Permit CITY TIGARD PLUMBING PERMIT
At ' ' ' . i? JI DEVELOPMENT SERVICES DATE PERMIT #: ISSUED: 5/14/2004 00005
- ` - ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 07865 SW BONITA RD PARCEL: 2S112BA 00500
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: .
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 13
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 4
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 777 ft
DISHWASHERS: RAIN DRAIN: 1,108 ft
Remarks: Private water service and storm sewer service. 135' of footing drain, other fixtures are 4 manholes.
FEES
Owner:
Description Date Amount
DEREK L BROWN & ASSOCIATES INC
4949 SW MEADOWS #400 [PLUMB] Permit Fee 5/14/2004 $1,181.00
LAKE OSWEGO, OR 97035 [PLMPLN] Plan Review 5/14/2004 $295.25
[TAX] 8% State Surcharl 5/14/2004 $94.48
Phone : 971 233 - 0075 Total $1,570.73
Contractor:
TROY ELLIOTT PLUMBING
PO BOX 1958
NORTH PLAINS, OR 97133 REQUIRED INSPECTIONS
Phone : 503 Water Service Insp
Water Service Insp
Reg #: PLM 34 - 402PB Water Service Insp
LIC 152310 Water Service Insp
Water Service Insp
Water Service Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Final Inspection
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 fling (503)
246 - 6699. : `
/ Issued B `4 .,� Permittee Signature: Y, Ate! 9
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
4 i
•
/ Plumbing Permit Application FOR OFFICE USE ONLY •
City Of Tigard • Received ' m�A " PL M 206 6O
Date/By: J� Pemilt No.: ..
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review •
Phone: 503.639.4171 Fax: 503.598.1960 / AP I ON 1ti / Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 _` I L Date Ready/By: kris' 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
�..:- �`,�:- v?a� »�S^'.`x;� ;, �c^�. ; . ms s ;�,.,. �'i'rT'.a�; :'ji�A sf�+ "., ,:,, . '�. >�.;
' a ;� z ..< rF.s •� .0�• �.. �: r :� - ..�. '�% .z € x � A i.� u�. � ...... � �+ . a uxix,. �i �� �'Am
,- moo. '• *„ 'i4.k��- ,.'•'t. N .�4, Y�.�_ _. .. „ � ° �."
yy�� New construction ❑ Demolition For special information use checklist:
'I e' Description Qty. ] Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2 -family dwellings (includes 100 ft. for each utility connection)
; 1_ .. � . ` t3 E o ,. ^. ::
~ ',_.. m SFR (1) bath 249.20
rgs y.
1- and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building . ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
., ,_ � ..� , .ra a ' ar . . -:.s 'K .„, Fire sprinkler( sq.ft.) Page 2
� �x��,�'r'= �.�;�s: �;�s;,'?" :5?:�� �.wa..,�:�t.�.;= .:.5:.. � / �` � :A, , *,; x.:.� �,•... k ^�:.:�'*%�'�.�;c €�w� «. . :z� Site utilities
• Job site address: 7815 BoNrra- / c • Catch basin or area drain / j 16.60 15
City/State /71P: % a pi Drywell, leach line, or trench drain 16.60
no.: Project name: Footing drain (no. linear ft.: / ' Page 2
Suite/bldg./apt.
I j /3U N/ rec. /o wn h oar es
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60 (., (p. Li 0
(4 Fill& /Q &eel( Ora e°_- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: I/O) 8' Page 2 .51 9, �
�� Lot no.: 'S Water service (no. linear ft.: 2/) 1 Page 2 , ild
Subdivision:
/`3oNi � / ay)
0 �, 0 0 Fixture or item
Tax map /parcel no.: Z S i / 2 8,,4 Absorption valve 16.60
� s , .- : , ; r> � . -< : ° , � w„ ... - - atilA. - Backflow preventer Page 2
53 1.--oh ►'LSl' Nfia-'/ S11- b6/I✓l5taN adjacent-# Backwater valve 16.60
)7) eau i fi at L Fe? IVAl 0 GreGIL Uri ✓e - Clothes washer 16.60
Dishwasher 16.60 .
^, re s �: ; •. $ . Drinking fountain 16.60
, „ „ .� .. ; ..... § ; , .. .,a -.F � Ejectors /sump 16.60
Name: ( ' e re-e_ L . Q i w 1 t d c l . Sxz- , SN c. . Expansion tank 16.60
Address: G/ 5W 3W Splbl,t.' glvp(. 1 2ZO - • • Fixture/sewer cap 16.60
.City/State/ZIP: M✓1 el r'` CT 7
Floor drain/floor sink/hub 16.60
Phohe: (,D3) g q2 - X 75. ' Fax: (jL 3,) $'7 Z - g - j / Garbage disposal 16:60
Hose bib 16.60
4 °d l i Rc „ ; ... , Ice maker 16.60
Business name: St n e5 t ti n . L. L C Interceptor /grease trap 16.60
Contact name: S +e ve, Rvp e - . - P g_ Medical gas (value: $ ) Page 2
,
Address: g 9 /p S Li/ j-! i 8 ( ✓a9 _s ¢-e_ Z3 Primer 16.60
City/State /ZIP: 1 ea v6 ,.., 17 , iv , o g___ g7do Roof drain (commercial) • 16.60
Phone: (., 3 ) !f-z,6 /'.- (Z/ j I Fax: : (503) Lap el - R-5553 Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail; j{e re r-® ,5r et t 1 G . LO M Urinal 16.60
.: i "+,4 :s'�.i : "±, � = ;z;: :sz;;:` a:' ,° °'; ,:' V t
( - „,,,, ,', . t; - _ a.1 ;013 '.m , 16.60
"� . �a. �,._�.,.� �;�;�. �� �`_� ..,.�..,�� �� W a t er c
Business name: t
R Water heater 16.60
Address: Other:
Subtotal . . '
City/State /ZIP:
Minimum permit fee: $72.50 �Q
. Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 �� 0.1, C O .
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) a, ,tA5
State surcharge (8% of permit fee) 5 l ie
Authorized signature: TOTAL PERMIT FEE. 15
Print name: Date: 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.
c\Building\Permits\PLM- PermitApp.doc 12/03 440- 4616T(10 /02/COM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
, INSPECTION DIVISION Business Line: (503) 639 -4171 MST
22�� BUP
Received Date Requested -- J AM PM BUP
Location 0(a Suite MEC
Contact Person Ph ( ) 7 ' —9S73 PLM 619q — D O5
Contractor Ph ( ) 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 /� f
Framing e.er Y! ✓7 3J S� / Pej^^ %� ,0�N— 0000 I 12e-(`A1�� l,J��l✓ w,
Insulation i,
Drywall Nailing "`'`' 19 / S�� ��� ^"'
Firewall
Fire Sprinkler C ; )' TI0 0-4,1 i Qe., ,Of t arb rr,\ 1 tit ✓ .
Fire Alarm (v G f fI, ( 6eU r w VoL. tJe/ , „ A T t,J �✓ Mc�e ✓r ��s v .4 of
Susp d Ceiling T AT C� s� v
Roof Pi., C
Other:
Final ' ✓rf 'cVl gwtC Fl� f fe�c�LO� I�Q�Iu� �c�fic ✓T 12C�� 1�r To
PASS PART FAIL /�
PLUMBING 1, equ' ei/0A
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
41 ) PART 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 Date b I 3 0 10 y Inspector g Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL