Permit •
r CITY OF TIGARD PLUMBING PERMIT
(A. DEVELOPMENT SERVICES PERMIT #: PLM2004 -00157
�I II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/13/2004
SITE ADDRESS: 12395 SW 68TH AVE PARCEL: 2S101AA -04500
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 022 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: (1) utility sink.
FEES
Owner:
Description Date Amount
LOUIE, RICHARD C
12395 SW 68TH [PLUMB] Permit Fee 4/13/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchari 4/13/2004 $5.80
Total $78.30
Phone:
Contractor:
D + F PLUMBING
4636 N ALBINA
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 465
PLM 26 -23pb
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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -66 • ' .
!
Issue By: .!u �� • _ � � Permittee Signature Call (503 .39 -4175 by 7:00 P.M. for an inspection needed the next business day
Apr 04 03 :54P P.02
dui r IXLUJ
Numbing Permit Ap 1jation Rr i3jo_v88 rN°mv xml - ®o/5 . 2
`
I V P lanning proval Scwcr
V p ' ,,,
City of Tigard Q� Datc/By: Permit No,: /e.3-d0- m/7
13125 SW Hall Lilvd. i ` O� Plan Review Other
Tigard, Oregon 97223 `' �'0 Date/By: - Permit No.:
Phone: 503 - 639 -4171 Fax: , 0 ' ''59 8 - ..MtP.P%0 : Post - Review Land Use Y \•',; ., ' I ;'. Date/By: Case Nu.: •
Internet: www.ci.tigard.or.usl. O p\v \S r,•1 / I Contact Juris.: See Page 2 for
24 -hour inspection Request: v3- }t '175 �" Nani&Mcthod _ 1 ® Supplemental Informati
_ ,i as/ 0 1
• • • TYPE OF WORK FEE.. "•SCHEDULE (for special lnformation use checklist
D New construction U Demolition Descri . lion Qty. Fee(at.)
Addition /allcration/r'eplaccment 0 Other: New 1 -:& 2- family dwellings
CATEGORY OF CONSTRUCTION • • (Includes 100' ft. forma utility cenncctiaa) • SFR I bath 249.20
El 1 & 2- F amily dwelling Commercial /Industrial _ SFR(2)balh 350.00
r]Acccssory Building [] Multi - Family SFR (3) bath 399.00 -
ri Master Builder Q Other: Each additional bath/kitchen 45.00
.• JOB SITE INFORMATION and LOCATI N _ Fire sprinkler - sq. ft.: Pale 2
Job site address: 1 t3,3 S . . • Y ' S1te,Utilitles ••
1316 T /A t #: Catch basin /tuna drain 16.60
Suitt: #: _ P • Dr ell/leach line/trench drain 16.60
1'roject Name: t • ax . • Footing drain (no. linear ft.) _ Pagc 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear 11.) Pagc 2
• I Lot #: Storm sewer (no. linear f11 Page 2
Subdivisiotl: •- Water service Jno. linear ft.) Page 2
Tax map /parcel #: . • ..Fixture or Item • ... .. . •
r DESCRIPTION OF.WORK Absorption valve 16.60
ROLr' i'l 1'A 4/l4. ilig i✓ t..J 7 1. - T ie Backflow prcvcnter Pagc 2
iM ag% `` co P ' r .._ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
...E VRAPERTV OWNER • .... ..:i: 1 ENANTLLi .• ;ir • , Ejectors/sump 16.60
Name: DD. i E-Dy__ , Expansion tank 16.60
Address: [ Z 3q4 s ul 6 fl fiH
Fixture/scwcr cap 16.60
Floor drain /floor sink /heir IG.GU
City/State/ZAP: Ti i>� (�tZ- Garbage disposal 16.60
Phone: 5; e-- -`/2 Fax: _ I lose bib 16.60
APPLICANT ' . CONTACT' PERSON :�.• Ice maker 16.60
Name: of i=. pi, dII161"1J!s 0: Interceptor/grease trap 16.60
Addres AVE Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Q e-'17--1�1 �j ' /� t 7 Roof drainjcommcrcial) 16.60
Phone: ��;,t_OS� � , Fax: yP 21rk
Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower, pan 16.60
CONTRACTOR . Urinal 16.60
Water closet 16.60
Business Nat7 1e: c)n6 4 "of) Water heater 16.60
Address: . - Other: g) , v S ,'
i A /44.,.•1 /6 , -
City /State /Zip: Other:
Phone: Fax: . . .: Plarnblug Permit Fees` .
_ Subtotal �
CCB Lic. #: 4 PlPlumb. LiC. #: Minimum P erm i t F cc $72.50 $ _ _ L-
Authorized Residential Baokflow Minimum Fcc $36.25 -' � 2 ' .
Signature: / Date: Pl Review 25 % of Permit Fee 4 $ • (
» � L1J� _ State Surcharge (8% of Permit F -:�] r44 = '
._QII j ��' ( case punt runic) TOTAL PERMIT F ;- "
E ' 3f
Notice: This permit application expires If a permit is not obtained within All new commerdal buildings require 2 sets o plans with isometri . r
IRO days after it has been Accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Butldin ustry1ervIce Board.
is \L)sIa\Permit l+onns\PtmPcrmitApp.duc 01/03
7 fc,64.S
Apr -12 -04 01 :33P P.01
iSuiiaing r ixiurCs
Plumbing Permit Applicat ion Rcctivcd FOR OH'1 IC:L. USE ONLY
Plumbing
� D Date/By:
Permit No.: _
A City of GEN Planning Appwval - - Sewer
DatclRy: Permit No.:
13125 SW Hal lvd. Plan Revicw Otlicr
Tigard, Oregon 17333 '. r- 2004 Datc/By: - Permit No.: _
Phone: 503 -63971 Tax 5 q 98 -1 )GO Post Land Use
c
Internet: www mC � t1 ' I h'' Iii
��t 1 O : �1� Contact Jufis•: Sec Page 2 for
24 -hour Inspect }c��1t{ (a9 -b -4175 Namc/Mcthod: 1 Supplemental Information.
TYPE OF WORK FEE* SCHEDULE for s . dal Information use ehoeldist
❑ New constriction Demolition Description Qty. Fce(ca.) Tula'
�Ad _ dition/alteration/replaccmcnl Other: New 1- &:2-family dwellings
CATEGORY OF .CONSTRUCTION . (includes l00 i't. for each utility connection)
2-Family dwellin Commercial/Industrial SFR (1) bath 35 0.00
1 &
❑ ._,.. Y S PR (2) bath 350.00
❑Accessory Ruilding_ ❑M ult i - Family SFR (3) bath 399.00 •
-[] Master Builder ❑ Other: Each tulditional bath/kitchen 45,00
• JOB SITE INFORMATION and LOCATI N Firc sprinkler - s9. ft.: _ Pagc 2
Job site address: -S . W _. _ sue :mime. •
Suite 11: 1 Ride,. /Apt. //: catch basin /arcadrain 16.60
- � � O� D�ell/leach linc/trcneh drain 16.60
Project Name: Fooling drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110,00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear fl.) Pagc 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Pagc 2
mar /parcel # Water service (no. linear ft.) Page 2
Tax
.•• : :: ii :, , ::•``.:.' •.. , ... Flxture''or Item . -
' TN OF WORK •
pp� .. Absorption valve 16.60
frp1 h 1'A OA . f 2 ik) /4 i. _ f • /r/11C_ 13ackflow prcvcntcr Pa.e 2
IA U/1_ etc,` i; Go1' t rc/Qr I I Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
;
:PROPERTY OWNFR • . . TF.NAN # ; Ejectors/sump 16.60
Name: pa,,, Q t -- &7_ Expansion tank 16.60
Address: I Z 3 -,I._s , t.) 616 fiH Fixture/sewer cap 16.60
Cit /State /Zi T i • pea_ I(Z_ Flour drain /fluor sink/hub 16.60
Y . ` p' Garbage disposal 16.60
Phone: 3j e - `12 4 -( hax: Hose bib 16.60
•❑.APPLICAN [' CONTA CT.PERSAN! : • • lcc maker 16.60
Name: (:),Of. r(_d✓1us/nl [ 0 Interceptor /grease trop J 16.60
Address: '/' 3 � /et Ave, Medical gas • value: $ Pagc 2
City/State/Zip: PO 2 _ Primer 16.60
� oe 51 z i 7
Roof drain (commercial) 16.60
Phone: a ly,z -01:...4 I i
Fax: 9.3 St'S Qt OV sink/basin/lavatory 16.60
E -mail: Tub/showcr /showcr.pan 16.60 ,
.CONTRACTOR Urinal 16.60 •
m e: Water closet 16.60
Business Na
� . � � Pi�� � Water heater 16.60
Address: . , _ .. other: )T ;1; 1 y Belli /G- 0 I.6...-
City /State /Zip: Other:
Phone: Fax: . Plumb1_n ;Permlt•Fees *. • . .• ..
CCB Lic. #• /1 Plumb. # :
c. X a3 Subtotal $ -
• 7 � � Min imum Permit Tcc $72.50 $ -
_
Authorired / Residential Backilow Minimum Fee $36.25
Signature: Date; � ' / Z / Plan itevicw (25% of Permit Fee $ •
G , "J y / g ; State Surchaae (8% of Permit F , $
/ (' case print name) T OTAL PERMIT F . E S
Notice: This permit application expires If a permit is not obtained within All Kew commercial buildings require 2 sets a plans with Isometr , r
1S0 thus aver It has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri County building , u: ervlce Board.
i: 'Dsts \Permit Fornns\PInd•c 01/03
77,9-t! /°61956'.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re ueste "(77 a d, AM PM BUP
Location 1 3 c7� Suite
L 3/ 3 609 0 /5 , -
Contact Person PIFVT P ( ) 9 t u 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner X 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
Roof
Other:
Final A-11". - 1 -AO � � • < _
PASS _ ; RT FAIL `
:, 3r. G 40 Lam. �� /, / / ,���✓ /
• Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Oth
( *ART FAIL
AL
Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk
Date ( a t Inspector i / o� Ext
PP
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL