yes ' Ne O mid.
with A
residential 0 Commercial 0 Any Trap or Waste Not Connected to a Fixture 8.00
EMI ;dditlonal description of work: Catch Basin
0.00
p
Insp. of Existing Plumbing 11111 40
Specially Requested inspections 40.00
•er/hr
re you capping, moving or replacing any fixtures? Rain Drain, single family dwelling
Yes O No O Grease Traps 30,00
yes, see back of form to indicate work performed by 9.00
Al
cture. FAILURE TO ACCURATELY
C`
'ORK COULD RESULT IN REPORT FIXTURE IaornetAcattaerdiA QUANTITY TOTAL tzM.r' :,:.�f;:: :
.
ereby COUL ed a that I N INCREASED SEWER .F gram Is requires gQuentR Is a 9 r yi,,,,, N:L
' g have read this application, that the Information ' SUBTOTAL «:r." ',F = I ;,
en Is correct, that I em the Owner or authorized agent of the r (` W "s+ ; ' - 5
at plans submitted are In compliance with Oregon State owner. and 5% 3 i ` �
7 attire of Owner/ ant g Laws. SURCHARGE s'; a'G ; stM s-
,l i, I I �j - 1 - 9 /� R- .u'ued op n EvIEW 28% OF SUBTOTAL ,""'1';'17-4, 1 ,1:"`,",,,Z,..,', ,
. [ ,� J ,�_ G 7 b. mane qty, total Is .. 9
�ntee Pars n Name k. °. r',2,,,... .:: ,. , .„ : .
11 •S -- 9(.3 ors TOTAL s:. » ,
.. .: •s ;" '
;
5 4 'Minimum permit foe is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans withlsomeulc or riser diagram
and plan review
4 +faPp.doc 7/2/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST
BUP
Date Requested D AM PM BLD
Location AA7 4-- ,i,A ) Suite MEC
Contact Person - • Ph 73/ Ks-yy PLM T 2 C f
—
Contractor Ph SWR
pulp:N:91 Tenant/Owner ELC
Retaining Wall ELR
Footing
Foundation 0 (1-11/1 FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath/Shear - r/C 4 - 11 q Ca-0-0 &-
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
•- Drains
Are.1
= 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 e; Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.