Permit CIT OF T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00478
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/18/2004
SITE ADDRESS: 15915 SW 87TH AVE PARCEL: 2S111 DD 09200
SUBDIVISION: CHESSMAN DOWNS ZONING: R -7
BLOCK: LOT: 018 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: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install new Jacuzzi /whirlpool, move: tub, sink & water closet.
FEES
Owner:
Description Date Amount
WEISS, PATRICIA I
15915 SW 87TH AVE [PLUMB] Permit Fee 10/18/200 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 10/18/200 $5.80
Total $78.30
Phone:
Contractor:
PLUMB CRAZY
52683 NE SHEENA PL
SCAPPOOSE, OR 97056 REQUIRED INSPECTIONS
Phone : 503-570-0128 Top -out Insp
Final Inspection
Reg #: LIC 138864
PLM 3436 -PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: % .T>e, Permittee Signature:
it
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
.- IR ECEIVED
Plumbinz Permit Application ZQ n 1.01. 01 11( l- I ' � I ifs 1 i 1
iv�x
City of Tigard a,tt,sue..0 y. l �- Peirnit No.: �V'` °1 ' d
a yV y 7
13125 SW Han Blvd., Ti TIG St an I��,irW
Tigard, OR 97223 CITY OF / P / (J y if " 7
Phone: 501639.4171 Fax: 503.598.1.960 i � zatiKi Odic( Permit No •
24 Boar Inspection Line' 503. 639.417$ BUILDING C' �n .l 11:0 see Ya e 2 for u�, '� tt 1 1)au B
., Ready /11y,
]ntcrnet: ,v,w/. C�.tagartt.!Y.U9 a .N.,u1•w vt.lams Tn(trrmn
� ,. 0,7 ten � y 2 �� fit
•, "ii ` t •
�� : 't; fi ��"'A"'Y :i. .Y: '.t " :� = . � , � , ; i Z`��.'
New construction ❑ Demolition
Fvr sQtlCinl illfargsarion use checklist. _
0
De iptiuu I Qty. I r;a- _ .,, Total
ddition /alteration/replaccrnent 0 Other: New 1- 2- family dwellings (includes 100 it 1:or each utility connection)
t }tr uay. ,,:t.. ° "Zsr i. :: .i .............,�
249 -20
1 "�`% • Sl: l bath _
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath _„ 350,00
❑ Accessory building El Multi-family SFR (3) bath 399.00
— — Each additional baib/Isitchnn 45.00
❑ Master builder ❑ Other: ., --
7.77."^„ ^.'Y`i�,. ,a ... nr.. . Fire sprinkler (- 9(I Page 2 _....,. ,
t . : :�' : ;; :r :'''
:l� :;., :.5` :.• , .:�'� : 's;? , � Sltext #tlitie -4 __ _ •
Job site address: et lt * •N ) c3 `lC A Catch basins or itr,aa rain 16,60
City/State/ZIP: T\ gDs d ovL _ _ I�' w ro ll, l each line or trench drain 1660 ^ -
guile/bldg./apt. no, 5 " U i I Proj rain:
Footing drain (no. linear 13.: ) r. � '� Page 2
Manufactured hot= utilities 110.00
Cross strcet/directioas to job site: - . --- ..:...,-.- Manholes 16.60
Rain strain connector 16.60
... _ Sani tary aewcn' (no. )inear ft.: ) Page 2
Storm sewer (no. linear ft.: ) „ _... Page 2 , - ,_-
Subdivision: - Lot no.: W service (no_ linear lt.: ) rage 2
Tax map /parcel no, : ► , ► / ,. ♦ A ' • . nature or item ____....-....-
:. "; ,� y w .�� y ti , - Absorption valve '
_ Abcor 16 FO
t., M
h a'e2
�: ,....;! , $:....: R fl
• w
ask O C ntet
„ ,., ... ..tan ,:;: :.. . . . ., VC K
", . :: :. . :. .. „ti .. .. ;:
~
Backwater valve 16.60
Clothca warkber 16 -60
._- ,r..., ....... Dishwasher .... .,, 1660
r ;; 2 ?' Drinking fountain � ~ 16.60
' ..
Sii
;; ' ... ,.., .... .., ,.... E 16.60 ..:;:.
Name: • -Sc. ,... Vl��� l ]c7 _ �, Expansion tank ., 16.60 . ..,.
Address. I �j I � 74- 1 -- Fixture/sewer carp �_ _ 16.60
City /State/lIP: 1 � �� Z floor drain/floor sink/hub __ _ 16.60
— �...... ,. _... 16 -60
Phone: (5-OZ 9 9 Garbage disposal
Fax: ( ) T ...�
r. . a.
ti ;f 1 ,;: . in %t> Hu asluilr 16.60
,:r
� . ,.., Eccntakar 16,60
13ustinra& dame:
.._.. Inlmceptvr /tsetrap �y 16.60 f ,,
Contact name: . k . a ,. ` it — . - Medial gas (value: $ ) Page 2
Address: Primer W16,60 • ■ Rnnf ,train (commercial) 16,60
City/State/Li?: rt., 9 ►. . w ∎� C ". __ _ . 16.60 1 6.6o
Phone %� '1k Fax; z � r Si . '7'2- 2
Ph.- .. :...••• - I — + t � U LJ : ... YL. � Tub/shower /shower pan _ _ 16 - ? . 2. 2_ d
I'- rnait: � 1ti.6U µ
y
i s
y�
. �: 7Ak':�;ti ?;.. :«. a il :,i . : :; :i�a A Weer closet 1 _ 16.60 it, 4 0
, l3uaineafi name' ` • • `►.Ifr, .,...r — Water beater 16.60
Address: , II: 1 IA / = , I.., O °' Other:
73 City /State✓LIP: 0 , . ti , , ct (p _— b�lttotal 2e lV
l `• Minimum permit foe: $73.50
. ' Phone: 4111 ) • = F' '
- - ( ) tteaideatital hackflow minimum pt rinit few: $36.25
� CCI3 Lie.: I A , Plumbing Lie. no,: t Plat, review (25% of permit lice)
s _ • �1Ik� �i / �.._ _ state /surcharge (846 of permit foe) 5"
Authorized signatu / \ ' a % J ,?7 "'." .�
'TOTAL PERMI.'i' kk.k: . .. d
Print name- tl►ft, a - Date: f 01 1 This penult application expires 1f a penult is not obtained within
1tla days alter it lose beta t►aocpte as complete.
*Fee tnt3lradology Sat b Tai - Cowry Building Industry Service bast,
E0 39Vd 1S3ANI 1biLlfll33LIHD v 00LET9LE09 05 :L0 b00Z /9I /0t
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location S /�'P� Suite MEC
Contact Person (.d -aCc j — Ph ( `( -- 11 ) 570 PLM ° 00 / 7'
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain �`� p
Slab Inspection Notes: �y / ✓ A , SIT
Post & Beam C y
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
Other:
l•ASS PART FAIL
M ' 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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2 9/ 0 5 Inspector ( ' )' '°"" °" Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL