Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2000 - 00167
r� 11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/25/00
SITE ADDRESS: 11748 SW TALLWOOD DR PARCEL: 1 S133CD 12600
SUBDIVISION: PEBBLECREEK ZONING: R -
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: OTR 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
GENE D PRMT DEB 5/24/00 $25.00 0002420
11748 SW SW TALLWOOD DR
TIGARD, OR 97223 5PCT DEB 5/24/00 $2.00 0002420
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
0 °
P�-
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.
Iss d By: /� t I ; Permittee Signature: lile6.446-1/65
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
06/05/99 TUE 10:57 FAX 503 598 1960 CITY OF TIGARD qj 002
CITY,OF T vARD Plumbing Permit Application Plan Check
13125 SW HALL BLVR \EV Commercial and Residential Recd By /!'iAou�{
TIGARD, OR 97223 IN Data Recd," /7-0
(503) 639 -4171 MAY 1 7 Date to P.E. ---
Print or Type Date to DS
C It ietetibr illegible applications will not be accepted Permit it -r, } - 0/69 7
commum U� Related SJvR x
• Called
// Name of Deve,opment/Prcjec: _ .Fl%c_rliRE S (li'idivi al) '' , .` a _ : . PI`(-" . ICE °?AMT
Job (7CJ �L S i,,k 11.50
treetAddrress / �/� n I Suite Lavatory 11
Address 4 p �� TIN I'1 W C*Xt Tub or Tub /Shower Comb. • 11.5C
Bldg tY City /State Zip Shower Only 11.50
` 1 15 c1c1 o k G D0-3
Wate Closet 11.50
Nam, e, it n ✓JCA{`&i Clshwasher i 11.50
Owner Maitng Address Suite Garbage Disposal I 11.50
Washing Machine 11.50
City/State Zip Phone
Floor Drain/Floor Sink 2" 11.50
Name 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater O conversion O hike kind 11.50
Gas piping requires a separate mechanical permit.
CityiState Zip Phone Laundry Room Tray 11.50
Urinal 11.50
Name
Pr-0 &10 S S Lard Sc ap-e> Other Fixtures (Specify) 15.00
Contractor Mailing Address Suite DO
; -w lGnS/116 n 2D
Prior to permit City/State Zip Phone i Sever 1st 100' 38.00
Issuance, a copy (,U t s n U tilt D C170-16
0 . Sayer - Say - each additional 100 32.00
of all licenses are Oregon Conat. Cont. Board Lic.# Exp. Date ' Water Service -1st 1:7.0' 38.00
required if (t713(p gJ3) /G0
expired In COT Plumbing Lic. # Fes. Date' Water Service - each additional 20G' 32.00
database 1 4.
h Storrs & Rain Drain- 1st 100' 38.00 I
Name Storm & Rain Drain - each additional 100' 32.00
I
Architect P Mobile Home Space , 32.00
or - Mailing Address Suite Commercial Back Flaw Prevention Device or Anti- I 32.00
Pollution Device
•
Engineer I City/State Zip Phone Residential Bacidlow Prevention Device' I 19.00
(I rrigation timing devices require a separate I9
te
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 0 Commercial 0 tea, Basin 11.50
Additional description of work: Insp. of Existing ?ltmbirg 50.00 }
• per/hr 1
Are you capping, moving or replacing any fixtures? Specially Requested Inspections 50.00 I
Yes 0 No 0 - Rain Drain, single family dwelling 45.00 1
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 hereby acknowledge that i have read this application, that the information Isome-rie cr riser diag is required if Quantify Taal is > 9
given is correct, that I am the owner or authorized agent of Lhe owner, and '- *SUBTOTAL - _ I .y r ,(TO
that plans submitted are in compilance with Cregon State Laws. - =
Signature of Ow e[ /Agent Date , SURCHARGE kg- _
ELW a-A. u) sIis _ : . :5 :°
Contact Person Name Phone � ' *PLAN REVIEW 25% OF SUBTOTAL " `:
E � f"t ► t t " " to p Q - (oO"
Rege d only iT firm fir. total is > 9 l
,� I ` -_ _ _= TOTAL _ ...'r!
� r
- A �to zsaua=m =���`' ^z_�_�Y _� ,.-� __ _�� d - � '; :=< -' -
, - ° ° = -T ` -V, e- - -t � t � _ _ ;;r__- _ ;
��� ri >:": --� `Mi nimum permit fee is $50 + 5 °ro surcharge, except
_ f { . ' Nbt ! $ t $ 2 B'f -_ _ _, : v.;c _ _ - -- _ ---___ arch t Residential Backflow
P
. a 1 * iii i i 3 1 1 1 ��:. . - °^ Prevention Device, which is $25 + 5;b surcharge
f'.^ 7h .-.51 #1:.F- ...1.E1, .. _1 _,N , er W$?.�fa?' _(ffA.�4 . :_ z :i
= lOO fv a#.sahitat�rsayrer_ Sign '_seer? - - - - -- i�l'Frl § _�+;'_ �_ - ` "Alt New Commercial Buildings require plans with isometric or riser diagram
t� z._.r.n „ ,�._ _ -. and plan review
1 adstsl`::rms• plum app.dcc 5t2159
06/08/99 TUE 10:59 FAX 503 598 1960 CITY OF TIGARD 01003
•
• ,
PLEASE COMPLETE: •
:..:..... . .
ure: e.::: .:Quanti b Work Performed
placed p
::.Re :`_ Reriiwedl.Cap ed'
Sink
Lavatory
Tub or Tub /Shower Combination , I
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)
BA-GC fire -d .4
COMMENTS REGARDING ABOVE:
•
!Ad :tsfor, \p urr.app doc 6/2/SS
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 ' Business Line: 639 -4171
/O0 BUD
I Date Re / g v uested r/ / AM PM BLD
Location 1) - I p OCR Gl Or. Suite /,, MEC
Contact Person CI <.Q Ph Ca K2 -(0.0 70 PLM 2m_O01(o?
Contractor Ph k IA SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain / •
Crawl Drain Inspec on Notes:
SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /
Susp'd Ceiling / �!
Roof C�
Misc:
Final
p S _. FAIL
UMBINg,.)
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
yy =" 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk G
Other Date / / //� % / Inspector �,/ .% Ext?
Final
PASS PART FAIL • 0 NOT REMOVE this inspection record from the job site.