Permit CITY TIGARD PLUMBING PERMIT
I�. DEVELOPMENT SERVICES PERMIT #: PLM2004 -00311
` ���I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/2/2004
SITE ADDRESS: 15920 SW ALDERBROOK CIR PARCEL: 2S111 DC -01400
SUBDIVISION: SUMMERFIELD NO.8 ZONING: R -7
BLOCK: LOT: 461 JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Kitchen Remodel. Other fixtures: ice maker and hose bibb.
FEES
Owner:
Description Date Amount
JAN VANDERPOOL
15920 SW ALDERBROOK CIR [PLUMB] Permit Fee 7/2/2004 $83.00
TIGARD, OR 97224 [TAX] 8% State Surcharo 7/2/2004 $6.64
Total $89.64
Phone : 503 244 - 5154
Contractor:
POWER PLUMBING CO
P BOX 19418
PORTLAND, OR 97280 REQUIRED INSPECTIONS
Phone : 503 244 - 1900 Top p -oout ut lnsp
Insp
Tnsp
Reg #: LIC 52378 Final Inspection
PLM 34 -150PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: : /1' / •y . Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
J u2.'F 3O 2004 12: 19 HP LASERJET 3200 lo. 1
P mb ng Permit Applicat
��/ 1'012 (11'FICI: USE l) \L.1"
City of Tigard Reatiwtd vi� 0VED
13125 SW Hall Blvd., Tigard, OR 97223 Dat � Dy I,� Permit No.: A ..... y /�O_:{ 1 I
Phone: 503.639.4171 Fax: 503,598.1960 JUN 3 !, *� ? i..� , _ t < I:' Date/By: Other Permit No.: mob' V t
24 - Hour Inspection Line: 503.639.4175 �+�+r v v 20��L^� I i I" Dam R
Internet: www.citigard.or.us / e /Metho orris: S See Page 2 far
Dat Re �l
Notified/method: T7Q supplemental
`(4,� t i ins: �e g x �r� t ry _ PP eatat Information
nor$..,_ ,'n' -a 5 1 X � lr , ,.,. rs3 $ w•-- , + i �- '�4,�` .1i1, 1r ".}l£ 1P � t 11 r. '��t �.. n e ! a::, r
❑ New construction ❑ D emolition For special information use checklist I
►�
Addition/alteration/replacement Description 1 Qty. 1 Ea Total
❑ O ther New 1 - 2-family dwellings (includes 100 ft. for each utility connection
' '' t i ' .- ? i1t�y 3 11t) 1 ^�� f T 5 t 4. r 1 � � t 1 nn q t} )
: -. - ,th. - '11.,.,ft ...mrssk ~ �M.' . iihi � � >, i1 3 I
)"1 ..,t SFR (1) bath 249.20
A 1- and 2- family dwelling ❑ Conunerci al /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 39900
ID Master builder Each additional bath/kitchen 45.00
❑ Other:
° d' t s• sir s t, �.- Fire sprinkler ( sq. ft.) Page 2
7 '1i
,, ..t.� a... 1 ' I4 ....2 , a _ _ 1 & .>r,. - ��" 6 ` '�... F i N 1 r -, " t'r�..r; g
rw -- .,. - .• . -':rw Site Utih tle9
Job site address: i 5 920 s Go oc, Catch basin or area drain 16.60
City/State/ZIP: Ti q p of 4 "`+ Drywall, leach line, or trench drain 16.60
• Suite/bldg./apt. no.: Project name: `V 1(/l Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: '"'"'��� Manufactured home utilities 110.00
-: - - - -- - 7 • - -.- .._- .,__. -- - -- . . . Manholes
1.6.60
- - Rain drain connector 16.60
Sanitary sewer (no, linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft -: ) Page 2
Tax inn I Fixture or Item
p/parcel no.:
- - ,t ..0, .3.... I` .'�I M . .-,. !�s .:2 : _x � -, , ` t<� 3: � = -"='�i a s •-s -.�:, , Absorption valve 16.60
. -» F --ai%t ,•!r' t5D t g`iira yy_}:` 1. �`" 4- - _
... .•;-F, :..,:,rs:+.._ r,a y„ :9 _. ,.-,, li.._::. t s., ',.a - Backflow preventer ,, /y ,... .- -�., ._ - pvener Page 2
rQ,t 3 ,1 .I 0Li fV\�1,. „ F Backwater valve 16.60
Clothes washer ' , 16.60 i L. to 0
Dishwasher 16.60
*.-.:. u•' 'N.i:• 1:i . :i ,z4 1.. - ..qii•:. _ :, • z.,--: Drinking fountain
a� :gjyj r i s;zerir :`" ti•�` -:F. .:,,c g 16.60
. -. .,,.., . �:"i,, „ zx -;t:. V :- �iT.x.: c.:..'•' > {: , 1 :- . ti ;1: • ' 14 n. `p 0° , 4 Ejectors/sump 16.60
Name:
' r ' _ Expansion tank 16.60
Address: I 6� b S 1 2 4e , o Fixture/sewer cap 16.60
City/State/ZIP: t
1 ((3)(- �'� �a Floor drain floor sink/hub 16.60
Phone: (503) 4-- 5 Fax: ( ) Garbage disposal 16.60
6t _: - x t
:. r._ ' t� t Ill�lr t r 16.60
-• , - � - : - •� . � •- a� a ,c a _ _ ` �_ , -�.-, ° Hose bib
:a ..... , .;a ,: a rea - _._..,�' - ':t= _ • ^:;:i .. •».,w � .,x.. -.•-.. r_. ' �I r L.�I
Business name: ) u) .� .1 J . l ,^ ^ (4)
Interceptor /grease trap 16.60
•
C
•
ontact name:
Ice maker i 16.60 f Gr. is 0 .
� �' �y( I � �^� 11 •
D Gl�ll Medical gas (value: S ) Page 2
Address: T 0 E. o ! G 4 1 ' a Primer 16.60
City/StatelzlP: P�-f-� f .� • ` Dy c l �1 -, LI , . Roof drain (commercial) 16.60
- Phone: (G' a� ono Fax: : (5(>3) mac 4 (1 r �2 Sink/basin / lavatory 1 16.60 f (• ( Q
Tub/shower/shower pan J 16.60 i
• E ' mail F,'r`,r• '� ;y;ds as = a,aa itl i =1a' i G r: :ll ,sta:..r.__ Urinal 16.60
� w . tt:1 41' .K :. , ,i� : aI` -- .. Kr 1. E, m. -14:"':, .rr_ ,..,. , ` Water closet 16.6U
~
Business name: ` t D(Qy' P. I JA , ._ '`� 7 �' ,l � Water heater 16.60
Address: CPl.l l) a � , 1 . . t
MILL. _ .! � _� . i Other: •
-
cit '5/+ 4 />. 3 subtotal 3
Phone:
Minimum permit fee: S72.50
(5 � � Li - 1 di a) - Fax: (5C>).2...t1 j --- rk�.5 Residential backflow minimum permit fee: $36.25 k 01)
CCB Lie.: 15 2 . 3 - 7 1 , Plumbing Lie, no.: 34. --JjV e., Plan review (25 %of permit fee)
Authorized signature: , i 62k7 State surcharge (8% of permit fee) Lod, LI
TOTAL PERMIT FEE rQ r (i^7
Print name: j e/ST 1/) E, . Date: 41_31-46 V This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
'Fee methodology set by Tri -County Building Industry Service Board.
i_'BuildingP mite\PLM- permltApp,dx 12/03 440.4616-r(10W21COMtWEB)
•
CITY OF TIGARD 24 -Hour '' _
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested l — . ' ( AM PM BUP
Location / S 0 C .eij Suite MEC
Contact Person 92-1/1 > V' Ph ( ): 0 —3) Li b 61_1WaO''- 603/
Contractor Ph �a - 19‘2, 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 v
Framing 4.,y_ �wr- I g of �.ife-e,�- d
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PAS FAIL
G
& eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Othe .
in
S PART FAIL
MECHANICAL -
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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date J j2) a <- Inspectors k \\ '`" Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL