Permit IC
CITY OF TIGARD
PLUMBING PERMIT
:�l�l DEVELOPMENT SERVICES DATE ESSUED: 2/7/2005 5 -00046
' ` �---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12160 SW ANN PL PARCEL: 2S103BB 11700
SUBDIVISION: YE OLDE WINDMILL ZONING: R -4.5
BLOCK: LOT: 036 JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 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: Water heater replace.
FEES
Owner:
Description Date Amount
OTT, ANITA B
12160 SW ANN PLACE. [PLUMB] Permit Fee 2/7/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchari 2/7/2005 $5.80
Total $78.30
Phone : 503 810 - 2468
Contractor:
MT TABOR PLUMBING
13324 NW GLENRIDGE DR
PORTLAND, OR 97229 REQUIRED INSPECTIONS
Phone : 503 -579 -8134 Plumbing final
Reg #: L1C 110945
PLM 34 -358PB
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: Permittee Signature: /� -1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business da
/ /�
y d• .. _ 4- RECEIVE[
Plumbing Permit Application . F OR OFFICE USE ONLY
City of Tigard FEB 0 7 2005 l ate ea 7 - C�5 j � �
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Permit Permit ikiM 7 i(�
Phone: 503.639.4171 Fax: 503.598 y Plan Review 771 VV�� ��
24 -Hour Inspection Line: 503.639.41 Y OF TIG s 4 . ? Date/By: Other Permit No.:
Internet: www_ci.tigard.or.us • RI TI Date Ready/By: "�% H See Page 2 for
ILDING DIV '`' ' " • Notified/Method: 1 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist.
❑ New construction ❑Demolition
Addition/alteration/replacement Description I Qty. I Ea. I Total
❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
(I 1 - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder ❑ Other:
Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: ) Z 1 62 C) SGl /17 Z11 Catch basin or area drain I I 16.60
City/State /ZIP: 7 0/2 97 22 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: / Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
Manholes 16.60
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 map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
P / . ` Backflow preventer Page 2
!-`LPL . )J, J Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Zi PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
1 Electors /sum
Name: /9N On
P 16.60
Expansion tank 16.60
Address:
Fixture/sewer cap 16.60
City /State /ZIP: / • Floor drain/floor sink/hub 16.60
•t/ Phone: ($ gl 0 - 2 Fax: ( ) Garbage disposal 16.60
j APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name: ►M/T r r arZ r !
./l /� Ice maker 16.60
�^ - Interceptor /grease trap 16.60
Contact name: r 8 _ I
Medical gas (value: $ ) Page 2
Address: / 2/6S^ c.; b., *Ai it/ PC, Primer
16.60
City/State /ZIP: 17 6A 4 , 072_ 9 7 V2- 3 Roof drain (commercial) 16.60
Phone: (.S . ) 3'19 - gi?? I Fax: : (5c ).5-74' S131/ Sink /basin /lavab ly 16.60
E - mail: Tub /shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet
n ' /� CY 16.60
,n
Business name: / r l T , vut7re Pty Water heater i
16.60
Address: ) 2.,( 6S 5 t.-w'/ f O L Other:
City/State /ZIP: /7 6 frreD 1 0,2 9? z Z 3 Subtotal
Phone: (S�3) S) G } �/ Fax: 3 L Minimum permit fee: $72.50 -7 •
/ (5 S 9 - $ 3 / Residential backflow minimum permit fee: $36.25 ! 2 1)
CCB Lie.: C 3 P3
j /0 � �� \ - "� 5 _ D � Plnmbvtg Lic. no.: �- S� Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee) 5 �
�� f 7
� . k -- _ � TOTAL PERMIT FEE..
, 7vL Z��� 7 w , 3v
Print name:
ate: 2 / /�O S 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:l Bur lding\Pennits\PLM- PermitApp.doc 12/03 440 - 46161(10 /07lCOM/WEB)
CITY OF TIGARD 24- Hour.
BUILDING; y Inspection L ine: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location /( 6 U e- Suite MEC `��
Contact Person Ph ( ) g (re —4 0 PLMADD d 7-6.
Contractor Ph ( ) SWR
BUILDING ELC
Footing
Foundation , ELC
Ftg Drain Access: 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
O a - r:
•AS 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 '' Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ?) J o J o C Inspector 6 \i ' k \ ■''L Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL