Permit C ITY OF TIGARD PLUMBING PERMIT
I t' DEVELOPMENT SERVICES PERMIT #: PLM2001 -00460
- � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/26/01
SITE ADDRESS: 13422 SW 128TH PL PARCEL: 2S104DA -02100
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: ALT 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: Irrigation backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
KANG, IN S. & YOUNG H PRMT CTR 9/26/01 $36.25 27200100000
16107 NW PAISLEY DR 5PCT CTR 9/26/01 $2.90 27200100000
BEAVERTON, OR 97006
Total $39.15
Phone 1: 690 -3057
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone 1: 503 - 642 -7323 RP /Backflow Preventer
Reg #: LIC 24184 Final Inspection
PLM 26 -162PB
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: 211/77
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
r #��> i , City of Tigard
Cii Date received: 9 /ZS /0/ Permit no.: /)ir1100 / .dD
,� J `J g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By:4JY1 Receipt no.:
Land use approval: Case file no.: Payment type:
& 2 family dwelling or accessory ❑ Commercial/industrial O Multi- family ❑ Tenant improvement
111.4 ew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCI I EDULE (for special inforn anon use checklist)
Job address: / 2 2-Z- u,/ / 2 S"' /4 fr - Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 10011. for each utility connection)
Tax map/tax lot/account no.: SFR (1) bath
Lot: i f q (Block: / IS (vision: SFR (2) bath
/V
Project name: / j J () / 2 f) t SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
t i /,t 1)l1i► -) ) we C VAl 476 Catch basin/area drain
•
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. tin. ft.)
Manufactured home utilities
Business name: 4 Chi. `alb 15 iN -rAJC. Manholes
Address: / (,4700 5-,../ /�E/Z 6. /ZO Rain drain connector
City: f I State:e,,� I ZIP: 99e0(.7 Sanitary sewer (no. lin. ft.)
��Z �'� Fax: �Z�I E -mail:
Phone: Storm sewer (no. lin. ft.) CCB no.: ZGf / 5g I Plumb. bus. reg. no: 2.6,- - /60. f-6 Water service (no. tin. ft.)
City /metro tic. no.: / S - V Fixture or item:
,����� Absorption valve
Contractor's ..,4,-- s representative signature: . e %��`"' _ Back flow preventer / � /j
Print name: L Date: — /9--6/ Backwater valve
Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s) •
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OW1'NU11 Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): Garbage disposal
Mailing address: Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: _ Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $
Plan review (at _ %) $
O Visa l] MasterCard expires if a permit is not obtained
Credit card number / / within 180 days after it has been State surcharge (8 %) .... $ - 2 }q
Expires TOTAL $ ! • /5
Na of cardholder as shown on credit cud accepted as complete.
Nam
$
Cardholder signature Amount 440-4616 (6/00/COM)
•
-.Choi 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 / 3 7 Z Z /a - F Suite MEC `/
Contact Person Ph ( ) PLM. ? O/ — 60 ? 6 C
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain (j /i 4,1 /A flew.
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear ` 1
Framing S ��L / a5S l� L fo • --4 s ,
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
' 1ZI r
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: ' T
• ART FAIL
"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 Dat ® Inspector L � - Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL