Permit CITY OF TIGARD
4,,k4, DEVELOPMENT SERVICES PLUMBING PERMIT
� PERMIT # PLM99 -0074
' !� "' 13125 SW Hall Blvd ., Tigard, OR97223(503)639 -4171 DATE ISSUED: 03/17/99
PARCEL: 1S134BC -00300
SITE ADDRESS...: 12220 SW SCHOLLS FERRY RD
SUBDIVISION • ZONING: C —G PD
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:M 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
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: Commercial backflow prevention device
Owner: FEES
BURNHAM PACIFIC OPERATING PART type amount by date recpt
610 W ASH ST STE 1600 PRMT $ 25.00 B 03/17/99 99- 313769
SAN DIEGO CA 92101 5PCT $ 1.25 B 03/17/99 99- 313769
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 RP /Backflow 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 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 OI)NC by calling
(503)246 -1987.
Issued By: emal.„____ Per mittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + +Y + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + ++
OIL
CITY OF. TIGARD Plumbing Permit Application Rec'd By f 'V�1
Date Recd '5 - 11 - 1. "
13125 SW HALL BLVD. Commercial and Residential
Date to P.E.
TIGARD, OR 97223 Date to DST
(503) 639 -4171 Permit # 0..Nl _,f, '1
Print or Type Related SWR #
64 ). Incomplete or illegible applications will not be accepted Called
� �_ ,z
Name of Development/Project On back Indicate Work Performed by fixture.
Job FIXTURES (Individual) QTY PRICE AMT
Address Street Address - Suite Sink 9.00
2 220 5Lo e' . Lavatory 9.00
Bldg # City/State Zip Tub or Tub/Shower Comb. 9.00
N1�^e� ' Shower Only 9.00
Y� JI�JQ t'd % Or 5C h0 l L5 Water Closet 9.00
Owner Mailing Address 5'( e Suite Dishwasher 9.00
l'2-2o 61-4-) Garbage Disposal 9.00
Ci / Zi Phone
1 ∎ care' ( e' o ' 550.1D 5 $ Washing Machine 9.00
Name l 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 K. `- - Urinal 9.00
'e fl fl C �-1 Au m bl ► q Other Fixtures (Specify) 9.00
Contractor Ilin Address l Suite / 9.00
8 5 510 41m;
Prior to permit tats i P 9.00
issuance, a copy - r - ‘ 5,(4-r) - r - ‘ 5,(4-r) or 00,5 bo4 ,5535 9.00
of all licenses are Oregon Const. Cont. aoard Lic.# Exp. Date 9.00
required if 314 -4 29
Sewer - 1st 100' 30.00
expired in COT Plumbing Ll D 9) Exp. Date
database 1 Sewer - each additional 100' 25.00
Name Water Service - 1st 100' 30.00 -
Architect Water Service - each additional 200' 25.00
Or Meiling 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 I
Describe work New 0 Addition 0 Alteration 0 Repair 0 Pollution Device
to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device' 15.00
Additional description of work: ,, ,{ ■ Any Trap or Waste Not Connected to a Fixture 9.00
tic' t0-0 d JCt CC-'k CJ LoiJ t U-' 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
QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram Is required if Quanity Total Is > 9 - . a 5,Q�
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. .: 25, 0
Signature of Owner /Agent Date
5% SURCHARGE
Con t Person Name Phone PLAN REVIEW 25% OF SUBTOTAL 5
Required only if fixture qty. total is > 9
6� 3, 5 535 TOTAL P6 ,�,G
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
hdatslpanapp.doc 5197
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:
t 5197
3/8/00 Activities for Case #: PLM99 -00074
3:02:57 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 3/17/99 B RECD BON 3/17/99
PLMC005 Permit Created 3/17/99 B DONE BON 3/17/99
PLMC799 Final Inspection 3/18/99 TLP PASS TLP 3/18/99 •
PLMC750 RP /Backflow Preventer 3/17/99 3/18/99 TLP PASS TLP 3/18/99
PLMCO50 (F) Issue permit 3/17/99 B PASS BON 3/17/99
PLMC800 Case Finaled 3/18/99 VLN 3/18/99
•
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Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
q�q BUP
C)
Date Requested 3-18- [ / AM PM BLD
Location (Z 2 2 o �x MS cP /u1A3 Suite MEC
Contact Person S Ph eQq — SS3S PLM gq-Qx7
Contractor ai1n KS P ba Ph SWR
BUILDING owner 44' 0We: r Gt S 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 r ■• /C.
e
Fin
Final
nal
PAS PART FAIL
(PLUMBING
Post & Beam �
Under Slab 86 i C � n 5 f' 47 9
Top Out C
Water Service'
Sanitary Sewer
`'rains
ASS y PART FAIL
MECHANICAL
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 rei spectio RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 4111PY
Other Date Inspector . Ext
Final
PASS PART . FAIL DO NOT REMOVE this inspection record from the job site.