Permit CITY TIGARD PLUMBING PERMIT
1.40 A DEVELOPMENT SERVICES PERMIT #: PLM2003 -00418
..� I - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/18/03
SITE ADDRESS: 12665 SW 69TH AVE PARCEL: 2S101AD -02800
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 031 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B FLOOR DRAINS; 3 TRAPS:
STORIES: 2 WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 5 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 5 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Plumbing for new office building. Other fixtures are (2) primers.
FEES
Owner:
Description Date Amount
CEDAR ENTERPRISES
MARTY GOLDSMITH & RON ENYEART [PLUMB] Permit Fee 9/18/03 $378.40
4004 KRUSE PLACE [PLMPLN] Plan Review 9/18/03 $94.60
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 9/18/03 $30.28
Phone : Total $503.28
Contractor:
KSM PLUMBING INC
DBA SUNSET PLUMBING
PO BOX 628 REQUIRED INSPECTIONS
WEST LINN, OR 97086
Phone : 503 Rough -in Insp
Rain Drain Insp
Reg #: LIC 141154 RP /Backflow Preventer
PLM 34 -366PB 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
Issued By: _41,, i / Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing OFFICE;iJSE ONLY '
>lnbin Permit Application _ Received ., Ism
c,.,, F,,,/ _ I V L7 J Date/I3 : r ` � 1 Permit No.: MBE=
Planning A.proval Sewer 1 p „ _ _ - 'o 3J
City of Tigard Date/13 Permit r\o.' at�JJ
13125 SW Hall Blvd. AUG 1 -; Plan Revi w Other
Date /l3 17 P • No. ►�, A - - cY?.0 7
Tigard, Oregon 97223 Post - Review Land Use
Phone: 503 -639 -4171 Fax: 503 - 5 "6'0F Ti , r I A Date/g : Case No.: ��:5 -U . O
BUILDING D . .iuns.: Z See Page 2 for
Internet: www.ci.tigard.or.us n Contact
1L2
24 -hour Inspection Request: 503 - 639 -4175 Name /Method: Su IementalInformation.
• TYPE OF WORK . I FEE* SCHEDULE (for special information use checklist) .
® New construction ❑ Demolition Description I Qty. 1 Fec(ca.) 1 Total
New 1- & 2- family dwellings
111 Addition alteration /replacement ❑ Other: (includes 100 0. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1 & 2- Family dwelling Commercial /Industrial SFR (2) bath 350.00
['Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder
❑ Other: E additional bath/kitchen 45.00
2 e
• • JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page I
� -g, //1L i, Site Utilities
Job site address: / ZIOIA S " � 16.60
Bldg./Apt.#: Catch basin/area drain
Suite #: _ Drywell /leach Tine /trench drain 16.60
Project Name: S o u S f 1 - / F ooting drain (no. linear f t.) Page 2
Cross street/Directions to job site: Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear 0.) Page 2
I , Storm sewer (no. linear ft.) Page 2
_ Subdivision: l of ` Page 2
Water service (no. linear ft.)
Tax map /parcel #: .. - Fixture or Item • - .
. q t C.: 12,-. N OF WORK Absorption valve 16.60
- 12-. �' = � % � /,,,17 • if Backflow preventer i Page 2 16 . Backwater valve 16.60
• • Clothes washer 16.60
Dishwasher r ,% i 16.60 /it . 100
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name:
Ex tank 16.60 Address: Fixture/sewer cap 1 6.60
Floor drain/floor sink/hub , ,,3 16.60 '4j 80
City /State /Zip: Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
❑ APPLICANT ` , ❑ CONTACT PERSON Ice maker 16.60
S r)1.^ 5 s , 1 i41 / -1 Ci K ` I / trap 16.60
Name: Pa e 2
Medical gas - value: $ g
Address: p,o • ; * `eM q Primer 16.60 33 .
City /State /Zip: t �t ✓� U r 2 Roof drain (commercial) 16.60
' S l 'v Fax: 7v ` 3 Sink/basin/lavatory ✓(e2 111" 16.60 qg• (ac
Phone: $�± - S7�- ILO 1 I S 3 s bi/lt 16.60
Tub /shower /shower pan
J E-mail: Urinal v 2. 16.60 aR). C
. CONTRA OR Water closet r / S. 16.60 in , GI
Business Name: Water heater i 16.60 114.00
Address: Other:
City /State /Zip: Other: ,
. ::Plumbing Permit Fees*
Phone: Fax: Subtotal $
CCB Lic. #: ' lumb. „c. #: Minimum Permit Fee $72.50 $ � �
Authorized J ' Residential Backflow Minimum Fee $36.25 • pr ,, , Date: `b -1 7') Plan Review (25% of Penult Fee) $ C ignature: / "
° �Ci VP / // State Surcharge (8% of Permit Fee) $ 0 • r
• lease print name) TOTAL PERMIT FEE $ ,r) 03 •
Notice: This permit application expires if a permit is not obtained within All new w commercial m for l buildings . require 2 sets of plans with Isometric or
180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board.
i :\Dsts\Pemvt Form almPermitApp.doc 01/03
∎- •
OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
' BUP
Received 3 ; ei/e Date Requested y/ -2Z 7 �4 M PM BUP
Location / 2 lP eo 5 % 1 Suite MEC
Contact Person )6(.4 UY(- Ph ( )A0/ — 5 7/a2 1 3 –00q/e1
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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 1
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL C
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
P AS PART FAIL
HANICAL
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: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date V` 7 6 L C Inspector ' 72-) ' .fr'
Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL