Permit CITY TIGARD PLUMBING PERMIT
Ail DEVELOPMENT SERVICES PERMIT #: PLM2003 -00342
Ai 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/14/03
SITE ADDRESS: 12753 SW 68TH AVE PARCEL: 2S101AD -02400
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 032 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: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocating 1 toilet and 1 lay.
FEES
Owner:
Description Date Amount
WESTERN EVANGELICAL SEMINARY
PO BOX 23939 [PLUMB] Permit Fee 7/14/03 $72.50
PORTLAND, OR 97281 [TAX] 8% State Tax 7/14/03 $5.80
Total $78.30
Phone :
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223
REQUIRED INSPECTIONS
Phone : 503 - 639 - 5296 Rough -in Insp
Top -out lnsp
Reg #: MET 00001703 Final Inspection
LIC 2439
PLM 34 -29PB
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 -6699.
Issued By: . ' Permittee Signature:
Cali (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Air , 3 -0-6 3 - - k
•
Plumbing Permit Application FOR OFFICE USE ONLY
Receive• Plumbing
`
Date/B : - 7 U� z Permit No.: I / , 3 "OD
City of Tigard CE ii \I Elp Planning Approval Sewer
Date/B Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 ^" Date/B : Permit No.:
t
Phone: 503- 639 -4171 Fax: 5098- 960 s _ r d . + , Post- Review L Use
Date/B : Case No.:
Internet: www.ci.tigard.or.us � v O �I C� A � .�`, ;,� �I Conta e Sec Page 2 for
`
24 -hour Inspection Request: , 9 7(S1l�ll. Name /Method: liffM Su..Iemental Information.
TYPE OF WORK . • FEE* SCHEDULE (for special information Use checklist)
❑ New construction ❑ Demolition Description 1 Qty. I Fee(ea.) 1 Total
' Addition/alteration/replacement ❑ Other: • ;New 1- & 2- family dwellings '• •
CATEGORYOF CONSTRUCTION (includes 100 ft. for each utility connection)
El 1 & 2-Family dwelling �CommerciaWlndustrial SFR ( bath 249.20
SFR (2) bath 350.00
Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Each additional bath/kitchen 45.00
. • JOB.SITE INFORMATION and LOCATION . Fire sprinkler - sq. ft.: Page 2
Job site address: /a 7,5.3 Sk✓ 6r , Site Utilities • "
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name:61 AX .4/ re` Drywell /leach line /trench drain 16.60
Footing 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 ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft. Page 2
Tax map /parcel #: = - "'''` or Iteiii: .' ; .
' ' ` `' ' DESCRIPTION OF WORK • -
' / Absorption valve 16.60
A O t� I✓. c. 9- avi CA Backflow preventer Page 2
Backwater valve 16.60
. Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
O : PROPERTY::OWNER 1 ❑ TENANT. - • • - . Ejectors/sump 16.60
Name: Geaeor / X av /viep,' Expansion tank 16.60
Address: ) 27f. ft,/ Ere. Fixture /sewer cap 16.60
City /State /Zip: -"lbw e( Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City /State /Zip: Primer a 16.60
Roof drain commercial) + 16.60
Phone: Fax: Sink/basi avatory 1 16.60 //
r .,
E -mail: Tub /shower /s ower pan \ ?( 16.60
• • .CONTRACTOR . - Urinal e 1' 16.60 b V
Business Name: (. /E- C77 €,f/ ,,��P Bode Water closet / 16.60 I.
,� Water heater 16.60
Address: 9r60 ,S"/ �/7,, /,Aiif' ..fv rte Other:
City /State /Zip: j 6,41' of 9211 Other:
Phone: - q6 - Fax: � eAsf-90..f . Plumbing Permit Fees*
CCB Lic. #: J'9 Plumb. Lic. #:3Y.We Subtotal $
Minimum Permit Fee $72.50 $ 7 A)
Authorized - / R esidential Backflow Minimum Fee $36.25
Signature: �N Date: 7 0 3 Plan Review (25% of Permit Fee) $ -
7 1 ,f State Surcharge (8% of Permit Fee) $ .S. if 6
(Please print name) TOTAL PERMIT FEE $ .3 0
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location / 2.753 a g Trl A-Ve • Suite MEC
Contact Person Ph ( ) (c' C' 3-0O21a-
Contractor Ph ( n ) SWR
BUILDING Tenant/Owner �aR R )c 1 {oL$ • 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: /MIL % "
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
,? PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final -
PASS PART FAIL
ELECTRICAL
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 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /I ADA
Approach/Sidewalk Date
• Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL