Permit ,;.
CITY OFTIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT `= 13125SW Hall Blvd ., Tigard, OR97223(503)639 -4171 # PLM98 -0453
DATE ISSUED: 12/09/98
PARCEL: 1S126DC -04800
SITE ADDRESS...: 09495 SW LOCUST ST #A
SUBDIVISION....: LEHMANN ACRE TRACT ZONING: C —P
BLOCK ....... ° °.: LOT :004 JURISDICTION: TIG
CLASS OF WORK.. :ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE • °COM WASHING MACH 0 BACKFLOW PREVNTRS...: 0
OCCUPANCY GRP.. :B 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: Alteration to replace water heater with like kind.
Owner: FEES
MBM ASSOCIATES type amount by date recpt
9495 SW LOCUST PRMT $ 25.00 DLH 12/09/98 98- 311398
STE A 5PCT $ 1.25 DLF-I 12/09/98 98- 311398
TIGARD OR 97223
Phone #:
Contractor
KENNEDY PLUMBING
13985 SW FARMINGTON RD •
•
BEAVERTON OR 97005 - - - -- _•
Phone #: 643 -5535 $ 26.25 TOTAL
Reg #..: 001009
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 'r -0010 through OAR 952 - 0001 - 0080. You eay
obtain copies of these rules or direct questions to OUNC by calling
(5031246 -1987.
•
kloo
Issued By: 4(, Permittee Signature:
++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + ++ + + + + + + + + + + + + ++
Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
•
CITY OF ;TIGARD Plumbing Application Rec'd By Zi- - -L/7
• 13125 SW HALL BLVD. Commercial and Residential Date Recd iz /9/9?
Date to P.E.
TIGARD, OR 97223 Date to DST
(503) 639 -4171 Permit* / - O 'f._3
Print or Related SR #
Incomplete or illegible applications will not be accepted
ted Called
Name of Development/Project
Job eft brr■ C 55o G • •FDRURES , , -,i,12-1m:QTY PRICE . AMT.,
Address Street Address Sul t 9.00
I' j 5 5,) l o cus+ S'f' Lavatory
9.00
Bldg # ty/State Zip Tub or Tub /Shower Comb. 9.00
pf Q-7 2.23
Name Shower Only 9.00
Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
li�
` O me, Garbage Disposal 9.00
City/State Zip Phone Washing Machine 9.00
Name Floor Drain , 2" 9.00
3" ' 9.00
Occupant Mailing Address Suite 4' 9.00
Water Heater 0 conversion like kind I 9.00 Q, Do
City/State Zip Phone -
laundry Room Tray 9.00 .
•
N me Urinal 9.00
t<e nn Pct-Li 1 U rn Ur Other Fixtures (Specify) 9.00
Contractor Mailing Address{ ! Suite
1 3g 8 5 So 46 ✓m; t-or 9.00
(Prior to issuance ity/State Zip Phone 9.00
applicant must �(4- a t 1 2'2.3 kA-3,5535 9.00
provide all Oregon Const. Cot. Board Lic.# Exp. Date 9.00
contractors ' 4. - 2 r3 3 d 9 9 9.00
license Plumbing Lic. # Expo'. Date / Sewer - 1st 100" 30.00
information if 1 09 b 7 " l= `
expired 1 /2 � ` 7� Sewer - each additional 100' 25.00
in COT COT Busin ss Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
database). I 6-1.3 Water Service - each additional 200' 25.00
Name •
Storm & Rain Drain - 1st 100' 30.00
Architect Storm & Rain Drain - each additional 100' 25.00
. Or Mailing Address Suite
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Describe work New 0 Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
1(p t
,p . 6 ^ �� Do i f� per/hr
`� " r` Specially Requested Inspections 40.00
Existing use of per/hr
building or property Rain Drain, single family dwelling 30.00
Proposed use of
Grease Traps 9.00
building or property QUANTITY TOTAL - r � ,
Are you capping , moving or replacing any fixtures? Yes ❑ No ❑ Isometric or riser diagram is required if Quanity Total is > 9 0< 5
(If yes see back of form)
*SUBTOTAL
I hereby acknowledge that I have read this application, that the information 5% SURCHARGE J C
given is correct, that I am the owner or authorized agent of the owner, and I • 1
th plans submitted are in compliance with Oregon State Laws. PLAN REVIEW 25% OF SUBTOTAL
Sig a ure of Owner /Agent Date
Required only if fixture qty. total is > 9
kkAa 9 ' D.a , ( k 3 TOTAL 24S
I Contact Person Na Phone 'Minimum permit fee is 525 + 5% surcharge, except Residential Backflow
.I. ir .') FSs b , 5535 Prevention Device, which is 515 + 5% surcharge
I:ldsts\plmapp.doc 5/97
•
PLEASE COMPLETE AS APPROPRIATE TO PROJECT: ;.
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3 "
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:ldstslptmapp.doc 5/97
1/31/00 Activities for Case #: PLM98 -00453
1:48:04 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 12/9/98 DLH RECD DLH 12/9/98
PLMC005 Permit Created 12/9/98 DLH • DONE DLH 12/9/98
PLMC799 Final Inspection 12/10/99 MRS PASS MRS 12/10/99
PLMC740 Misc. Inspection 12/9/98 DLH 12/9/98
PLMCO50 (F) Issue permit 12/9/98 DLH • DONE DLH 12/9/98
PLMA800 Case Finaled 12/17/99 JMT DONE No Hold JMT 12/17/99
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 0 41V AM / PM BLD
Location 7t(4 ) C4 4 Suite MEC
Contact Person 5Lty / yt,t PaLs 6 Ph U PLM qg 0 4(4-3
Contractor Ph SWR
BUILDING ` � Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation puvryt FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: / �� w �� kzej
Slab (D SIT
Post & Beam
Ext Sheath /Shear �/yl
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
RT FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
R.i. Drains
!r
r • S PART FAIL
ECHANICAL ° `y
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
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
A roach /Sidewalk
pP Date -2 ( Inspector /7M , /f Ext _g•
Other ' ,
Final (/
. PASS PART FAIL DO NOT REMOVE this inspection record from the job site.