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Permit CITY OF TIGARD PLUMBING PERMIT ,, r � DEVELOPMENT SERVICES PLUMBING PLM1999 -00140 ,,� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/4/99 SITE ADDRESS: 09975 SW WALNUT ST PARCEL: 2S102BD -01001 SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: R -12 BLOCK: LOT: 007 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: 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: 160 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace an existing water service line for duplex. FEES Owner: Type By Date Amount Receipt RON BLINE PRMT GEO 5/4/99 $55.00 99- 315063 2190 SKYLINE DRIVE MISC GEO 5/4/99 $2.75 99- 315063 SEASIDE, OR 97138 Total $57.75 Phone 1: Contractor: ORIGINAL KENNEDY PLUMBING 13985 SW FARMINGTON RD BEAVERTON, OR 97005 REQUIRED INSPECTIONS Phone 1: 643 -5535 Water Line Insp Reg #: LIC 001009 Final Inspection PLM 34 -42PB 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 (7 13) 246 -1987. Issued By: �� Permittee Signature: I ` � AL Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin ,ss dy CITY OF TLGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIGARD, OR 97223 M y' Date Rec'd (503) 639 -4171 Date to P.E. Print or Type Date to D Incomplete or illegible applications will not be accepted Related SWR ! y' Called Name of � FIXTURES (individual) 4 QTY sA , PRICE 'MT Job Lt- C�UL(1L Cbu..)&� . Q n it } Sink 9.00 Address t Address :) , .1,, (�,� Suit Lavatory 9 00 11 ) WW11 1(ki St • Tub or Tub /Shower Comb. 9.00 Bldg # City/State Zi 1 Shower Only 9.00 e © � Water Closet 9.00 �n Il6 Dishwasher 9.00 Owner Mailinn Address 1 Suite Garbage Disposal 9.00 P4 1Cy1 t Washing Machine 9.00 City / p�p Zi o Phone Q � *7 Floor Drain/Floor Sink 2° 9.00 rnr i Q i t J1L f.3 � 1 3 Th i .% / 3• 9.00 Name 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 Na,� Urinal 9.00 1/ P o n ec ` , A _ ' ,� i Other Fixtures (Specify) 9.00 Contractor Mailing Address `� J Suit 9.00 I W") 1-aft ; 9.00 Prior to permit City /State Zi Phon S ewer - 1st 100' 30.00 issuance, a copy (47,45 (0t./.3-55 Sewer - each additional 100' 25.00 of all licenses are Oregon Const.tont. Board Lic.# Exp. Date required if / n9 (D ? Water Service -1st 100' I 30.00 ID CID expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' ( 25.00 A cs . 01) database 344 - 99. P.B 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 Describe work to be done: restricted energy permit.) New 0 ReRalr 0 Replace with like kind: Yes X No 0 Any Trap or Waste Not Connected to a Fixture 9.00 Residential 1 0 Commercial 0 Catch Basin 9.00 Additional descri tion of work: Insp. of Existing Plumbing 40.00 per/hr SIA v \ .+57\ L1 D a // , Specially Requested Inspections 40.00 • Are you capping, moving or re lacing any fixtures? Rain Drain, single family dwelling 30.00 Yes 0 No Grease Traps 9.00 If yes, see back of form to indicate work performed by QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total Is > 9 , WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL -:-; ' • , z, I hereby acknowledge that I have read this application, that the information ,_� . , • 57 given is correct, that I am the owner or authorized agent of the owner, and 6% SURCHARGE A''," r � , r � that plans submitted are in compliance with Oregon State Laws. s . , r -a-° 1 � Signature of Owner /Agent Date ��// "PLAN REVIEW 25% OF SUBTOTAL , )4,4) `•• - =:,,,,, �� CA CA •� Li _) ( ( ], / Required only ff fixture qty. total is > g _ , • fi n Contact Person Name Phone ^� TOTAL` C.5,..I �_ `^- -/� t -n ,^ C lsr r .- , J�J • vimum permit fee i $15 + $25 5 surcharge, except Residential Backflow � l (.,j � J� � Ci{ ►J k-f ti Prerevention Device, which which s $15 + 5 % surcharge "All New Commercial Buildings require plans with isometric or riser diagram and plan review I:tdststplumepp doc 7/2198 1 , , • PLEASE COMPLETE: Fixture Type Quantity by Work Performed New - Moved I Replaced Removed /Capped 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: I:tdsts\plumapp.doc 7/7/98 CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested (Pt AM PM BLD Location 4 r) 5 G ,(4 Suite MEC G� Contact Person ,S Ph 0 3 PLM l ��� 4 /0 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 Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler 1 �/ C �'/ e". Fire Alarm • Susp'd Ceiling ` ,�/ Roof Misc: SCC �� /UM /`P f /�P t 1 Final PASS PART FAIL Post Beam / � S CC- e--77e) Under Slab & / h tAJ P2 A / S /C Top Out er Se an, ary Sewer Rain Drains PART FAIL MECHANICAL ' Ter- t /, f i/ Beft /yv evr % (/t. Post & Beam J Rough In Gas Line / /J,-P /4/ —U�/ /T 64./A tot Sedt /G Smoke Dampers te / c Final PASS PART FAIL ELECTRICAL Service Rough In �-+ UG /Slab 1 9 3 E <t-t Q t— 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 /? Other Date 5 Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.