Permit . •
C ITY OF TIGARD PLUMBING PERMIT
P ERMIT #: PLM2000 -00332
-- �L`'y DEVELOPMENT SERVICES DATE ISSUED: 9/8/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12493 SW QUAIL CREEK LN PARCEL: 2S103CB -08800
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: ALT 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 PRMT CTR 9/8/00 $36.25 27200000000
4230 GALEWOOD 5PCT CTR 9/8/00 $2.90 27200000000
LAKE OSWEGO, OR 97035
Total $39.15
Phone 1: 387 -7538
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 6136
PLM 11558
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 g/- �-� Permittee Signapre :
Call (503) 639.4175 by 7:00 P.M. for an inspection needed the next bus ss day
UO /OV /UV - r i.1/ vo.ao Jn.° v..v .t. +..�
CITY OF TIGARD REC‘Ilumbing Permit Application Plan Chock it
13125 SW HALL BLVD. 1 v, %mmercial and Residential Reed By -• e--ti`
TIGARD, OR 97223 Date Recd 9�s
C��Q IA-4-1-°"61A1 Date to P.E.
(503) 6394171 Date to DST
C�MM�N\r Permit # / ,"® ?�
Print or Type Related SWR#
Incomplete or illegible applications will not be accepted Called • Name of Deveiop•nent/Project '.FIXTU -RES tintivrdtiai - __ :i;j :_i` - = t '
- = ft5:i:a = - - - `_ :trice` ^Total t
J 1. .L JCL LQ� l�v l l(ttiu :..- .r.. - . ... y
Sink 18.80
Acd
Street ress uite
Address t S q3 C ,t.a� „,Stile L(L„ v Lavatory 16.60
Bldg # ry!State n Zip Tub or Tub/Shower Comb. 16.60
j aAci 012. 4 `12.73 Shower Only 16.60
Name ,/ yY1 Water Closet 16.60 •
bar) i
me s ' i{t)_" ' es Urinal 1180
Owner I Mailing Address Suite X60 -
1 /3.3() c) (
Sic) Dishwasher 16.60
I Zip Pho Garbage Disposal 16.60
( r'v-t Q jC Q�, 3 5 7'" - 7573d - Laundry Tray 1660 •
ame Washing Machine 19.50
Occupant Maio Address Suite Floor Drain/Floor Sink 2" 15.90
3' 16.60
CltylStale Zlp Phone 4" , 16.60 '
Water Heater O conversion 0 like kind 16.60
P k !erne Gas piping requires a separate mechanical permit.
ia i rag' LancScap& Inc, I MFG Home New Waver Service 46.40
Contractor MaiMg.Address 1 tufts MFG Home New San/Storm Sewer 46.40
�Sq5 tans -ma i2D Hose Bbs 16.80
Prior to permit It ate 21p9")0 I Phone
issuance, a copy l.0 i S151 1 I I F, 0 te. I tog '-ono s/ Roof Drains 16.60 1
of all licenses are Oregon Cons!. Cont. P . Board Licit Exp. Date Drinking Fountain - 16.60
required if ,Q n
I3 I s Other Fixtures ;Specify) 21.75
expired In COT Plumbing Lto. # Exp. Date
database
Name _
Architect l
O r
Malting Address Suite Sewer -1st 100 55.00
Sewer- each addItional 100' 46.40
Engineer CitylState Zip Phone Water Service -1st 100' 55.00
Water Service - each additional 200' 46.40
De ribe work tc to done
Storm 5 Rain Drain -1st 100' 65.00 I
New � pair 0 Replace with like Kind: Yes 0 No O !
Residen I Commercial C Storm & Rain Drain - each additional 100' 46.40
Additional descri on of work: r-� Commercial Back Flow Pr evention Dev ice 46.40 i
E /C7'i0 -„ 1 P� / 7C dev/�/ Residential Backflow Prevention Device' f 27.55 S$j
Arre e yoou u capping, l W apping, moving or replacing any fixtures? C atch Basin 16.60 i
I
'Yes 0 No 0 Insp. of Existing Plumbing or Specially Requested 72.50
If yes, see back of form to indicate work performed by
Inspections per/hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Raln Drain. single family dwelling 65.25
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 16.60
I hereby eckncwledge that I have read this application, that the information QUANTITY TOTAL r. `, :,
given is correct, that I am the owner or authorized agent of the owner, and Isomeric or riser diagram is required if Quantity Total is S r "
that plan
are in compliance with Oregon State Laws. *SUBTOTAL 1 .r:':'
f�
ature of • er /Agent r4' .�
D TI a rot t o, 8% SURCHARGE ..
tact Pe o feame Phone a �.r
�� PF} ri c� �°�-�� "'PLAN REVIEW 25% OF SUBTOTAL '''
t` :1: BATH43 USE . ?49 * : : s f �y,` => .. ? N_r I Required only if tb6ure Sty. total is > 9 . . _ .. ■
,: -B FH i124: -40-3( O�_45- :-a :.. _ TOTAL .
t�fh nal lde4*Writif „g 31tagaiCiiiiiVAR aile f it
rr' �'t ,5'�' Sr: 4- zv xrl.ir^ ' 1- €l P
fiEnTg @ilgliale- 4;eaWer 'Pal!? _S°511, 1cii- a ,..'i,,; a -max ,`l •Minimum permit. fe surcharge.
"All New Commercial Buildings r with Isometric o .ser diagram and filar: review.
I:1dnb'ormslp :umspp_rev.dm S /24/00 /
Pt" 1V J AS G , 2-5
Tex ,2, ?v
39, .5
•
03/30/00 IvLL) 0U:21 FAX DUJ DUO IOU iii or 1 iouu
PLEASE COMPLETE:
, •
ET-;41§0,4:6 3.ROprif.01
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Floor Sink 2"
3 "
4"
Water Heater
Other Fixtures (Specify)
1o/A)
COMMENTS REGARDING ABOVE:
lAdsts'icrms‘plumapp_rev Jac 8/291C0
CITY OF TIGARD BUILDING INSPECTION MST
24 -Hour Inspection Line: 639 -4175 Business e: 639 -4171
BUP
Date Requested AM PM BLD
Location / 7 - (- 1 f 3 S w QtA <� t CSC Suite MEC
Contact Person Ph 2 " 6/X 3 7 PLM " 'GG 33 Z d
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
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
RT FAIL
PLUMB
Post & Beam
Under Slab
Top Out Oadye
Water Se
Sanitary Sewer A 0
Rain Drains J
Final r
PASS PART FAIL
MECHANICAL ‘77•
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 p
Other D Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.