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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 business Phone: 6394171
Date Requested: _ _ A.M. P.M. MST:
Location: t'5( BUP:
Tenant: Sui& Bldg:
Contractor: R�- Phone: _�! — Q ZPL 4: V_tr
Phone: _ L,C: __
ELR:
t/ ► _ _ SIT:
BUILDING BLDG(con'1)` �PLUM —� MECHANICAL ELECTRIC,41, SITE —
Site Post/Beam Post/13w„ PostfBcatn Cover/Service Sewer/Storm
Footing Roof Undl,!/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Linc Rough-In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnec+. Vault
l3smt Damp Drywall Stonp Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/," UG Slab
Shear/Sheath Fire Spklr/,Um Crawl/round Dr I letd Pump Low Volt
Approved A proved Approved Approved App ed
Appr/Sdwlk Not Approved ved Not Approved Not Approved Not Approved 1
FINAL FINAL FINAL FINAL FINAL
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O Cali for reinspection I Reinspection fee of S rquired before next inspection Cl linable to inspect
ln.4pect.;r: i� __._� Dole,. ? _ f ___ Page_ of V
CITY OF T'IGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT 0. . . . . . . : F-ILM'38-01"-'7
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 DATE ISSUED: 05/08/98
PARCEL : 25112CC-08400
SITE ADDRESS. . . : 156179 SW 82ND AVE
SUBDIVISION. . . . : LANGTREE ESTATES ZONING: R-12
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .016 JURIS3DICTTO1\1. TIG
-------------------------------------------------------------------------------------
CL.ASS OF WORK. . :ADD GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : I
OCCUPANCY GRP. . R33 FLOOR DRAfNS. . . . . . .. 0 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . : 0
FIXTURES---------._---__— LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . . 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAP='S. . . . . 0
LAVATORIES. . . . . 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . V)
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Add residential bacl�flow prevention device to an existing rt- idence.
Owner-: ------------------------------------------------------ FEES
ACEVEDO M ARCEVEDO type amni-int by date rer-pt.
15679 SW 82ND AVE PRMT $ 15. 00 GEO 05/08/98 98-30561 -:)
TIGARD OR 97224 5PCT $ 0. 75 GEO 05/08/98 98-305613
Phone #: 624--9017
Cont ract
0',-)NER
-------------------------------
Phom? #: 15. 75 TOTAL_
Reg #. . - 000000
---- REDUIRED INSPECTIONS -------
This permit is issued subject to the regulations contained in the RP/biAc k f I ow Prev
Tigard Municipal Code, State of Ore. Specialty Cidps and all other Final In�pection
applicable laws. All work will be done in accordance with
approved plans. This pervit will expire if work is not started
within l"A days of issuance, or if work is suspended for more
than 188 days. ATTENTION: Oregon )a" requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-888I-8010 through OAR 952-9 1I-OW. you may
obtain copies of these rules or direct questions to MINC by callino
(503)246-1987.
I ssi-ted By : -A. Permittee Signature :
f......... ....4.......3-+++-+ .+ ....................4.........I?+....4++A+4++ ++4++++++-+-+
Call 639-4175 by 7:00 p. m. for an inspection needed the next br-(siness day
........................*.....................4.............................
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Permit #:
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Address:
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Issued b�/;j ? .-�atc:
Statement: Information Notice to Property Owners
About Construction ,3esponsibilities
Note: Oregon Law, URS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can he issued. This statement is required
for residential Building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration cinder ORS 701.010(7),
reed not submit this statement. This statement will befled with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
® 1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
F-1 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
a
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board, If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
-' Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
r
(Si ature of permit applicant) ate)
(White copy to issuing agency permit fila.
pink ropy to applicant)
CITY OF TIGARD Plumbing Permit Application Plan Check
13125 SW HALL BLVD. Commercial and Residential Recd By
T,''YARD, OR 97,223 Date R J —
(503) 639-4171 Date to P.E. _
Print of Type Date to DST
Incomplete of illegihle applications will not be accented Permit# L
Related SWR 9
Q Called _
Name of Development/Project 1
On back indicate Work Performed by fixture.
Job FIXTURES (Individual) QTY PRICE AMT
Address Street Address Suite Sink 9.00
Lavatory _ 9.00
Bldg# City/State Zip Tub or Tub/Shower Comb.
9,00
Name I /I/ Shower Only 9.00 ____7C C'•(�C.C ' Water Closet 4 00
Owner Mailing Address Suite
� u� Di:ehwasher _ 9.00 �
Garbage Disposo: 9.00
City/State Zip Phone _
Washing Machine_- 9.00
Name Floor Dram 2' 9m
3 9.00
Occupant Mailing Address Suite 4' — 9.00
City/State Zip Phone Water Heater O conversion O like-km 9.00
Laundry Room-,,ny 9.00 _ a
Name Unnal _ 9A0
Other Fixtures(Specify) g Q0
Contractor Mailing Address Suite _f
9.00
Poor to permit City/Stale Zip Phone 9.00 -
issuance,a copy Sewer-1st 100' 30.00
of all licenses are Oregon Const.Cont.Board Lic# Exp,Date Sewer-each additional 100' _ � 25.00 I
required if Water Service- 1 st 100' L 30.00 J
expired in COT Plumbing Lic.# Exp.Dale Water Service-each addillonal 2U0'
database .'5A0
Name Storm&Rain Drain-1st 100' 3t 174
Architect Storn&Rain Drain-each additional 100' 25.10
or Mailing Address Suite Mob'e Home apace 25.0
_ Commercial Back Flow Prevention Device or Anti- 25.00
Engineer City/State Zlp Phone Pollution Device
Residential Backflow Prevention Device' 15.00 /�-
Descnoe work New O Addition O Alteration O Repair O Any Trap or Waste Not Connected to a Fixture 9.00
to be done. Residen!Ial O Non-residential O Catch Basin 9.00
,4ddilicnal dpdpgcription of work: Insp.of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40 On
per/hr
r_ --- — — Rain Drain,single family dwsiling 30.00
t„ Existinq use of ____�_ _
cn building or property - _ Grease Traps 9.00 —I
_ Proposed use of QUANTITY TOTAL
building or property, Isomemc or riser diagram is required N 9uantly Total is 19
r: 'SUBTOTAL
I hereby acknowledge that I have read this application,that the information
given is correct,that 1 am the owner or authorized agent of the owner,and 5%SURCHARGE a !.. r,
- that plans submitted are in compliance with Oregon State Laws. `I
919natum of Owner/Agent Date "PLAN REVIEW 25% OF SUBTOTAL
G Required onty d flOurs qty total is>9
„�i J TOTAL
Con�ct •non Na Phone
'Mlnlmum permit fee is$25+5%surcharge,except Residential Backflow
- �1 7��F., AV C✓e-CtPrevention Device,which is$15+5%surrharge
**All New Commercial Buildings requirr plans with isometric or ris tr diagram
and plan review
I:Wtlalplumbagr.doe 01111111
PLEASE COMPLETE:
Fixture Type �-----,
YP Quantity by Work Performed
New Moved Replacod Removed/Capped
Sink _ �—
Lavatory
Tub or Tub/Shower Combination~
Shower Only _
Water Closet
Dishwasher - —�
Garbage_Disposal
Washing Machine
Floor Drain_ 2"
4"
Water Heater
Laundry Roorn Traw
Urinal
Other Fixtures (Specify)
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,OMMENTS REGARDING ABOVE:
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