Permit C ITY OF TIG PLUMBING PERMIT
M11A DEVELOPMENT SERVICES PERMIT #: PLM2004 -00388
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/27/2004
SITE ADDRESS: 10900 SW 69TH AVE PARCEL: 1S136AD -06503
SUBDIVISION: WAY LEE ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: UNK FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: 0 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Remodel
FEES
Owner:
Description Date Amount
WAY W LEE GENERAL
CONTRACTOR [TAX] 8% State Surchan 8/27/2004 $9.02
5210 SE 26TH [PLUMB] Permit Fee 8/27/2004 $112.80
PORTLAND, OR 97202 Total $121.82
Phone:
Contractor:
MP (MILWAUKIE) PLUMBING CO
P.O. BOX 393
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone : 503 - 655 - 9161 Rough -in Insp
Top -out lnsp
Reg #: LIC 5002 RP /Backflow Preventer
PLM 3 -17PB Final lnspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246- = : • • .
Iss ed By: � ,, ; i � Permittee Signature: . ��-
A
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
08- 24 -'04 03:55 FROM -MP PLUMBING CO. 5036507050 T -009 P02/03 U -481
f- ,�
Building Fixtures ((P3
plu bing Permit Applicatio `r i �/ �/ � y iED City of Tig$rd �i l�teeeiv „, _ r
13123 SW Hall Blvd., Tigard, OR 97EZ� D eJB : _ -ay IM Peralil No,:' (../V\4200(4-/, fn
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(] Demolition For ipeclat Informallon sat checklist
G Addition/alteration/replacement ❑ Other Descri Qb, Ea Ti
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't r " J r � > . �,ti r , • *, New 1- 2- family dwellings (includes
,: , , � ' p,,,',.',..-, � I ;^ i t � 7" , a 6 $a C cs 100 ft. for each utility connc
❑ 1- and 2-family dwelling W SF (1 b at h _ 249.20
❑ CotnmetciaUindilsfisl SFR (2) bath
-
350.00
❑ Accessory building ❑ Multi-family SFR (3) bath 399.00
13 Master budder I Ma / Each additional bath/kitchen 45.00
+ �/
.`I' - .,. • u� i� ; , / � . I . t� 7 , 7 . ■ fi-• - . , _ Fire sprinkler( s it
{ .. � p l 'a , �j t , t,j q' ) Pagt2
_ , , i'^- -0',': t:....... -t s � ;% tip Site utilltioa
J. b st e address: ���
'� / Catch basin or arcs drain 1660
City/State/ZIP: � / ' - ---- --
-t.. , , /� ,:-.. 3 Drywell, leach line, or trench drain 16.60
Suitebbldg ✓ apt. no.: * Project name: /t // �/ /
Footing rain (no. linear ft.: ) Page 2
/ / 6
Cross street/directions to job site: Manufactured home utilities 11000
- Manholes 16.60
-- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ ) • Page 2
Storm sewer (no. linear ft: ____) Page 2
Subdivision: Lot no.: Water service (no. linear ft-: `_ Page 2
Tax map /parcel no G 3 ) 3 0 � k G Fixture or item
r te ( t �: yi- , r i . .. c r ry . ""17 7 ; STN' • ��' 41 , Absorption valv r
''':" � 7 �- ai%i h. :]t __ 4∎13 t�w:.ra.. _. �.Y.L .'r .. M1 cy 1 ; 1g. 60 Al
���i6P�� '� " �1�'' -• -� Backtlow preventer r Page 2 4
---_ _ Backwater valve
16.60 - Clothes washer 16.60 _ 1
x y W r Dishwasher I 16.60 �� f
:5: :....4 - „ L� � r >FvS';a , .S.; °q ty '" . [ e .1 a *; ( . ^� . 't r K king fountain t
�• - r ��sr Drinking 16.60
Name: i "~ �� t :r,. Ejectors/sump 16.60
1 �e.iii
Address: - _ Expansion rank 16,60
Fixture/sewer cap 16.60
City/State/ZIP: Floor drain /floor sink/hub
16.60
/ y Garbage disposal
16.60
,4•7c7: . y � 1,. , � t t i .r r � $` c , ' 7 H ose
,. te `'r ! i* L." a. .5, ` r ' t ` r i �"` t bib 16.60
!! / ,, i _ _ •�. krx < . Ice maktr
i 16.60
Contact name: - 1n t�eptor /grease trap 16.60
Address: ..,,,./ Medical gas (value: $ ge 2
Pa
Prima 16.60
City/State/ZIP: ��j Roof drain (commercial) 16.60 /
phone: ( ) J .i4/ Fax; : FA /JD Sink/basin/lavatory � 1 ,
phone:
` 16.60 r/� /
E-mail: Tub /shower /shower pan 16,60
. v.-..... � �' ` " c;tren •- •, t ) el i s ` a1° , a .. � �,�'� -�tiE p r y P Urinal 16.60 -
ah �: b • ..:�Ci�... �i '14' '• �'; • - '• Water closet 16.60
-
Business name: /, /
•")) J'/ !! _ / Water heater 16.60
Address: / I `/ ,
Other.
City/State/ZIP: J / � .
/� , .a `� Subtotal
Phone: ( ) w i Fax: ( ) Sp. . 7
•
Minimum permit fee: 57.50
Residential backflow minimum permit fee: $36.25
�
CCB Lic.: / J ;, • / N-, Plumbing Lic. rm.:• "029 Plan review (25% of permit fee) • Authorized signature: a ' S rate surcharge (8% of petrnit fee) Qx
Print name. TOTAL PERMIT FEE
Date'
�yi1 -ei 3 p
• � This permit application expires i a permit is not obtained withi
180 days after it has been accepted as complete.
/2„1 nor w�.w.�t.. _ .. , Fee merhodolocv set by 7t... nunr. a.,it,+: tw .l...w.. c......./...7.
�.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
q / BUP
Received Date Requested / AM PM BUP
Location / 0 96 v 69 Suite MEC
Contact Person `/ Ph ( ) Ste` 9 / PLM DU 4 1 - 00g
Contractor Ph ( ) �/� �S W RR
BUILDING Tenant/Owner 0/1 I g /S /��r E L C
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear / P /,� j - ���
Framing 00w IA¢�; •.e t- S -A Ti•'t t / 17- W 6-4 c./
Insulation
Drywall Nailing '���� n
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab -
'•Ig -n
ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
i-
47t 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 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
Approach/Sidewalk Date q J i) U 4 Inspector CrD `� ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL