Permit CITY OFTIGARD
. DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # • PLM99 -0086
DATE ISSUED: 03/24/99
PARCEL: ES101BC -01700
SITE ADDRESS....: 12450 SW KNOLL DR
SUBDIVISION TIGARDIA TERRACE ZONING: R -4.5
BLOCK • LOT :002 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP.. :R3 FLOOR DRAINS • 0 TRAPS • 0
STORIES 0 WATER HEATERS • 1 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: Water heater conversion
Owner: FEES
CHARLES E DEFOE JR type amount by date recpt
18205 SW CORRAL CREEK RD PRMT $ 25.O0 B 03/24/99 99- 313951
NEWBERG OR 5PCT $ 1.25 B 03/24/99 99- 313951
Phone #:
Contractor
OWNER
SIGNED RESPONSIBILITY FORM
IN FILE
Phone #: $ 26.25 TOTAL
Reg #..
REQU IRED INSPECT
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 pereit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
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 Yd'.1 -0010 through OAR 952-0001-0080. You say
obtain copies of these rules or direct questions to OIJNC by calling
(503)246 -1987.
Issued By :6" A e V" Permittee Signature: (9i{rn& ( "4-1.A.4 L° 0-1--
+++++++++++++++++++++++++++ +++ + + + + + + + + + + + + + + + + + + + + + + + + + + ++ +� C + + . + +_ _ +- + + +- + + ++ - - - - Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Check#
131.SIALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 • Date Rec'd S - 2- 4-
(503) 639 -4171 Date to P.E.
Print or Type Date to DS
Incomplete or illegible applications will not be accepted Permit# LNL (p
Related SWR.#
•
Called
Name of Development/Project
1XTURES� "a'XIj `���; TAY: "' �`PitI,GEA
�: MT,°
as a�.�f„A,�... „�;a.�. ,.:� E; .- �� f�;•et.: ��� <."��.•saf- .;;:...sue, � ti..
Job Sink 9.00
Address ' Street Address Suite Lavatory 9.00
j ' 5 0 co ' z} iNo l Px Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9:00
7 / oP 99 ?aS _
Water Closet 9.00
Nam � 4')if 5 9FfOE OR . Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
City /State Zip Phone
6.25 to 9 PY Floor Drain/Floor Sink 2" 9.00.
Name 3" 9.00
4" 9.00
Occupant Mailing Address Suite Water Heater //conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit. i
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Nagle / -
r�
d.wly e I� hA /ES E . - 12,tr� 0 I A. Other Fixtures (Specify) 9.00
Contractor . Mailing Address Suite 9.00
`di?d7 S ec;fy,rce/ 9.00
Prior to permit C,iyState Zip.‘ Phone Sewer - 1st 100' 30.00
issuance, a copy /1X... et 6,1_3-‘? $`
Sewer - each additional 100' 25.00
of all licenses are Oregon Con Board Lic.# Exp. Date
required if Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database 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
Describe work to be done: restricted energy permit.)
New 0 Re i air 0 Replace with like kind: Yes 0 NO Any Trap or Waste Not Connected to a Fixture 9.00
Residential Commercial 0 a Catch Basin 9.00
Additional description of work:, Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
per/hr
Are you capping, moving or replacing any fixtures? Rain Drain single family dwelling 30.00
Yes 0 No O Grease Traps 9.00
If yes, see back of form to indicate work performed by .,F.:
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL I �. r
Isometric or riser diagram is required if Quantity Total is 9 :
WORK COULD RESULT IN INCREASED SEWER.FEES. s a Y > . .� -o
I hereb c acknowledge that I have read this application, that the information *SUBTOTAL . ,; 1 t
"
Y 9 PP �� � �^
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE O, m`;? N . ;,, -
that plans submitted are in coy pliance with Oregon State Laws. `; ( .. Z5
Signature of Ow Age,/ Date o - , 1, ,
PLAN RE VIEW 25% OF SUBTOTAL r �. _„
R wired only if fixture
qty. total is t
✓i / TOTAL ''! ; ; .
Contact P. a - e / Phone w , . ', ;-y hW
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5 %- surcharge - - - -- - - - --
* *AII New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:'dststplumapp.doc 7/2/98
-- PLEASE COMPLETE: -
........................................................................................................................ New Moved Rep aced .......... RemovedlCapped
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:
I: \dstslplumapp.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested ?- ?i -.9 AM PM BLD p
Location f 7, Llc(C, tr�e^�r -�� / G Suite MEC F-, /3
Contact Person Ph PLM c' d�
Contractor Ph SWR
Tenant/Owner ELC
s..
�.
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: K
Final
PASS P • RT FAIL
MB
Post & Beam
Under Slab
Top Out
Water Service 110
Sanitary Sewer
ains
;� FAIL
Post & Beam
Rough In
Gas Line
Smoke Dampers n /
41 Ina (''
)'ASS PART AIL
ELECTRICAL, , Pw
4 )44\(\.'
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 c t
Date -itE�Q
Other l Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.