Permit CITY tIGARD PLUMBING PERMIT
' I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00318
E � I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/8/2004
SITE ADDRESS: 14390 SW 130TH AVE PARCEL: 2S109AA 01700
SUBDIVISION: WOODFORD ESTATES ZONING: R -7
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of (1) hose bib and 15' of ABS DWV piping in crawl space.
FEES
Owner:
Description Date Amount
BOYD, TERRENCE M AND DEE ANN
14390 SW 130TH AVE [PLUMB] Permit Fee 7/8/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 7/8/2004 $5.80
Total $78.30
Phone:
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 42671
PLM 34 -70PB
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: � � f - Permittee Si g nature: D`l�/`��f�i°Li C'� /��/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
2004 08:47 503 -771 -9454 CROWN PLUMBING PAGE 02
Plum ;n n Pet mlit Application foil oi'I ICI:; L' I O\I..\'.
Q~xt25 Tigard
y €1•f gard D Raaeivcd I
Da[cBy: � ' ?d ��r
13 sw �rf n Iiivd., , OR 97223 � Pian ]review
Phone; 50 :1,639.4171 Fax: 503.598] U y�, y ,, � pa 0[her Pit No,:
24- Hour l :tsp ction Line 503.6394 [75 2007 ,� ,�) ;J J I y'
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New co Ist union 0 t7et[r >I Trion For special information use checklist.
x Additio Ja teration/r D - Description I Qty I Ea, Total
eplacement Othe
Ncw 1- 2- family dwellings (includes 100 1t_ for tech utility connection)
y !
1FF Ii "1 � "€ L ,' +S h�• ^ O�•• � ; rM + r, "pti ) f _
i!:n ";I!(+S•b:I'ih, j''1 : /i9 : >na;iv.lt ^n +.r; °^n 9 I 'L`1`3'i71;f�'.lir"1�a ° {�E =41 sl'1Z(1)bath 249.20
�] 1 - and 2 fa oily dwelling 0 Com:nercial /industrial SF'R (2) bath 350,00
C] Access < ry luilding Q Mull: - family SFR (3) bah 999.00 _ .-
C] Masted un der 0 Other:
Each additional bath/kitchen 45.00
1 ��r:,�; . i° Site utilities ww °' �M•oYr,. 4.w•:::' ,.,. r Fire sprinkler ( sq. f.) _ Page 2 . --
;�',:sf. . !,4 RI ;S:):} {..al .. I v r. ; 4! ` ?' G '4 %l,;e , I er ^ �., fi 1 i fy1' }1k'a ;
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3c,b site add :es;: 14390 SW 130th AVE Catch basin or area drain 1.6.60
I
City/State i .IP TIGARD, O1R 97224 Drywcll, leach line, or trench drain 16.60
Suite/bldg,/ tpt no.: Project name: Footing dram (no. Linear ft.: ) Page 2
Cross street dir ections to job site: Manufactured home utilities 110.00 -
- Manholes 16.60
- - Rain drain oanneetor 1 &60
- Sanitary sewer (no. linear ft.: ) Page 2
Stoi'rn sewer (no, linear ft.: ) Page 2
Subdivision Lot ttp,; Water scrvieo (no, linear fl.: g
}_. Pa 2
- - Fb turc or item
Tax map /pa 'cc no.: _
.-rr ;•l + "6 'gi'4!c" : P c ', ji' •- + i �3 y a . . r , ' ,. . � Absorption valve 16 -
;i`'.!::�t {,��f'. "xn ` It +�''i Y' e Y � r17:�{f;( GSt^�. ��. �• ''I''i' �:olry {. friit{:'j.,:{ i ..�1 •,.., Sri::;� >
�i._' .;• »' _` _
:__ L .. 1. 1. , ....:r^.+r'.S,',•n: , x � a! l e•.. rc r;+ d.•• y%• e: zrr'.^;i!r. >U;;':',: :, $aelCfloWpreventcr Pagl'.2
ADD (1) H+ :IS BIBS; .REPLACE APPROX. iS FEET ,l.BS DWV PIPING IN Backwater valve r fi -fi0
CRAWL Sl STRAP & INSULATE. •ffi it iJ4Jt. f' Clothes washer 16.60 �-
Dishwasher 16,60
g • ' e } I :,xF�i7 1:!:r4;.•.,,.:er„ / "• K!jr1}.5' Y Drinkin
' d 91 �i • a ^; g fountain 16.60
: i� , +.11:!( i.il:�. h ia�':.:ti'' '�� "'I�F«a 4 + ui . •.),� �.M�:� Sn ; �_ � i
Ejcctox3/sump 16 -f0
Name: DE IE Al JN BOYD .
Expansion tank 16.60
_Address: 14. 9a SW 130th AVE Fixrure/sewercap 16.60
City /Statc/Z P: TIGARD, OR 97224 Floordrain/floor sink/hub - 16.60
Phone; (503 1621 -1165 Fax: ( ) y Garpgcdisposal 16.60
j'IGt , •l I:' r.. , ;; - ' tli!',�•:f (� i 'S ar,iY;g'. /l' 'a y�arlyr - ; , li' "' "r, 1•�iZ�y r1! Hose bib 16.60 I �q
, it}!�.... :iiL... p r .qt {. <. �r. ', j� f��i.5t';,�.�;; _: �� 'P, I I� tl�.�!��Ii �I:� G -GV
l.u�, ., r ;... �: � r: .� xr :.:,ass ' ... j •,.; �. Ice naakee _ L 6.60
l3us(ness can 'tc;
- Interceptor /grease trap _ 16.60
Contact nam _ Medical as (value: $ _ _ ) . Page 2
Address: Primer 16.60
City /State /Z: I: Roof drain (commercial) 16.60
Phone: ( ) F ax: ; ( ) Sink/basin/lavarory 16.60 -^
F. -mail TulYshower /showerpan 16,60
,!� .iii (1;� �, � }�. �', w „r t, , ,,,(,�:,; y, *;° �. r, ,„,. r•:r, Urinal 16.60
v A_�' , w < � i +H , ,r +1\•r ?�'��,t� W,^7,: :.:1, .'i' � f 'Ya" f S
i �) i,riVi).y..•,:! �.:,f,;_ ;.: id t.:_ %, Y.+ wk:,.: u:;` 1Q1' �a ^1r<tl��l,�';i�!ty:En {;, Wfl1k:rClvSet 16.60
Business nan !e: CLOWN PLTJ14>;131NG Water heater 16.60
Address; 5429 SE FRANCIS STREET Othct j�.- r 4 S
City/State /ZI ': I'ORTJ, AND, OR 97206 Subtotal
T_ �'f Fax: (5Q 77X -945 Residential baekt1ow mininitun permit fcC; $36.25 7 Z . S
CCS Lie.: 47 'iT Plumbing L o.: 34.70PB f /��( Plan review (25% of permit fcc)
Authorized si ;n,iture- 1t ( ! ff State surchargc ( %ofpexmit t "cc) s _g0
TOTAL PERMIT F EE 7&
/Print name: l .eft its Underwood ! Date: ! • This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
;:,t1 lydn . r r�;u' :'t n r- P 'Fee methodology set by Tri- Ccnsnty Building Industry Services Eoard.
s 4�nitApp.duc 12/93 44 9-46 r6T11mo2/COM'W
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:,(50.. 639 5 MST
INSPECTION DIVISION Btisiness Line: (503) 6 9
BUP
Received / Date Requested 7 ` �P AM I/ 3 d PM BUP
Location / %' 3 Suite MEC p�
Contact Person Ph ( )'2 T7 / ,_ 9I Lf� �` 2 ) 6 31
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: 0 ) I� n . I _ ) 5 / SIT
Post & Beam f 1 51 V )
Shear Anchors —NO v �, k '
Ext Sheath /Shear �- '
Int Sheath /Shear
Framing �
Insulation l l
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm , J vv v 7
Susp'd Ceiling
Roof �•� `3L , _ - _Q �C��J
Other:
Final
PASS PART FAIL
PLUMBING Q ` l Lam✓\ Li 0
Post & Beam
bider Slab
ough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
m
PASS FAIL
MECHAN AL
Post & Be m
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 C e Approach /Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL