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12456 SW KING GEORGE DR.
CI'T'Y OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inewrtion Line: 63?-4,75 Business Line: 639-4171 MST
5UP
—Date Requested 5-11' AM _PM BLD
Location �`? `> suite
MEC
Contact Person — "T�iJ Q,L� Ph I G-/-1 C �'� PLM 7LW -Doi
Contractor —i _ _ Ph �d `� Z SWR
BUILDING —^ Tenant/owner _ ELC
li'claining Wa!I ELR
`-noting �'
Foundation Accpss" FPS
Ftg Drain _
Crawl Drain Inspection Notes: SGN _—
Slab ---- --�- SIT
Post& Beam
Ext Snoath/Shear
Int Sheath/Shear
Framing
Insulation -- - --
Drywall Nailing
Firewall
Fire Sprinkler
Fire Aiarm ---
Suap'd Ceiling i
Roof
Final - -
PA3S PART FAIL_
FP
P.s Beam
eam
Under Slab
Top Out - - - - --
Water Service
Sanitary Sewer - -
Rain Dr ins
FART FAIL
ANICAL --
----
Post 8 Beam -- -------- ------ -
Rough In __.—_—_----____--
Gas Line
Smoke Dampers
Final ------ _ ___
PASS FART FAIL. - ,—
ELECTRICAL _--__--_-
Service
Rough In -- - - ----
UG/Slab
Low Voltage - --
Fire Alarm
Final
PASS PART FAIL _-
31TE ----�—
Backfill/Grbding -- -- - —-----__ -- --- - -----— --
Sanitary Sewer
Storm Drain I I Reinspection fee of$— —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line I )Please call for reinspection RF W_ _ _ ( J Unable to Inspect-no access
ADA
Approach/Sidewalk r�l
Other Date �_' Inspector� 1; I�<11 s E
Final tl�
PASS PART FAIL DO NOT EMOVE this inspection record from the job Site.
a
/\ CITY OF TIGARD PLUMBING PERMIT
UEVELOPNIENT SERVICES PERMIT 9: PLM2000-00'143
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4 DATE ISSUED: 5/4/00
SITE ADDRESS: 12456 SW KING GEORGE DR
' PARCEL: 2S11 OCC-18000
SUBDIVISIr)N: KING CITY NO. 5 ZONING:
BLOCK: LOT: 057 JURISDICTION: KIN
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME C"ACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GR?: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY T RAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER I.INE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHER: RAIN DRAIN: ft
Remarks: Installation of +ential backflow preventiL device
FEES
Owner:
Type By Date Amount Receipt
CRAVE, P FRANKLIN -- —
12456 SW KING t1EORGE DR PRMT iDF3 6!4/00 $25.00 KING CITY
KING CITY, OR 97224 —5PCT -_DEE3 —� 5/4/00 $2.00 KING CITY
Total $27.00
Phone 1:
Contractor:
JANIES R DENNY
PO BOX 160
SHERWOOD, OR 97140 REQUIRED IKSPECTIONS
Phone 1: 590-1945 RP/Backflow Preventer
Rea it- LIC '1804 PLUS BACKFLOW Final Inspection
This perrr.i', is issued subject to he regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be Sone in accordance with approved ►clans.
This permit will expire if work is not starf,d within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon li w requires you 'o follow rules adopted by the Oregon Utility
Notification Center Those rules are set orth 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) 2.401-1987.
Issued By: �f21 Y�1 � Permittee Signature: _ L
\ Cal' (503) SIT.4175 by 7:00 P,M. for an inspection needed the next business day
r,
WED ;13;03 PM City 01 Ki-, - City FAK.503 639 3771 PAGE 2
:!TY OF TIGARD Plumbing Permit Application Plan Check 0
12125 SW HALL. BLVD. Commercial and Residential Recd ey._E.`Na-�3-
TIGARU OR 97223 '/ Date Rec'd �3_ ,_
r ' LL r „ Gate to P.F. _
(503) 639A171 i III Date to DST �=-OQ
Print or Type Pn„It�
ermit
Incnmlplete or illegible applications will not be accepted PSWR>r
Celled_ _
- Name of Devetopmenl/Prolad `FIXTURES (Individual) QTY'" ''PR CE ''AMT
Job /MG C P� Sink
Address Street Address Suhe Lavatory Y - 11 50
2 � �k1 �� Tub or Tub/Showel Comb.
Bldg 0 Ctry/State LiP r Shower Only 1 LS
a" C V7-"-X Water Closetuinal (Specify) 11.50
1 me
�d � Dishwasher 11.50
Owner Mailing Address Surto Ufinal 11.50
sG _ S 11,so
� K_• �'�''- Garbage Disposal
City/ ail', lip Pix ne Laundry Tray 11,50
r _
Washlnq Machinellaundry Tray wpecify) 11.i0
Name V v
I. Floor DralnlFloer Sink -T-2` -- 11,50
Occupant Ma6in d Suite N 3' 11.50
11,50
CRyI tate Zip Pone -- -
Water Hater O conversion O like kind 11.50
Gas pl in re uires a se arate mechanical eM
/Q/Ylg �4� MFG Itome New Water Service 28.00
-�- - — r 'AFG Home New Sen/Storm ewer i 28.00
Contractor PAEkiling Address Sulte -
Hose Blba 11
Prior to permit C ty tate /Gz1 Phone - Roof Drains 11.50
Issuance.a�npy Cult LV►0 '11,-7 590- DrinkUg ountain J 11.50
4
of all livrnses are Orrgorn�Const.Cont.Hoard Uc,# Exp.Date Other Fixtures(Specify) 15.00
required tro ----._.r
expired In COT Plumbing Llc.0 Eng.Date -
database -
Npt^e
Arr:hitect Sewer-tot 100' 3800 1
or Mailing AGdress Suite Sewer-each additional 100-
Water eivica•1st lou _ W00
i
En neer City/stale zip Phone —
9 Water 9ervtoe-ra;h addltlonel 200' i 32.00
Desulbe to be done: Storm 6 Raln Drain••1st 100' 39.00
New a, Repair O Replace with like kind; Yes O No O Stonn rk Rain Drain-each additional 100' 32.00
Residential O Commetcial O cnmrnerclal @a k Flow Prevention Device 72,00
Additional description of work:n-9-% 1 h —
T-, L Reaidenlial Beck ow Prevention Device' 1 g.00
L 1f f Q'� 5Y-51�s'YL � Catch Basin — 11.50
Are you capping,moving or ree6quing any fixtures? Insp.of Existing Plumbing or Spedally Requested 5000
Yes O No 1111, Inspections r1hr -
If yes,see beck of forth to IndifaiA work performed by Rain Drain,single femtly dwelling 48.00
fixture FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps
WORr,COULD RESULT IN INCREASED SEWER FEES. -
+QUANTITY TOTAL
I hereby acknowledge that I have rvan this appllcahon,That tits Information Iaortretric or dsm•dl#igi m is rnjirealf OuantRy Tou+l LS 9
given Is cormd,that I am the owner or authorized agent of the owner,and �—"— •SUBTOTAL
that plans submitted are In compliance with Oregon State Laws i p
aiixrna
nor/ nt �,�� ��� syr SURCHARGE P
--
q0 "PLAN REVIEW 25%OF.1; 1!1 rAL
t•'^r ry" v 4>_ t Required Grill s Oxtumtotal h>0 —
sur _._TOTA�-
I,�tr� , ,ass� tl
f '*
tgzn. Y rf+ Minimum per+nit tee is$50"s% charge,a leap ResMarAlal BeckSctiv Prevenrinn )iQom
"
i YKr +moi . r!`fl ��.7!�•L'% ._..,� _ e G ..4j t•Jevlrw Ia «a6 n
•JkII Now cammerrcei BuildIngi m
quke pMns with'wmernr.4 riser dirlgrem and
plan review
1 v!s eMurm slph�rnapp.Gee idrMJ - -