Permit 4 CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
- Ill 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE I ISSUED: 03/ 29 / 99 -0090
='
PARCEL: 28114BA -03300
SITE ADDRESS...: 09620 SW SERENA WAY
SUBDIVISION • PICKS LANDING NO.2 ZONING: R -4.5
BLOCK LOT •106 JURISDICTION: TIG
CLASS OF WORK..:ALT 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
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: Install residential backlow prevention device.
Owner: FEES
JOHN T LYONS type amount by date recpt
9620 SW SERENA WAY 5PCT $ 0.75 GEO 03/29/99 99- 314023
TIGARD OR 97223 PRMT $ 15.00 GEO 03/29/99 99- 314023
Phone #:
Contractor
TRYON CREEK LANDSCAPE INC
11400 SW NORTH DAKOTA ST
TIGARD OR 97223
Phone #: $ 15.75 TOTAL
Reg #..: 000115
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- 000180. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued By: Permittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CI * ( TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 Y / i ate to P.E.
Print or Type " Date to DST
#pc /7-177 Incomplete or illegible applications will not be accepted Related wR _ �0 d
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job L,Njor45 Sink 9.00
Address Street Address Suite- Lavatory 9.00
R f P Z b ,J Se«R Tub or Tub /Shower Comb. 9.00
Bldg # City/State , Shower Only 9.00
6i , flR °f 7)-3-3 Water Closet 9.00
Name �
pp�
�VtUV L. l{ ON S Dishwasher 9.00
Owner Mailing Address Suite- Garbage Disposal 9.00
CI (-620 5W S -&re.. t'4 Washing Machine 9.00
City /State Zip Pho a Floor Drain/Floor Sink 2° 9.00
-T r, q ?-2- (o 20 y 9�
Name 3" 9.00
. 7 H«v'4Q 4" 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City/State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
ti' -{00 s .) N. 4 af St 9.00
Prior to permit City /State Zip Phon Sewer - 1st 100' 30.00
issuance, a copy 1X5}2' c 9 -7-z-2,-2, (02" 2-I +Li Sewer -each additional 100' 25.00
of all licenses are Oregen-Genst. Cont. Board Lic.# Exp. Date Water Service 1st 100' 30.00
required if Lflrlo. j.pe (9 29 Co to - -1ct
expired in COT Wwbing Exp. Date Water Service - each additional 200' 25.00
database 1 Flow I I r7 - 7-5 5 - zj ( - 9 9 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 1 /5. go_
Describe work to be done: restricted energy permit.)
New )8( Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential g Commercial 0 Catch Basin 9.00
Additional description of work:
' CAN J Al 0..)2_ t (V 5�4- `` Insp. of Existing Plumbing per/hr
Specially Requested Inspections 40.00
±c) il'r�S'rT; tr „A ` 1NK AU-SyS, per/hr
Rain Drain, single family dwelling 30.00
Are you capping, moving or replacing any fixtures?
Yes O No O Grease Traps 9.00
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL
Isometric or riser diagram is required If Quantity Total is > 8
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL
I hereby acknowledge that I have read this application, that the information
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE
that plans submitted are In compliance with Oregon State Laws.
Signs ure of ner /Agent Date "PLAN REVIEW 25% OF SUBTOTAL
T, _ 29 -99 Required only if fixture qty. total Is > 9
Contact Person Name Phone TOTAL 15,.,----
-1 PC(_.t 1 W 4..,i �(Z 6-2,q '1
21 `. ( •Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
••AII New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:tdststpiumapp.doc 7/2/98
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
Ne Move .
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:
•
hdstMplumapp.doc 717198
03/03/2000 Activities for Case #: PLM99 -00090
8:21:36 AM
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 03/29/1999 GEO RECD DST 03/29/1999
PLMA005 Create Permit 03/29/1999 GEO DONE DST 03/29/1999
PLMA799 Final Inspection ST 02/04/2000 2/4/00- inspection request to
Hap
PLMA750 RP /Backflow Preventer 03/29/1999 02/18/2000 RB PASS AKJ 02/21/2000
•
PLMA050 (F) Issue permit 03/29/1999 GEO PASS DST 03/29/1999
PLMA800 Case Finaled 02/21/2000 AKJ DONE No Hold AKJ 02/21/2000
•
•
Page 1 of 1 •
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / � ° 0 AM PM BLD
Location WO 20 54cr t.Vl_. t,0 0 1 4 t Suite MEC
Contact Person Ph tair. 99 -two ?c
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing /
Foundation NOT REQUESTED FPS
Ftg Drain
Crawl Drain I FOUND DURING RESEARCH Q SGN
Slab NO INSPECTION(S) FOUND IN FILE r 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
MBI
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Ra'n rains
Fin
ASS PART FAIL
HANICAL
Post & Beam
Rough In (7-13
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 Q�
Approach /Sidewalk l V 0 6 J � Ext - 5 1 j
Other Date I nspector
Et
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.