Permit CITY TIGARD PLUMBING PERMIT
ilvI� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00173
a 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/2004
SITE ADDRESS: 14665 SW 79TH AVE PARCEL: 2S1126D -02800
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: 30'6 ft 506
DISHWASHERS: RAIN DRAIN: 500 ft
Remarks: Site utilities.
FEES
Owner:
Description Date Amount
MATRIX DEVELOPMENT
6900 SW HAINES STREET [PLUMB] Permit Fee 6/4/2004 $452.80
PLAZA 2, SUITE 200 [PLMPLN] Plan Review 6/4/2004 $113.70
TIGARD, OR 97223 [TAX] 8% State Surcharl 6/4/2004 $36.23
Phone : 620 - 80810 Total $602.73
Contractor:
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone : 667 - 1781 Water Service Insp
Water Service Insp
Reg #: LIC 23847 Water Service Insp
PLM 26 - 208PB Water Service Insp
Water Service Insp
Storm Drain lnsp
Storm Drain Insp
Storm Drain lnsp
Storm Drain Insp
Storm Drain Insp
Final Inspection
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: J Permittee Signature: , r l
ak--Cger-/
Call ( 3� 3) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
;Te - RECEIVED _ t �- X 00
TI C -A T , )
Plumbin Permit ppll oil 20 4 FOR OFFICE USE ONLY
City Of Tigard Received w1/- ^
C ITY OF TIGARD Date/By: Permit No.: ' 0 ,' Q O 17
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639:4171 Fax: 503.598.1 111 ILDING DIVISIO.4,0 l l I A Date/By: - Other PemutNo.:
1i
24- Hour pection Line: 503.639.4175 _ t
Internet: www.ci.tigard.or.us -+ Date Ready/By: See Page 2 for
B Notified/Method: Supplemental upplemental Information
,zi' -,y�'Y ^�. `�iX' . ZifeHi� }° � '�, 3� ''� Ff ;�E / t ^'A!;A ` ? �w dpi Ls.hT:u'q� '� S
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14 New construction • ❑ Demolition For special information use checklist
•
Description 1 1 Qty. Ea. 1 Total ,
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
A.TEGOiti QF :CONSTiti1C >(ON _ A SFR (1) bath 249.20
t 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder • ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
",':,,: K... tiV - , ti _ i iiii4 FORM TION ��1�1),VA iii . �"
�� s -, / „ ,F , ,,, Site utilities
i
Job site address: '-.:/..,,,/, {(p(p 5 �.,() 79/ • - Catch basin or area drain 2. 16.60 '3 3, 20
City/State /ZIP: 77 r -1, D Ave-- Drywell, leach line, or trench drain 0 16.60
Suite/bldg. /apt. no.: vJ Project name: /,e Parma Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities Q 110.00
Cross street/directions to job site: 5 tv 8 1 f- Ave- , Manholes 2. 16.60 3 3. ;l 0
1. - ?. Rain drain connector 0 16.60
Sanitary sewer (no. linear ft.: ) • O Page 2'
Storm sewer (no. .linear ft.: `'123) • - Page 2 A, f/p, IOO
Subdivision: Le/ e parK Lot no.: Water servic,, (no. linea5,ft.: " i'j r Page 2 7`
j �
Tax map /parcel no ZS 1 12- - tut' 300 �,y / / , L.. -t 22-1.0 . on or item
,. fr/ y , / Absorpt valve 16.60
r�'�� , DESCRi I. -14 i WURK
,, i.: r -407 , ..e,, ,z, .,..., ,. .., 9. .. .. F . .t,, diami, Back low pre•ienter Page 2
(re L* _ l G1 • - ‘ ( e...-
.. - j e r „ (1 ►'mss i .,.,- ,,-ft,• -•1 fes, iiirai'al Backwater valve 16.60
Clothes washer 16.60 .
Dishwasher 16.60
l , iWil O E�� f ° 6 . ii t ` � �'„ T il. r Tr Drinking fountain 16.60
a . -a,. H . ,? , . .ou �.., . a. Ejectors /sump 16.60
Name: M a'� n2Ve�! opit'►eAI f I9 r'
(O Expansion tank 16.60
Address: 1 Z-7.Sb" S w/ , L( r''' A f-e , ,. j c- 10 0 Fixture/sewer. cap 16.60
;; City/State /ZIP: / ov l 4 d, e k, q 7 Z Z 3 Floor drain/floor sink/hub 16.60
Phone: (5/3 ) 1 , l ( . 7 Fax: (� 3) 5y r - OD Garbage disposal 16.60
a i s vx @ Hose bib 16.60
PL°ICA V V t ss o- GU C 1 '1'EkSU I
. >. ...,,. ICe maker • 16.60
Business name: Si- .00$ 1l 0, C,[.. -e' , Interceptor /grease trap 16.60
Contact name: 5 f' t r v I _ o p Pi Medical gas (value: $ ) Page 2
Address: 81 J L Slit/ (-/z/ 8 (ad . 5,'e 2,3 2.- Primer 16.60
City/State /ZIP: gea ✓2rtvKi, p 47L2,d Roof drain (commercial) 16.60
Phone: (533 ) Lft,, 6t -1243 Fax:: (- J3 ) (16,q _ es Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60 •
' E-mail: �k ve /-( r( f 1G w..4 Urinal 16.66
at .- �' 1CONT1OR 4 a. l t ; �,. ._.„ Water closet 16.60
mow„ ,
�, Business name: _.C �
,..�, t
k _� .,,^ � Water heater 16.60
1 1 Address: `� - - . `(7JJ , Other:
Subtotal
City /State /ZD 1./5,1,20)
Minimum permit fee: $72.50
Phone: ( ) , i Fax: ( ) Residential backflow minimum permit fee: $36.25 45 2 ,, q 0 -
_
_
CCB Lie. • Plumbing Lie. no -: .
Plan review (25 %ofpermitfee) //`3 •
Authorized signatur ��j� State surcharge (8% of permit fee) 3 �,a
���� "'°'" t `' TOTAL PERMIT FEE 6,0 73
Print name: 74.,a a-71_ / %fn/ - Date: (; / //f /or:� This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete. •
*Fee inethodology,set by Tri-County Building Industry Service Board.
i :\ Building \Pemvts \PLM- PetmitApp.doc 12/03 440- 4616T(10 /02 /COM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspect,io0 Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / c AM PM BUP
``
Location / `i Ca c 7 f q- Suite MEC
Contact Person / / 4 .- . Ph ( ) PLM ADD —0 6 1 73
Contractor /Y �L { Ph ( q 1/ ) a- 3s 3S 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
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ,`
a7r
Roof
Other:
Final
FAIL
Post & Beam
Under Slab
Rou• h -In
ova. J
Sanitary Sewer
Rain Drains
•
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin,
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 n Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: II Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date ` 2 1 1 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL