Permit 71 CITY OF TIGARD PLUMBING PERMIT
CIA DEVELOPMENT SERVICES PERMIT #: PLM2004 -00503
'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/8/2004
SITE ADDRESS: 16101 SW 72ND AVE BLDG A -200 PARCEL: 2S113A6 -00101
SUBDIVISION: ZONING: IP
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Installation of new fixtures for TI. Other fixture includes (1) primer.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES [PLUMB] Permit Fee 11/5/2004 $83.00
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [TAX] 8% State Surcharl 11/5/2004 $6.64
Total $89.64
Phone: 503 624 - 6300
Contractor:
POWER PLUMBING CO .
P O BOX 19418
PORTLAND, OR 97280 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 52378
PLM 34 -150PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 -000 ifl0.,You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 L k �\ _
Issu . �� Permittee Signature: .�, `,,1 / /ar,�' ti
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b mess clay
Nov 03 2004 13: 16 HP LASERJET 3200 p.1
" - ' I V E D . c av - , ? _ - . ? . ' ' P lum bing Permit A 1 ( , is ()II I l 1 1 , I c,.\ l . \
1 w T i�aa Blvd., Tigard, OR 97223 1004 . / /3%,y, f4 I ii m oil ti�c��e3 ,
Phone: 503.639.4171 Fax 503.598.1960 Plan Revtav /
2R- Houtlns ectlonLine: 503.639.417S1rI : , . , :ii yY O aPerrnit /1 - G ' 0
P !. - •• Date ad]�y: 121 See Page 1 for � II
Ii Internet www.ci tigard.or.us B ILUIIVG DIM! Notified/Method: Supple
mental loformarion
C L'iY :;14:" .r.4;1:: I?jiiis. �olr ei -t�'•r.)..p;$Sg!9' ^.rrllll;" - - 5'7 ¢T °:iii' I qx! . t. n : U'i ^ -:`n" .. i"; r✓c• - ; '• ° r3
°•>� 74.4r ;. 'r)-`' �r• Zs.:75 . -CL _..1 ��itl " e .: a. E. N . 4! 4:: 'a . f 7n i .._ ..
, 3, . ~ ,.r�`T . , �V, .a.. 1}•. •.le -- -sell r•, ' 4 :t ;,. h �ti r" =r>x i.',o
IN:Kr,Ns �„� tlt'";;::L�S���:.Ull!i�J� } ti��:;�.• -==' �i•;'; - � � it x ^ '�� -�-s�l � `f ;• n � , � ��- ' � '',-2.-,.-
i s�fi _- e�'�?� =�::' i�)iiil�,ttflF�hl �. ta s� � •- �ril�;lftl�l..r' 7 �m�:: -` >•�i•�•i•nm �n r n. 11 I d {:rr?:�- .�.•>:e•: -.
ill ❑ New construction ❑ Demolition For special information use cfecltl&
II ❑ Addition /alteration/replacement ❑ Other: Description Qty. I Ea. I Total
'New 1- t- family dwellings (includes 100 !t. for each utility connection)
! Il i 443rg �1 -r i s - "`' r 1t -rc,s rr�e & rijrrt 249:20
I 1 :7 4 T r, ,, - . ..- s .a?131iLdA .::li' .,*.'4, Ems= ; - -r _ }i ;:31.,6 ' SFR (1) bath
i ❑ 1- and 2- family dwelling Commercial/industrial SFR (2) bath 350.00
l Accessory building ❑ Multi- family SFR (3) bath 399.00
� 1::1 Accessory additional bath/kitchen 45.00
I CI Maater builder ❑ O Fire sprinkler ( sq. ft.) Page 2
r i:c '~-'1 "7.5,.'i . - .. r h,-;.'.:Ti . ,.. .. _ .� ice s- ni �t•4 -g
1∎ 51'i' ' M '_:. .- hi rt tialt ' .:� .
5 t?.J.0 :1 . : ` _ : tr`t�= i ,1e. _ R :u7-.1.":= 1
;"_ •r, l . y ., b
' Site Utiddea
1 Job site address: 0 - ',- en) Catch basin or area drain 16.60
1 I - , t�/ / L , by . 74a- a Drywell, leach line, or trench drain 16.60 .
!! Suite/bldg./apt. no.: Project name: if ,, . _) . 4 4 A 1 Footing drain (no. linear ft.: ) Page 2
1' Cross streel/directions to job site: Manufactured home utilities 110.00
Manholes 1
• Ram drain connector 16.60
!li Sanitary sewer (no. linear ft.: ) Page 2
11 Storm sewer (no. linear ft.: 1 _ Page 2
Water service linear ft.: Page
! vice (no li ft ) Pa 2
Subdivision: l Lot no.:
Tax map/parcel no.: Fixture or item
I a r: _:: - 1 ., = ��..., _ _. _ _ .. �i:�r,i i � __......_ _ Absorption valve 16.60
„ . ' : siFill =_ yr, L -ss :: t s "' ai h
';:,� �/+r; �:.. fa- d� Beckflow preve Page 2
� � :ti ' : i c ��i ?r' :s-r .:c ���� _._.. T
� p.}f.'I_'Ir.}C7�11 .•e �; �� 'F e �
. A a �.4 . ...-1a��_ Backwater valve 16.60
/1 Clothes washer 16.60
I Dishwasher ./ 1 16.60 14 . G b
l l �� -�... _ _.. :,w ... -- _ ,;:,. �,.Lw, „.,, - Drinking fountain 16.60
' S - Ejeciors/sump 16.60
Name: T - Expansion tank 16.60 -
i Address: Fixture/sewer cap 16.60
II City/State/ZIP: • Floor drain/floor sink/hub Z" / 1 16.60 /G_ (
II Phone: ( 5 6g4„/---5.0c) Fax: ( ) Garbage disposal 16.60
ya 1� y r� ne r �i < Ici r„ �i i t 3 s = -. R =_. =� t Hose bib 16.60
Lil y,,, -lad v Sn f` i�`L ii i, P_ 5 . . 2/1
'. T 1 „72.. .Zcr= zp���+rvt h le §L!Yi. �..1 -':_`4 rti�:fL•q,. l l1.` - '.zt .'$i. Eims 1 P - -P•'•
1! Business name: �()
I Ice maker 16.60
Interceptor /grease trap 16.60
l! Contact name: kin--. 0 Medical gas (value: S ) Page 2
(i Address: ' 0 g 4/V Primer ✓ P . 16.60 i lip 40
CitylSuae2IP: jjYT / � y -`. a 1 .2,90 ' •••' ..-. commercial) 16.60
OEff n/lxvatory ✓ , 16.60 go - L 0
Phone: ( ) 7-Lii-fr VI 0 Fax:: ( ) 0 d .5
Tub/shower/shower pan 16.60
E-mail:
Urinal 16.60
_ .
1 444-‘4,-to L_ +� „ .7 , u '' �i 111 s�� Water closet 16.60
`'; a..F°.'..- .-.-. . , . .IR - - ' "'Ji =. /I � .G. _1... 1.: 4 01,
I Business name: (ado (1 � j / p 1 ,,,� ,, ` I^ " D' , Water heater t/ 1 16.60 /C /06 Il Address: (a ..�11.J Cy" in•�' II �'W Other.
. City/State/ZIP: / 1 /
C ( pi - q -- 7 - ,2, 3
lj Phone: ( Subtotal
M inimum permit fee: $72.50 ('
) �t1 Pa ). )L/q- p'�S - Residential beckflow minimum permit fee: $3625 b 3
CCB Lic.: 523 7s, Plumbing Lic. no.: 3 4 -1 S D Plan review. (25% of permit fee)
i State surcharge (8% of permit fee) (e 4
! Authorized signature: TOTAL PERMIT FEE Q
I Print name: ,L4 j s /7,60 Date: 1 ( 3 0 Li This permit applIcation expires if a permit Is cot obtained within
180 days after It has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
i:\ Buildi rg1Permits1PLAI-PwaitAppdoc 12/03 44O4616T(10/02)C0M/WEB)
I I
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 3 AM PM BUP
Location - • a_ , J ao MEC
Contact Person Ph ( ) PLM ?O ' av SZ3
Contractor Ph ( ) °2 C / cI o6 SWR
BUILDING Tenant/Owner C ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: - SIT
Post & Beam
Shear Anchors i J} �
Ext Sheath/Shear /�J !�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling j
Roof ; /AMY _ i �7�/
Other:
Final
PASS PART FAIL
PLUMBING /1
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan ,
Other:
PART FAIL
' .1
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA �/�
Approach/Sidewalk Date l Inspector � � ` 1 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL