Permit CITY OF TIGARD PLUMBING PERMIT
Pik DEVELOPMENT SERVICES PERMIT #: PLM2004 -00546
F�I DATE ISSUED: 12/8/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11230 SW 83RD AVE PARCEL: 1S136CB- 06100
SUBDIVISION: STEVE + HUGHIE'S PLACE ZONING: R -4.5
BLOCK: LOT: 033 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE SF WASHING MACH: BACKFLOW PREVNTRS:
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: 45 ft
DISHWASHERS: RAIN'DRAIN: ft •
Remarks: Replacement of water service.
FEES
Owner:
Description Date Amount
DUNN, CHARLES A + TAMARA S
11230 SW 3RD
[PLUMB] Permit Fee 12/8/2004 $72.50
8
TIGARD, OR 97223 [TAX] 8% State Surcharp 12/8/2004 $5.80
Total . $78.30
Phone:
Contractor:
WOLCOTT PLUMBING CONTRACTORS -
1075 W HISTORIC COLUMBIA RIVER
TROUTDALE, OR 97060 REQUIRED INSPECTIONS
•
Phone : 503 Water Line Insp
Final Inspection
Reg #: LIC 23847
PLM 26 -208PB .. -
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 Permittee Signature: _ SR-Q Qr
e G
Call (503) 639 -4175 by 7 :00 P.M. for an inspection needed the next business day •
r
RE( -EIVED .41 i
P am bin Permit A► t 1 licatio i - .
FOR oEFlC1a. USE ONLY
.r ,,', vi,
City o�Tigerd r I q I A + ; .. , . 11r._ i:� E
13125 SW Hall Blvd., Tigunl, OR 97223 I , , ., '1111 P'� - e /, v Other Pemm[ No.:
Mill
24 Hour Inspection Line: 639 4175 BUIL 1 1 6 ' nl:s li: ` ) . 1 r ' • ' J'• oadernar ® See Page 2 fur
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Internet ww.ei.tignrd.or.us „ otilied/Methe4 1 6npplemeotallnl. . atiaa
TYPE OF WO . FEE" yC HEDltLE b
La Now construction `I Demolition _ - For special l formatian use checklist b
w. 1
Description Qjv a Ea. II Total
I Addition /alteratiOn/replacement [I Other: New 1-2-family dwellings (includes 100 ft. for each utility - .. action)
CATEGORY OF CONS' RUCTION SFR (1) bath 24920 I E
n [ Comrnercial/industrial SFR (2) bath 350.00 I
V - and 2-family dwellin
SFR (3) bath 399.00
ED Accessory building Multifamily 45.00
Each additional bath/kitchen
❑ Master builder 1 Other Fire sprinkler (__ s9. g,) Page 2
JOB SITE INFORMATION 1 LOCATION Site utilities
lob site address: f , ♦ C atch basin or area chain 16.60
_ Dr leach line, or trench drain 1660 I�
City/State/ZIP: �. JL D ��� �- - Footing drain (no, linear fl.: J Page 2 11
Suite/b14124R no.: Project name:
Manufactured home utilities 110.00 I I
Cross street/directions to job sue: - _ Manholes 16.60
Aer' Rain drain connector 16.60 I Li
Sanitary sewer (no. linear ft.: ) r Pagc 2 III
Storm sewer (no. linear R: _) M Page 2 I
f Lot no.: Water service (no. linear fl .J -: AN Page 2 I�ot LTi
Subdivision; / Fixture or item 8
t/ Me Tax map/parcel no.: - ,, f/r Absorption valve 16.60 MI
pESCRIPTION 0' WORT: Baekdowpreventer Paget I
Backwater valve 16.60 I
e �P1 ! J" Clothes washer 16.60
� Dishwasher 16.60 in
- Drinking fountain �� 16.60
V. . PRO 'ERT1 OWNER 1 El TENANT Ejectors/sump d M1 16.60
�/ �
Name: ��� � � �� r E rili L�� 1 16.60 IMMO
,. � e / ' ;. M 1� 16.60 AIM
Address: � � � � ��
16.6n
, boor si /
CQy/StaM./Z]P: � 1� � ► � �1'i t � �� 16.60 � •
oSe MEI
Phone: ( �J s /". i rJT� Aril - ) VI ,
;b �� 16.60 E
U CONTACT PERSO _ �c fi r. ' / �M r 16.60 MIEN
Business name: Wolcott Plumbing dba Jack II , k Plumbing 'A t #, ocptod, . ' lr- 16.60 I
+>
Contact name: l 0 . & � �. f / M kai 7 ` r page 2
Address: 1075 W Historic Coln River H ■ ' • '11V 16.60
lt.„ drain (commercial) - 16.60 MOM
City/State/7 Troutdale, OR 97060 sink/basin/lavatory 16.60
Phone: (503) 235-8754 Fax: : (503) 491 -2932 Tub/shower /shower pan 16.60 4
E -mail: _ Urinal 16.60 1
CONTRACT r R Waxer closet 16.60
Business name: Wolcott Plumbing dba Jack H i wk Plumbing Water heater 16.60 I
Other: /`�
Address : 1075 W Historic Columbia River Hw, _ - Subtotal I , i�°
City/State/Z8. Troutdale, OR 97060 _ Minimum permit fee: $72.50
503 491 -2932 Residential bact�ow minim permit fee: $36.25
Phone: (503) 235 -8784 Fax: ( ) plan review (25% of permit fee) I
CCB Lie.: 23847 ' lumbing Lie. no.: 2 - 208 PS
State surcharge (8% of permit fee) I` /A
Authorized signature! ►I TOTAL PERMIT FEE f
{ i . This permit application expires if a permit it not o ; ii'i ,.. li
I Print name: l ` �L L.�.4 Lr� ' 180 days after it has been accepted an eompl'+
'Fee methodology set by Tri- Cnunty Building Indushv `i wise Board.
Td POL ' ON 9NISWlld >IMOH >IJllf WdLT : t7 17002'2. : 0311 --
—
CITY OF TIGARD - 24 -Hour
BUILDING ,Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received II Date Requested AM PM BUP
Location (f a 3n 33 Suite MEC
Contact Person Ph ( ) 2 3S-2 PLMo?I1 6 - I 6-53/4
Contractor Ph ( ) SWR
BUILDING Tenant/Owner - ELC
Footing
ELC
Foundation
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
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 V
Other:
40
PART FAIL
I ANICAL
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 Q Please call for reinspection RE: Ei Unable to inspect — no access
Fire Supply Line
ADA 1/41 / ' Approach/Sidewalk
Date 6 v�-' Inspector Ext
Other: -
Final - ' DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL ..