Permit C ITY OF TIGARD PLUMBING PERMIT
�� DEVELOPMENT SERVICES PERMIT #: PLM2002 -00421
4 J- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/8/03
SITE ADDRESS: 12750 SW 68TH AVE PARCEL: 2S101AD -01300
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 033 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Medical Gas - Tenant Improvement
FEES
Owner: Description Date Amount
HAMPTON BUILDING, THE LLC
6803 SW WHEATLAND RUN [PLUMB] Permit Fee 1/8/03 $72.50
WILSONVILLE, OR 97070 [TAX] 8% State Tax 1/8/03 $5.80
Total $78.30
Phone :
Contractor:
NORTHWEST CENTRAL PLUMBING
2870 SW 221ST
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone : 642 - 2067 Final Inspection
Reg #: MET 00001690
LIC 72253
PLM 34 -197PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: l (ei — Permittee Signature: _1/1 / %
Call 50175 by 7:00 P.M. for an inspection needed the next busin ss .ay
JAN -08 -2003 11 16
ri p, 02
Pigmbing Permit Application f l
Plovehlos
, / o _ Pam* Elyt 200a- OD i
Planing Approval Scow
City of Tigard Polak Other
13125 SW Hall Blvd. r sera too 8 P�•�
Tigard, Oregon 97223
Physic; 503 - 6394171 Fax 503- 398.1960 Lead. roe
Internet www.eitigard.orms 2+4-baur 503 -639 -4175 �. �,.., � : 7hals : -
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In Ncw coo ati ^ [U Demolition -1_ - Ob. 101EN4
k7_p_ _Y ..'.- a u _u stR �';; 244.20 i
Ii „{ _ L vi COMIngrCiaNIOUStri SFR. ) bath MN 350.00
(11 ;..;::,:.; r:1: -aT_11 Multi-$ami • bah 309.00
1! Master Bader i■ other. Each additional bathikirdien INN 45.00
C : Fire ' . War- • ft.: MI Il"rn
Job site address: o MI= 2NEEra Enslawilmwalimig
Subset - :Ire ELn ,. / - rad *sin 1660 16-60
Na: 81P p R _ �� � _ l. F..,.': •: drain no. lst+ear & � ' 71
Cross street/Directions to job site: , .. _ io.00
Manholes .. ,,.,... 16.60
.■ ;,, drain cor ' IMMO
, Subdivision: Lot #: storm sewer no- 1i>w ffi _ Kal
water service no. inter 111 j —
T 1t� t am : • -„ ; • .,�•,, . .:a..-{. Mli 16.60 NEM
EF 16-60
_ 16.60 _
IIIIIIIINMIIIIIMIIMMIIIIIIIIIIIIIIIIII briskly . fountain -� .;',, n :� � 16.60 � _
�. ta:dc 16.60
Address: Fixmretsswer -- MN — Fl drain/floor sadrAn b t♦ 1640
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Phone: Fax: ... ■16.
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Address - :-
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• Primer 16.0A
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Roof drain _ . r - 16.60 Phone: —
1 Fax: ,- ... t♦ 16.60 MOM
16.60
F1mat�_ thing 16.6
{ �i4. '2- A - 1 , g Water closet 16
Business* 1 �
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• e: 50 4 503 - Zy� -s-wy4 '� " MEM MM.
phone: 5 -6 �2 -lob 7 Fax — - subtotal EMIll 1
CCEI Lac. S: 7Z IS 3 Phtmb. Lic.#: .3N- 197-P% Pew Fee 57240 s - 7 .2 5 Amhor Residual BackfloW Minimum Fa 636.25
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New TbFspermbt+grprha its, peewit is sot a6nlaedwithin rewire
UN dscls after it im Mss sotteptad as complete. *Vas ass ay Tri• 000ty Wading Isidena Ser''ia Sena.
iMsts1PermitForsiffbroPereitApp.doc MAU
COIN 0NI99IL 30 um 09BT86St0S XVI 6t :TT cOOZ /80 /TO
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received L Date Requested AM PM BUP
Location ) 1 "7 1p �'�"�-- Suite MEC
Contact Person Ph ( ) S / ? – iF PLM o 2 - —00
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain
Slab InspeCe c � ! al 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
SS PAR FAIL
LUMBING
Under Slab -
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
I I* PART FAIL
"• ICAL
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
ADA /
Approach/Sidewalk Date t_ / U (O S Inspector /7"�'► � Ext
Other: /
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL