Permit • -4
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM1999 -00112
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/20/99
SITE ADDRESS: 11455 SW PACIFIC HY PARCEL: 1S136AD -05901
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: Fire damage - replace existing fixtures.
FEES
Owner:
Type By • Date Amount Receipt
DAY'S INN PRMT GEO 4/20/99 $171.00 99- 314705
11455 SW PACIFIC HWY MISC GEO 4/20/99 $8.55 99- 314705
TIGARD, OR 97223
Total $179.55
Phone 1:
Contractor:
WATSON PLUMBING CO
7935 E BURNSIDE ST
PORTLAND, OR 97215 REQUIRED INSPECTIONS
Phone 1: 256 -3720 Misc. Inspection
Final Inspection
Reg #: LIC 111855
PLM 26 -602PB
•
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.
Issued By: _ 4 ; f / Permittee Signature:
Call (503 : %4175 by 7:00 P.M. for an inspection needed the next business day
OITY'dit TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Rec'd 44 , - / 4
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit #0 r1 /f9q -e0//
Related SWR # /fff4 cadf 4
Called 4 / - 0 2 . 0- fl
L #r 10,E 7944- g . , 5i g
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job // Y `J A ) Sink 9.00
Address Stre et Address _ Suite , / �/ Lavatory fp 9.00 .5-9 / /4 7 � My (/'"/ e- / L J Tub or Tub /Shower Comb. s 9.00 S /s - .i
Bldg # City /State Zip Shower Only 9.00
N Water Closet 6, 9.00 5
/Sl y r j /4t) /l f Dishwasher 9.00
Owner CI -- Address _ I Suite ` Garbage Disposal 9.00
NCI 7LtJ Mil / � / Washing Machine 9.00
SIty� Zip Phone
1� Floor Drain/Floor Sink 2° / 9.00 q --
Name 3" 9.00
- S / /k At 4° 9.00
Occupant Mailing Addre ' n / /�i ` Sui Water Heater 0 conversion 0 like kind 9.00
1 1 - � � �[ V V�` t' L . 2 i ) Gas piping requires a separate mechanical permit.
City /Sta Zip Phone Laundry Room Tray / 9.00 L ---
l 16 rn` Urinal 9.00
3N U -+ /Ri PL-g6- aO Other Fbctures (Specify) 9.00
Contractor in Address Suite ! 9.00
Lr 3 s 6 �t A.2NSt 0 E 9.00
Prior to permit /State 1 Zip
hone Sewer -1st 100' 30.00
issuance, a copy `-1 ki 3 7D-.0
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# D e^
required if 61/ i --� --llama Water Service - 1st 100' 30.00
expired In COT P m ing uc #`` / ] D E xp. D Water Service - each additional 200' 25.00
database "- (IL p` Y D /� //9y 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 Repair 0 Replace with like kind: Yes `iKirlo O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial Catch Basin 9.00
Additional description of work:
F, (? /9�� /F �� / , Pb Insp. of Existing Plumbing per/hr
per/hr
' UA)/ v-5 YL N,? /�cf 40?)-7-Ai Specially Requested Inspections 40.00
per/hr
Rain Drain, single family dwelling 30.00
Are you capping, move g replacing any fixtures? Grease Traps 9.00
Yes o
If yes, see back of orm to indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required it Quantity Total Is > 9 t
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL
I hereby acknowledge that I have read this application, that the information 1W/
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE / r�
that plans submitted are in with Oregon State Laws. / �/ C 'T/CC-
7
SI rIre o /AgRn ( � a (`t C f
Required REVI 25% OF SUBTO
/�/) d only fud
If fixture qty. total Is > 9
TOTAL MO-
C ontact Person Name Phone
c 37 c9-0 *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
G� r « 1 ? 5. • _ Q F, 0 "All New Commercial Buildings require plans with isometric or riser diagram
(/ J and plan review
1:ldstslplumapp.doc 7/1/98
PLEASE COMPLETE:
e w Moped ::: Replaced :I emoted /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:
1:ldstMplumapp.doc 717/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested -- 71 ( Q Q ! AM X PM BLD
Location i i L A SS f4 (, l Ayer Suite MEC
Contact Person Ph 232 Z( PLM 19 Contractor Ph SWR
BUILDING To Owner t2 /,i's ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab 19 101 " fi ✓1iL0 prlA._.1 SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBIe46
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
in
V PART FAIL
ANICAL
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 //
J 1 �Z
Other Date ! 7 Inspector y% Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.