Permit (10) CITY F TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00104
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/16/04
SITE ADDRESS: 12256 SW GARDEN PL BLD.1 PARCEL: 2S101 BB 01500
SUBDIVISION: CROW PARK 217 ZONING: C -
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: - SEWER - LINE: --ft - -
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI, capping (1) toilet & (1) lay, replacing (1) sink.
FEES
Owner:
Description Date Amount
SPIEKER PROPERTIES LP
4380 SW MACADAM AVE STE 100 [PLUMB] Permit Fee 3/16/04 $72.50
PORTLAND, OR 97201 [TAX] 8% State Surcharl 3/16/04 $5.80
Total $78.30
Phone :
Contractor:
MIKE PATTERSON PLUMBING
15028 S MITCHELL LANE -
OREGON CITY, OR 97045 RE QUIRED INSPECTIONS
Rough - in Insp
Phone : 632 7374
Insp existing /capped fixtures
Reg #: MET 5242 Final Inspection
LIC 81746
PLM 3 -359PB
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
Issu- • By: i . ;1 „I // 1 " Permittee Signature: '
/ d7 '
Call (503) 639 -4 5 by 7:00 P.M. for an inspection needed the next bu i ess day
, Mar- 12 04 11:50a Mike Patterson Plumbing 503 - 632 -5647 p.1
. i ;,, : ->~ ., u
/
o — er g
4 „, Plumbing Permit Application n D ate received: , / 0 it Permit no.: 1 , .' i --ea e A
City ®f i 1� E I Sewer permit no.: i wilding permit no.:
' ' Address: 13125 SW Hall Blvd, Tigard OR797223
City of Tigard Phone: (503) 639.4171 Project/appl_ no.: Expire date:
Fax: (503) 598 -1960 MAR 12 2004 Date issued: By: Receipt no.:
Land use approval: CITY OF T I G A R D Case file no.: Payment type:
11'PI: OF P[R111'
'X1 & 2 family dwelling or accessory D Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction ” Addition/alteration/replacement ❑ Food service 0 Other:
• JOB SITL 1 \I ORMI.%TION I?I:I S(•IIEDI' C:.(t``or special inform :Itiott liar rlit•t•klkt .
Job address: 12251 5W U Gt:/GIe.„', P I • Description Qty. Fee(ea.) Total
Suite no.: New 1- and 2-family ly dwellings only:
Bldg no.: ( ntchides100 ft. for each nbTdyconnection)
Tax map /tax lot/account no.: 09 .- p167)0 - - SFR (1) - bath -
Lot: 'Block: I Subdivision: SFR (2) bath
Project name: DL W i 1 SOn /A (-2.... : 1 SFR (3) bath
City/county: "l' of l/d I ZIP: 'q 70 3- 224(P Each additional bath/kitchen .
Descri tion and location of work on premises: Site utilities:
Ia!z to•f2k)en Si() E. '. ec,.p 2 'X (oS Catch basin/area drain
Est. date of completion/inspection: Drywells/leaah line/uench drain
Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: (VI j G cc-} CISOV t P1 l.9')1 ti i ' - Manholes
Address: 15025 .5. M i Lie i l t.t-i Rain drain connector
City: Q glee 00 -c »
i I S: I ZIP: G 7G45 Sanitary sewer (no. lin. ft.)
Phone: (032. ? C� - 737 4 I Fax: 032.0d1 E -mail: Storm sewer (no. lin. ft.)
CCB no.: Plumb. b us. reg. no: ' f Water service (no. lin. ft)
$ ! �] 4 Co I 3 3� Fixture or item:
City/metro tic. no.: S.2 Absorption valve
Contractor's representative signature:4 1 - °- 2/-C- c Back flow preventer
Print name: I / iSeri 4.1-.--- te • 2 O Backwater valve
Basins/lavatory
Name: Clothes washer -
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E-mail: Expansion tank
OW `ER /no. .
Floor drains/floor sinks/hub
Name (print): Garbage disposal
Mailing address: Hose bibb
City: I State: 'ZIP: Ice maker
Phone: 'Fax: 1 E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation primer(s)
will be made by me or the maintenance and repair made by my regular Ro' _ drain (commercial)
employee on the property I own as per ORS Chapter 447. 1 Mr, basin(s), lays(s) r(/ I;4CE I /6 4 •
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E-mail: Total
Minimum fee $ 7A • S C)
Not all jurisdictions accept credit cards. please call jurisdiction for mom information. Notice: This permit application %) -�j—.
0 Visa 0 MasterCard if a permit is n obtained Plan review (at /o) $
Credit card number / / within 180 days after it has been State surcharge (8 %) $ 5 $v
Expires TOTAL $ 7 8 . 30
Name of cardholder as shown on credit card accepted as complete.
S
Cardholder signature Amount 440 -4616 (6Ao/COM)
Accumulative Sewer Tally Parcel # 2S101BB -01500
Tenant Nallo:-AsVoClated Building Contractors This SWRt N/A
Site Address: 12256 SW Garden Place This PLM# 2004 -00104
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #5 count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 — 0 0 -- 0 - 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 8 0 0 -2 -8
Current Fixture Value -8 divided by 16 = -0.5 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -8 divided by 16 = -0.5 over (under) $ (1,200.00)
Enter EDU Change Here -0.5
Notes: SEWERCREDLT
/ �;� r �
ignature: MI'!� /i� wry' . i.. Date: „ATM
Build' g Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
i \Building \Sewer Tally \SewerTallySheet.xls 11/19/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 6,--071 / A PM BUP
Location / ,?,.7\45---(0 eI Suite 214. ( MEC
Contact Person Ph ( ) 6 3 2- 7 3 7(1- PLM ateLa_V' 00 / d 4 4
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
e------d _____ _
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab •
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
AS 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 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line .
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO N • T REMOVE this inspection record from the job site.
PASS PART FAIL
•