Permit it CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2000 - 00216
l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/14/2000
SITE ADDRESS: 11645 SW TALLWOOD DR PARCEL: 1 S133CC 01900
SUBDIVISION: PEBBLECREEK ZONING: R -
BLOCK: LOT: 013 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: Install a residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
O, RENEE PRMT GEO 06/14/200C $25.00 0002958
11645 SW OD DR 5PCT GEO 06/14/200C $2.00 0002958
TIGARD, OR R 9722 97223
Total $27.00
Phone 1:
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
O
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: - Permittee Signature:,�J,�
Call (503) 639 4175 by 7:00 P.M. for an inspection needed the next business day
:.. 0648i 99 TLE 10:57 FAX 503 598 1960 CITY OF TIGAARD
0 002
.
CITY OF TIGARD Plumbing Permit Application Plan Cneck
13125 SW HALL BLVD. Commercial and Residential Redd By
TIGARD, OR 97223 Date Rec'd
(503) 539-4171 Date to P.E.
Print or Type v Date to DST
Incomplete or illegible applications will not be accepted Permit 4 eC45 boa /(o
Related S ,R #
Called
I Name ofDeve :opment/Projec: - - {indivi dual }; i y; - ., ? : QTY' . . :PlC;i,_ At+AT:,
Job sink I 11.56
S t reet Address I Suite Lavatory 11.50
Address i / WI 5 :I 'Fa up occ( De T
Tub or , ubiShovrer comb. 11.50
Bldg 4 City /State Zio
/ / / /// �, r� '3 Shower Only 11.50
Ti �t r �� G 2 Water Closet I 11.50
Name J - 11.50
K�y�e� 0 Dishwasher
Mall rig Address Suite Garbage Disposal 11.50
Owner I I y S At.; T d O►Z Mashing Machine 11.50
City-ISmte , Z° Phone Fl Crain/Floor Sink 2" • I 11.50
j 0cI L A uK < !7 2 Z : S,;04_ 34+i/ 3" 11.50
Name
` q° 11.50
Occupant ld ailin Address Suite • Water Heater O conversion 0 like kind 1
• Gas piping requires a separate mechanical permit. _
City /State Zip Phone Laundry Room Tray 11.50
I
Urinal 11.50
Name Other Fixtures (Specify) 15.00
Pro a {� d .< ]ili+'li l SCE�'{J
Contractor Maijin Address Ste
W) IC y acct,
Prier :0 permit City/State Zip Phone �� ` . Sewer - 1st 100' 38.00
issuancz, a copy I �OY1Jl 0 'R - )62.: - Con ��
4 Sewer - each additional 100' 32.00
of all licenses are Oregon Const. Cont. Board Lie.* Exp Date Water Service -1st 1:0' 38.00
.
required if Lei 3lo Si ' 0
Water Service -each edcltlonal 200 32.00
expired in COT Plumbing Lie. # f Exp. Date- 1
database i Storm 8i. Rain Drain - 1st 100' 38.00 I
Name ;
Storm & Rain Drain - each additional 100' 32.00
Architect Mobiie Home Space I 32.00
O Mailing Address Suite . Commercial Back Fiat Prevention Devi a or Anti- I 32.00
PollWcn Device
City/State Zip Phone Resitential Bac.tdlow Prevention Device' I 19.00 q 60 Engineer I (Irrigation timing devices require a separate 1 f
• Describe work to be done: restricted energy permit.)
New O Repair 0 Replace with like kind: Yes 0 No O Any Trap or Waste Not Connected to a Fixture 11.50
Residential C Commercial O Catch Basin 11.50
Additional description of work: .
Insp. of Existing ?lumbirg 50.00 1
• per/hr I
Specially Requester Inspections 50.00
Are you capping, moving or replacing any fixtures? I pednr
Yes 0 No 0 Rain Drain, single family 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 ' -
I :
I hereby acknowledge that i have rear this application• that the information Is er'-e' rie cr riser diag-am is required if Quan'irr Tctal is > 9 `!....:._ - . _ ..
given is correct, that I am the owner or authorized agent of the owner, and 'SUBTOTAL _ ti-' `°
that plans submitted are in compliance with Cregon State Laws.
of OwndriAgent I}ate g `5,1'. SURCHARGE :,: '
6L //YOZ - lG (g
� N P "PLAN REVIEW 25% OF SUBTOTAL - .
Contact Pores e
Reeurec only it fixate qtr. tota i s > 9 .. .........: ,..
_ TO TAL - • - 'Wm--
: ca:____:
f`_Y_BATNtiaUS� :37Y8 :U.4 � =_ _ _ == _ ;� y i ; -_ = =� rr :� : : :.. :. - =1 '.:_
BATH f 1o :1 ?_ :'ice =: =a . � < >' site •�--` -j - " ' " - t fee is 53 + 5 °4 surcharge, except Residential Ba thaw
i�..._ - . . __ _ - _ _ ' Minimum permit S
_t�t)$>• -$' nQQr _ =s'v - _':-'I~ --- - -- Prevention Device, which is,S25 + 5:1 surcharge
- 16
- 10de` sl ( ! 5= iii -I.!�= e 7iIf! .1fh it -. rciai s require plans with isometric or riser diagram 00 fi sariita ssvrer- Stermsev slidtwat seidbfa r- =r� = , "All New Commercial Buildings
f._ .___..._ ,_
.. -._ and plan review
•:5dsts'rrmsrptumapn.dcc 5/2195
0u/05/99 TUE 10:59 FAX 503 598 1960 CITY OF TICARD [7.]003
• <0
PLEASE COMPLETE:
l
Quantrty by Word PetfOrmed
YP
} p
Moved Repla Rem�yedlCap ed :.
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal i
Washing Machine
Floor Drain /Floor Sink 2"
3 1:
4
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
B I A r"
COMMENTS REGARDING ABOVE:
L s ' rrr,s \p tr app doc 6Rl &&
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
R BUP
Date Requested �� uested 7 / 00 AM PM BLD
Location (( �! (.1� / T (.c 2®O L 7 Suite MEC
WA P
Contact Person U` W 14x 2-650 7 7 PLM ?ZOO �p
Contractor Ph X Zf 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
PASS T FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rai Drains
e
PART FAIL
HANICAL
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 Date ( (9 / Inspector Ext
Other /
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.