Permit CITY OF TIGARD
PLUMBING PERMIT
lft DEVELOPMENT SERVICES PERMIT #: PLM2004 -00510
'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/12/2004
SITE ADDRESS: 10313 SW 69TH AVE PARCEL: 1S136AA -01500
SUBDIVISION: FUR VALLEY ZONING: R -4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: SR3.2 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: Add (1) lav and (1) water closet to residential group home.
FEES
Owner:
Description Date Amount
LUKE -DORF
10313 SW 69TH [PLUMB] Permit Fee 11/12/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 11/12/2004 $5.80
Total $78.30
Phone: 503- 624 -0866
Contractor:
JAY JAY'S PLUMBING
19447 E. BURNSIDE
PORTLAND, OR 97233 REQUIRED INSPECTIONS
Phone : 667-8420 Rough -in Insp
Final Inspection
Reg #: LIC 14332
MET 1977
PLM 26 -177PB
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 99.
Iss e d By: / �L i 14_,;_t,,,, Permittee Signature: _ -�� Q
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
lo
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Plugsblzg Permit Apvlication - Of d r o r :.. r rr i i t !_ LS-. E, ON f. v
City rl r,,, l D A .... I 1 Premix e o.:
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Pborw: 503:639,4171 Fme.303.596.1960. otaorPamieleo.: .
24- Hare Inspection LLnc 303.639.4175 s.ePa
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O� Description I Qty. j Pa. I Tout
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New 1- 2••IYm11 9datm C aoetudes 100 retiebwi
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_. -_ -.•'••':.,::::•_:•,. ._ _� . ' SFR(1)bads '249.20 '
o l- and 2 -ffismiy dtelbog 13 SFRa) bath - 330.00 _ -
❑ Aix:mum bang . . 0 Mfsmu1d -ly �( bah - 399m '
d� •
O Muter b Q Other: addioies l batiIdaebea 45.00
.. tirespriatdetL__ sq. R• Page 2
. SiteaeWbies
Job siteaddrese jO3 t 5 lid Cog • i4-‘1/ Catch basis mama dada 16.60 •
a' /S ' ataMIX! T! /.: {� (r) EL - Gl 7 oa :: 3 - > 1L kacb line. or aaneb drain 16.60
Suitelb>agJapi aa.: 1 rat norm: r a Om > a:.� _ h i
awe ttreetidisectioas to job site a home laaxnae 11400
NLffiotes 16.40
• Baia *aim astnacmr 16-60
Sammy wee OM linear ft: Page 2
Soma sewer (pay 1tI sm• R= ) Page 2 ,
Subdivisiatc I Let I= Wass earvioe Om Nuns, 0:: ) - Pepe 2 -
Tax map/pareell1ar._ Fame ar -
. • `. .. - . - - ..._ .- - ._._ . — 2_.':`4: Hu]dlorrprmatter Pspe2
� t ( Beok�wegvalve • - 16-60
` �CSr �P.Aa ^ jr Li.t.11. one” and= washer 16.60 -
Dhboasher • 16.60 •
•
16.60
— ..... --
neacesisongs a . — G - -
Nam I.v.1kt �A 16.60 .•
1'a�rmaiQa nab - 16.60
Addrtar 1031 S 8kiti• 1t AV‘ • FileetdSenneTeasp 16.60 • n ~ 0, A.12:0 0R, 4 7 42-3 Flax dran,aoms; rb -- • 16.60 .
(5a1 to . - • Faac ( ) e 1 16.60
-
1fine2ab 16.60
mete: 1460
Bmss mmm 14--1 --/ S PL►VI. AI..8 t ti 4s. �u kterceprorIgienso tap 16.60
Camara maw ik., e Ai enn_- L T 14 61e6e11 ram (SralueS ) _ Page 2
A f �L .'4 ? 6 L t.1. rem. S Co e• - Mac 16.60 -
Cib/Statc/13� JZ'Z r.j.4 6 I 0 c- . 7 --1_3 d
� 3 Roof drain ( ei) _ ' - 16.60
? ) ( —Is (f 1 y ! Faoe : CSo9 Sf /2,-43%65
vamp 1 . 1660 [t ..".4, ''
• Tublehavedehowar 16,60
Eao$1 Meal • ' 16.60
i. .:. .- - - -- - ._ - - r >,'_ s,. . .- .' . - .. __ - . . I - Wour closet . 1 16.60 1f, £v'
%miaowsame Water beam 163
. Addresen 1411t1 oboe
°hy ees $72i0
•
Ma=
a= ( ) Fee ( ) . Reaideaea badmow aoiniraum pewit fee 636.21 ?�+
C® Lin.: f �� 4 _ Lie. m. ., 1 7 pp Plc review as% of patois Lae) _ ?
State (8%eaEpematfbe) 5
neaboedaadstgaahres 0.4 _ _ _ 1_ ..u+ 7' 1 I ef - ic+rtr L PFI e' 7 S. 30
Pmt name K/•1 SW1 LTH / raw g 3—vy Tefm p°mit app aspires n a permit a nos obratead wields
180 days after le has hems accepted as mmptete: •
*Fee e0 01odolo®r ectby Tt*Camq Bolding Industry Service Baiea4.
T0001 AMV9TY Jr' ITT ► vv-t erw.vv aww.. •ww »+
a• d • d6.. :iO b0 SO AoW
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION I DIVISION Business Line: (503) 639 -4171 MST
i BUP
Received D Date Requested /1 AM PM BUP
Location I 0 3 ) 9 Suite MEC
Contact Person Ph (5D ) C0 7 — � � PLM ,6
Contractor J J Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
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 / & 71/1 "
Other: /
Final
PASS PART FAIL
P MEIN
Po m
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1 Inspec Ext
Other:
Final DO OT REMOVE this inspection record from the job site.
PASS PART FAIL