Permit CITY OF TIGARD
ia� .,.c , DEVELOPMENT SERVICES 7l ��� G PERMIT ^� I r�EI�I�I # ...: F�LM98 -•0070
13125 SW Hall Blvd., Tigard, OR 97223 (503)639 -4171 DATE ]ISSUED: 03/16/98
PARCEL: 2S104DB•- -2300
SITE ADDRESS...: 13151 SW ROCKINGHAM PL
SUBDIVISION ° AMESBURY HEIGHTS ZONING: R-4.5
BLOCK ° LOT °0P3 JURISDICTION: TIG
CLASS OF WORK.. :ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE °SF WASHING MACH.......: 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP.. :R3 FLOOR DRAINS - 0 TRAPS - 0
STORIES : 0 WATER HEATERS ° 0 CATCH BASINS ° 0
FIXTURES - - - - -- LAUNDRY TRAYS 0 SF RAIN DRAINS ° 0
SINKS ° 0 URINALS ° 0 GREASE TRAPS - 0
L_AVATC)RIES ° 0 OTHER FIXTURES ° 0
TUB/SHOWERS....: 0 SEWER LINE (ft) ...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHE :RS ° 0 RAIN DRAIN (ft) ...: 0
Remarks: Add residential backflow prevention device to a new single family
dwelling..
Owner: -_- - --- -------- ---- FEES -------
DALTON CONSTRUCTION INC type amount by date •recpt
8465 SW HEMLOCK ST PRMT $ 15.00 GEO 03/16/98 78- •304146
TIGARD OR 97223 SPCT $ 0.75 GEO 03/16/98 98- 30414E
Phone #:
Contractor - -- -- ------
KOREY WINCHELL
17465 NW CARL CT
PORTLAND OR 97229 --------- -- ____ ---
Phone #: 614 -0814 $ 15.75 TOTAL.
Reg #..: 000126
- REQUIREI) INSPECTIONS - • - - - - --
This permit is issued subject to the regulations contained in the RF' /Back f low Prey _ ____.__,^•_,_.___ _
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 188 days of issuance, or if work is suspended for more ______._._.__—._._._ ___ _____, _
than 188 days. ATTENTION: Oregon law requires you to follow rules _.____...__. _..._ ._____ _.._.__ ._.._._._.__._.__.
adopted by the Oregon Utility Notification Center. Those rules are _______-_____________.._.._._. __________ _____
set forth in OAR 952 - 8801 -8019 through OAR 952 -8891 -8888. You may ____ _ _ _ __ _
_ _ _ _
obtain copies of these rules or direct questions to Old by calling ,____• _ _ �______ _ , _._..______. _._._
(593)246 -1987.
Issued By° �/ i/ ._. _. Pe•rmi•t;tee Si
+++++•+•+++++++++++++++++++++•+++++++++++++++++++++ + + + + ++ + + + + + + + + + + + + + + + + ++• +• ++ ++
Call 639- -4175 by 7 :00 p.m. for an inspection needed the next business day
+•++++++++•+-+++•+++++++++++++•++•+•++•++++++++++++++++++ + + + + + + + +•++•+ + + + + +++ + ++ + + ++ + +++
CITY OF TIGARD Plumbing Permit Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd
TIGARD, OR 97223 Date to P.E.
Date to DST
(503) 639 4171 Permit # l r'J Sf --7d
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project On back Indicate Work Performed by fixture.
Job FIXTURES (Individual) QTY PRICE AMT
Address Street Address Suite Sink 9.00
131i Sc.) PvC-KI JG, ti.►'9_ Lavatory 9.00
Bldg # CiCity/State Zip Tub or Tub /Shower Comb. 9.00
Name
11,4412D f Shower Only 9.00
DAL-To /1 CO ik-iSW-ea 1 �,, / Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
4q66 A s"' ii-e4Ltizr,(45r, Garbage Disposal 9.00
City/State Zip Phone
1 ee 1,2223 1-162-016q Washing Machine 9.00
Name 1 Floor Drain 2" 9.00
3' 9.00
Occupant Mailing Address Suite 4" 9.00
City/State Zip Phone Water Heater 0 conversion 0 like kind ' 9.00
Laundry Room Tray 9.00
Name _ Urinal 9.00
t� Y g CA) 0 NG
t✓r LL Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite
t Mtli c i-eLt . 9.00
Prior to permit City/State Zip Phone 9.00
issuance, a cop wet L 'tD, of?.... 1 , 7 2 7 9 r 614 ---ag/L/ 9.00
of all licenses are Oregon Const. Cont. Board Lic.# Ex Date 9.00
required if t24, 3 I ti3 Sewer- 1st 100" 30.00
expired in COT Plumbing Lic. # Exp. Date Sewer - each additional 100' 25.00
database
Name Water Service - 1st 100' 30.00
Architect Water Service - each additional 200' 25.00
or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
Engineer City /State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration 0 Repair 0 Pollution Device
to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device' 1 15.00
Additional description of work: Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40.00
building or property per/hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL 1.fi00
Isometric or riser diagram is required If Ouanity Total is > 9
given is correct, that I am the owner or authorized agent of the owner, and "SUBTOTAL
that plans submitted are in compliance with Oregon State Laws. Y00
Signature of Owner /Agent Date 5 ° k SURCHARGE
t 3 - (�, -q� 1.
Contact arson Name Phone PLAN REVIEW 25% OF SUBTOT =
y / �.+, t UJ t G t- L bi Re quired Dory it llxture qty. total is > 9
, tJ c `7I 9 iti3 TOTAL I r
'Minimum permit fee is $25 + 5% surcharge, except Residential ackflow
Prevention Device, which is $15 + 5% surcharge
imststpunapp.doc 5/97
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved ': Replaced Removed /Capped
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: ldstslplmapp.doc 5197
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 ----' Business Line: 639 -4171
BUP
Date Requested _ AM PM BLD
Location 1-3/ / _3 C) , Suite MEC
Contact Person Ph PLM (/J '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 `'e— 18 /
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PISS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Fina
A PART FAIL
CHANICAL
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 �,
Other oach /Sidewalk Date f ` r l ( Inspector /7� � Ex
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.