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Permit
* CITY OF TIGARD PLUMBING PERMIT r DEVELOPMENT SERVICES PERMIT #: PLM2000 -00156 A . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/18/00 SITE ADDRESS: 12165 SW QUAIL CREEK LN • PARCEL: 2S103CB -10900 SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5 . BLOCK: LOT: 067 JURISDICTION: TIG CLASS OF WORK: OTR 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: Installation of residential backflow prevention device. FEES Owner: Type By Date Amount Receipt DON MORISSETTE HOMES INC PRMT DEB 5/18/00 $25.00 0002273 4230 SW GALEWOOD SPOT DEB 5/18/00 $2.00 0002273 LAKE OSWEGO, OR 97035 Total $27.00 Phone 1: 790 -6456 Contractor: PROGRASS LANDSCAPE SERVICES 29895 SW KINSMAN RD WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone 1: 682 -6076 RP /Backflow Preventer Reg #: LIC 00006136 Final Inspection PLM 11558 p 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 • copies of these rules or direct questions to OUNC by calling (503) 246 -1987. • Issued CXldil /� Pe rmittee Signature: �2U,e vAK1..0.Q —61# Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bu iness day 06/05/99 TUE 10:57 FAX 503 598 1960 CITY OF TIGARD x002 CITY OF TIGARD Plumbing Permit Application Pla Creeks 1 13125 SW HALL BLVD. Commercial and Residents Recd By Al TIGARD, OR 97223 _ ECEIVED / 1 Le Date Reed • 5 7,9 tea (503) 639°4171 oa:e to P.E. - Print or Type MAY 1 5 201i Date tc OST In or illegible applications will o e Permit* rtrfatroD o0 /.S-p � ) � Related SNR s Caked Name of Deve:opment/Project � b , 7 F 1xgURES (lrtdlviduiil) _=-, , :r � r .., t ; '¢ Y_ °_ „PRICE 4T.: Job ©A� &&L- �'0Um.11 Sink 11.50 Address Street Add s �i' I Syiie Lavatory 11.50 c�-I L.D s t� GILL ct-c1" `' ` Lan - e-- ) Tub or Tub/Shower Comb. 1 11.50 . • ' Bldg s 1 City /State Zip. . - ' . - . - Shower On! y 11.50 I . Ti q ol2 9 r) a-ay Name �J Water Closet I 11.50 t• ern (e-l1 1•fa»1 Cisi washer I 11.50 Owner Haling Address Suite Garbage Disposal 11.50 1-/a3C) Sw Galuvood. Washing Machine 11.50 City /State Zip Phone Fl Cris WFloor Sink 2° 11.50 Lake DS wcg0. o R.. 790- G ci So . Name 3" 11.50 • 4" 11.50 Occupant Mang Ad . ss Suite Water Heater O conversion 0 lice kind 11.53 • Gas piping requires a separate mechanical permit City /State Zip Phone Laundry Room Tray 11.53 i n�a Urinal 11.53 .. 1P-na Sco - Y Grass Laid SGap d.. Other Fixtures (Specify) 15.00 - l • Contractor Mailing Address Suite a9 N S go KiiKinaA,P -D Prier to permit City/State Zip Phone 1,0 - Sewer -1st 100' 38.00 Issuance, a copy w, O Sin in& OR. 97070 &'74 an - S ewer -each additional 100' 32.00 - of all licenses are ont. Cont. Board Uc.* Exp. Date required H � 13(a • $13 11oo Water Service -1st 100 38.00 _ expired In COT Plumbing tic. S Exp. Date' Water Service - each additional 20G' 32.0D database t Storm & Rain Drain - 1st 100' 38.00 Name Storm & Rain Drain - each additional 100' - 32.00 I • Architect Mobile Home Space 32. or - Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 32.00 • • Pollution Device Engineer f City/State Zip Phone Residential Bacxflow Prevention Device' I 19.00 / a� • (Irrigation timing devices require a separate 1 . Describe work to be done: . restricted energy permit.) New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 11.50 Residential 0 Commercial 0 Catch Basin 11.50 Additional description of work: . Insp. of Existing Plumbing 50.00 • per/hr I Are you capping, moving or replacing any fixtures? Specially Requested Inspections per /n j Ef /'if Yes 0 No 0 Rain Drain, single tamily dwelling 45.00 if yes, see back of form to indicate work performed by Grease Traps I 11.50 fixture. FAILURE TO ACCURATELY REPORT FIXTURE WORK COULD RESULT IN INCREASED SEWER FEES. - QUANTITY TOTAL a `.° 'k?: , I hereby acknowledge that i have read this application. that the information Isome•rie cr riser diagram is required If Quan:IN, Total is >9 given Is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL that plans submitted are in compilance with Cregon Stale Laws.. = -= )yaety 0,,Cw nj e nt d f r i(7. E% SURCHARGE _ _ . Contact Person Phone "PLAN REVIEW 25% OF SUBTOTAL - • Required oily H fbeure qty. total Is > 9 •-. "`-` .• 11,;e0.. Y :#:=E'• r.=•^ ::411gt. -rigra _ p TOTAL _ - . _=4c'- 1 � yq A'£lti�s?US� -_ Z$�Q•;' _' :} __ . �:_. = .,.^:�__s�7en.�„s:._c, e. Y...- ^ _... _ , . _ � _ :' �� -': n G' 7 - 'X.._. O ,S : %Q.x_.... :!a:.ty'.I st �r F.. �; ^•.. , .- s�..._ h :;. , - ; _,,�,�, g 1fr i _ ;. s - :_., ; p- i;: =s:? 'Minimum permit fee is $50 + 5% surcharge, except Residential Baokflow a�9 "" 'e":. " "a " :: _- - �` _ `"s * ' _= - - PrevenHon De 'cn e• wtlI h is 25 + 5% surcharge � = `ii r - S-'- = ° � _ " ` -3 p --mil g- "All New Commercial Buildings requi l re pans with isometric or riser ding, sin �'L'G�Brffi1i�� f9NOFSlOTirt•'t�7T� :__ - � �I �t °_. i'1.-'r': :' :� h and plan review 1:1de:sYxmslplumapp.dc.: Sr 0'55 • 05/26/2000 Activities for Case #: PLM2000 -00156 1:50:32 PM . Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMA003 Application received 05/15/2000 DEB MAIL No Hold DEB 05/18/2000 PLMA005 Create Permit 05/18/2000 DEB DONE No Hold DEB 05/18/2000 Delay in creating due to understaffing. PLMA750 RP /Backflow Preventer No Hold DEB 05/18/2000 PLMA799 Final Inspection 05/24/2000 MRS PASS No Hold AKJ 05/24/2000 PLMA050 (F) Issue permit 05/18/2000 DEB DONE No Hold DEB 05/18/2000 . PLMA800 Case Fineled 05/24/2000 AKJ DONE No Hold AKJ 05/24/2000 • Page 1 of 1 5/31/00 Activities for Case #: PLM20O0 -00156 1:32:54 PM Assigned Hold Updated • Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMA003 Application received 5/15/00 DEB MAIL No Hold DEB 5/18/00 PLMA005 Create Permit 5/18/00 DEB DONE No Hold DEB 5/18/00 Delay in creating due to understaffing. PLMA750 RP /Backfiow Preventer No Hold DEB 5/18/00 PLMA799 Final Inspection 5/24/00 MRS PASS No Hold AKJ 5/24/00 • PLMA050 (F) Issue permit 5/18/00 DEB DONE No Hold DEB 5/18/00 PLMA800 Case Finaled 5/24/00 AKJ DONE No Hold AKJ 5/24/00 • Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION Msr 2DCZ - POO �(o 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 5/ /C0 AM PM 8 BLD Location 121(AS ((71ka.t / ('/L -Q,Q . Suite MEC Contact Person Ph itg 3 PLM ZWO'00LS(4 Contractor Ph SWR BUILDING Tenant/Owner ELC 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 i Fire Alarm / ' 1 /, �` CJ� Susp'd Ceiling / Roof 4 f Misc: Final PASS PART FA L ;PLIJMBIR9) ofs &"beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains F; •_r pA T., FAIL ' ECHANICA Post & Beam Rough In Gas Line Smoke Dampers •A - PART FAIL ECTRICAL 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 lA Approach /Sidewalk Dat Inspector Ext e G Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.