Permit C ITY OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00063
A II 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/2005
SITE ADDRESS: 10640 SW 72ND AVE PARCEL: 1S136AC -02700
SUBDIVISION: METZGER ACRE TRACTS ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Backflow device.
FEES
Owner:
Description Date Amount
VINCENT, BRADFORD & KATHY
10640 SW 72ND [TAX] 8% State Surchari 2/18/2005 $2.90
TIGARD, OR 97223 [PLUMB] Permit Fee 2/18/2005 $36.25
Total $39.15
Phone : 503 - 293 - 0503
Contractor:
DOWN TO EARTH IRRIGATION
13075 SW PACIFIC•HWY REQUIRED ITEMS AND REPORTS
TIGARD, OR 97223
Phone : 503 684 - 3500
Reg #: LIC 8169
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: _ rL�� Permittee Signature:
Cali (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
FROM : :,' ° 17. May. 02 2002 12: 03PM P2
Building Fixtures 0� • •
X10
Plumbing Permit Applic i nl 4 FOR OFFICE: USE ONLY
City of Tigard
1 O � 'r ‘C) �'' fir, Received _ % �►__�� . i
13125 SW Hall Blvd., Tigard, OR 97223 r 1 '91 Nan Review
Phone: 503.639.4171 Fax: • 503.598.196-% -1 - :G • - I'; t Dak/B Ready/By: Other . e =t pie z tor
Internet: w �_
24- Hour Inspection Line: 503.639.417 �
ww.ci.ti d .or.uS
� Notified/Method: Supplemental Information
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For special
0 New construction ❑ Dem c ral information use checklist
Addition/alteration/replacement ❑other
Description 1, Qty. 1 Ea. 1 Total
dio riotyr
l�':T, Ad it n / a l t e a..1..?'-',.W.,;.. ep1 - r New 1- 2- family dwellings (includes 100 ft. for each utility connection)
7 4 T;. r� .„r: i , . 4 e7 i'.. S :., �f �� , r:"4 �t r, u „.. A.I L;, ` 9 Q S ' : , ( )
te` . , _�', .. : ..,2s, _ - , SFR E bath 249.20
1- and 2- family dwelling ❑ Com SFR (2) bath 350.00
- fa mily SFR (3) bath 399,00
0 Accessory building ❑ Multi
❑ Master builder ❑Other Each additional bath/kitchen 45.00
Fire
y E T mkler s. ft
�F'li•5r r���q .• 0 ;l 1'��,r�Y�l7 a ll %l , , am y Y t�+7?? d�! k m � 1 srt r Q ) Page 2
i
_ > ;.., . G -.. � ?�I+ Y ..� '� :F�'� Site utilities
Job site address: / • • S Catch basin or area dram 16.60
City/State/ZIP: ' +
I � ��( r
- Dtywell, leach line, or trench drain 16,60
Suite/bldg. /apt. no.: Project name: 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
Storm sewer (no. linear ft.: Page 2
Subdivision 1 Lot no.: Water service (no. linear ft.: ) Page 2
Tax map/patcel no.:
Fixture or item
q��''. ` r' :t ,4 s -, f Absorption valve 16.60
1' V :Fib r� t�+u.�l� 3 , ti- ;: �. P_� �ibKCl r� i P ly rr ,lets_ ' t t
i 4 .,r'i..�llEr2.i =.. : .. . ., w:7 a �r s . p i .lis4 .. 'y" '.:Olt.. 8ackflow preventeT Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
l. .ra'ahlli! r4 . r l'7 . ; r . ::;: � ;. '.,... FF " '; +';,4 -_ne = �� •a=r -i7�t 9, .' ;a]'= .T,+' �' "� • „ .
. rl r ? r 0 1 1 G .'4 : f A aY i. -,II i�', �lr 4r .1' 1 �' I ' f ie r L - iii • . 'jti• g 16.60
ru .• , 5�.f "Y. ....1 , . d � f ...�.' _ ..,s•c'`w. ° r � } Ejextors/sumP 16,60
,' 1 ' WAWA Expansion tank 16.60
Address: ` L f 4I0 `$ - Fixture/sewer cap I6.60
City/State/ZIP:: - . 4 4 ' Floor drain/floor sink/hub 16.60
Phone: � ) _4 r 0 Fax: ( ) Garbage disposal _ 16.60
and „ . ,,r , : r r , ❑. . , . . - r+''' -.� f r �] Hose bib 16.60 II
1i.' .� ....a -,'r, 1:� 2... ,...y. y ?.. r 1 , I 1 , � � : :- -. -v l , ,'Sr � ti � } . 1 $.70_
Business Hanle: 1 _ [� mSke 16.60
(.l I� �1 Interceptor/grease trap a 16.60
Contact name: AIL l Medical gas (value: S ) Page 2
Address: t al- �. Primer _ 16.60
City /State/ZZIP: j it 723 p Roof drain (commercial) 16.60
Phone: t,,, i ) , , _._y � Fax::� / _g2Cj Sink/basin/lavatory 16.60
5 E -mail: ! Tub /shower /shower pan 16.60
NO lilt 0y} r1n�� r ,7,6,V7'1.,-,„ � Q r , L " � Urinal 16.60
a m , ..... z..Z _ a „ ., : 1. ' 's
°.., . „ i l l ZY
o ,,�s� .t p a
Water closet 16.60
o-N Business name: '4 A. Water heater 16.60
, Address: \ rr Other.
City/Stat 1! 3- Subtotal
`" 1111P- % _ Minimum permit fee: $72.50 1 4 -
•
Phone_ ( Residential bacicflow minimum permit fee: S36.25 IP
Plumbing Lic. no.:
�'� A � g Plan review (25% of permit fee)
Authorized signature: I` . State surcharge (8% of permit fee)
TOTAL PERMIT FEE iy�
Print name: MIZANNVIIIMMINII Date:, 4 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
lAtaildin81Permiu •Mf- rareitApp.doe 12/03 440.461dT(10/02/COM/Wgg)
CITY OF TI'GARD 2
BUILDING .o,. inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested a c AM PM BUP
Location /6 Yd 7 a "7'1 Suite • MEC
Contact Person Ph ( ) VOa pLrAgjfkl S 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing G�
Firewall
p
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan ?
Other: '
1
•A'.- 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 / '
ADA /'
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL