Permit - A, CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00446
` I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/24/2004
SITE ADDRESS: 11670 SW BULL MOUNTAIN RD PARCEL: 2S110BD -01500
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 90 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace water service.
FEES
Owner:
Description Date Amount
OCONNER, THOMAS
11670 SW BULL MTN RD [PLUMB] Permit Fee 9/24/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 9/24/2004 $5.80
Total $78.30
Phone : 503 235 - 3577
Contractor:
BUDGET PLUMBING LLC
PO BOX 69003
PORTLAND, OR 97239 REQUIRED INSPECTIONS
Phone : 503 Water Line Insp
Final Inspection
Reg #: LIC 134355
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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: A Permittee Signature: J--<_ A, n vo
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busines day
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Plumbing Permit A !VI . c :4 . 2k1 IV ED
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City of Tigard g Q 7 al ecrmh N C 2 e0 c / 10
Phone: 503.639.4171 Fax: 503.598.1960 c/V
/3125 SW Nall Blvd.. Tigard, OR 97223 v
f, r 0 C) g 0 A Flan Review
1960 CI 4 ti 2° ,,. . , 1 Da
/By: Other Pennit No.:
24 Hour Inspection Line: 503.639A17 i)11.,V:i il te/By:
,....____.- Internet: iieww.ci.tigitretot.tis Cif Y OF Ti 1 --7. a ''''' Olaf Rw.4rBy:
Nonlied/Method: See Pegg 2 f or
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/ 6 Soppiontroual information
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0 New consuuction 0 Demolition For special information ewe ekeekliss
Description 1 Qty. j Ea. j Totul
0 Addition/rdterationkeplacement 0 Other:
New 1- 2-fattilly dwellings (Includes 100 ft. For each utility cormection)
).:-. ,' i4111?•!'.0.;i.:.iii400**"6 ' 0.›: 1 1 0 # 11 4 1 1 1 .0.;II:14, 4, .ii i '..; '.....:.:' .:::•:::::: SFR (I) bath 24920
A / - and 2-family dwelling 0 Commecial/indentrial SFR (2) bath . 350.00
SR (3) bath 399.00
0 Accessory building 0 Mufti-family
Each additional bath/kitchen 45.00
Cl Misster builder Cr Other
Fire sprinkler( sq. ft.) , Page 2
,;!:.11:;),1:€4:!:3i-•21,;.:',:i,...'iiikIlipAikiViwini. 'Z' :•".'::F:. I I -
1,,,.......,...!•.,. ! ,4.... ...e. .. .:. i ...,.:;,!),•,::-.,: ::.:: :. 1 Slte utilities
Job site address: f I 0 70 . 4, po 13 Lai 114,fil • Q. Catch basin or area drain 16.60
City/State/ZIP: - n(l Ct_rd 1' ()le? q 7 23 Drywell, leach line, or trench drain 16.60
Fooling drain (no. linear ft.: _J Page 2
Suite/bldg./apt no.: Li I Ptoject name:
Manufactured home utilities 330.00
Cross street/directions to job site:
Manholes 16.60
_ Rain drain connector 16.60
Sanitary sewer (no. linear ft.; ) Page 2
• Storm sewer (no. linear ft: ) Page 2
Subdivision: no.:.
Water service (no. linear R.: yfe efice Page 2 k 55 ....
•
I Lot
Fixture or item
Tax imp/parcel no.:
Absorption valve 16.60
.....; 1iq. "..' ' !,. 7. ...i . OP.I. PktIVOW::!::fi t;...! $* A Len
-Ur...CM preventer
Page 2
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ea . • 0 ' 1
4d ' 1 I 1 . 6 , Backwater vaNe 16.60
Clothes washer 16.60
, .
Dishwasher •
....____,
16.60 •
0:!:::- -i.. Drink fwntai
Ejectars/surnp 16.60
Name: 0 CO r\.. '- (1)/--• Expansion tank 16.60
Address:
' fixture/sewer' cap I 6.60
Ciry/Statc/LIP:
Floor drain/floor sink/hub 16.60
Phone: (179 - 75-9 7 Pax: ( ) Garbage disposal 16.60
. .
16.60
? j-L 1 1: i .. 1) - 1 ; '! i i in .... .; S:**44.01 ) ............. . U°e bib
lee maker 16.60 .'
Business name: 13 , ,,,, ,,„, I- ,..,A b • 4 ,
interceptor/greare r ap 16.60
Contact name: Let, ry- .6 Iv e t s
Medical gas (value; S ) Page 2
,
Address: c) .f., "s
Primer 16.00
City/State/ZIP: 1" g t a I 0 , 0' _ ft• RoordraM (commercial) 16.60
Phone: (503 4 _ ., ,
.40 SinIc/buirt/lavatory 16.60
Tub/showe r/shosver pan 16.60
E-mail:
;,1•;: ,' :P. ••;,: .; • ..,-;.:' Urinal I 6.60
s :,; : ,... is ; ',
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- 1 1 '' ,. ' , '%;•'• , :".": - • :'. z'''•''' , ," '. .... • ' ..... : • • -:.;,',.'-..:: ■;' :' f': • Water closet 16.60 ,
Busit's name !Ill •AA / P.A , O II Water heater 16.60
.. ,
Address:
Other:
City/Statc/Z11":
Subtotal
Minimum permit fee: r72.50
Phone: ( ) a„,,
Fax: ( )
Residential backflow minimum permit fee: 536.25 ''''" ' `-dC/
CCB Lic.: 1 ' ' 55 Plumbing Lie. no.: 3 .42gp: Plan review (25% of permit fee)
Authorized signanue: ATO
rt. 4 ■1 ..ddi. 2_ .:... 2:0 Stale surcharge (8°4 or pen-nit fee) t5.6
TOTAL PERMIT FEE z
Print name • . A IIIW II IMFLIIIIIII Dave: i" MEC This permit application =wires if a permit is not obtained within
IRO days after it ham been accepted as complete.
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'Fee methodolOgy Set by Tr County Building Industry Service Board. •
'-------. ImohrlioePernatd.Pt.M.PermitApp.d 121113 4140.4611M10/01.1COMAVIII)
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 9 -J`7 AM PM BUP
Location / / D /� -c-c ,(P �'�' , Suite MEC
Contact Person Ph ( ) 4 0` / — L-( (47 PLM - L / -'DULf q-k
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg l Drain
Drain
071/4 , % i �` 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
Other:
PART FAIL
HANICA
L .
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 D Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line r �
ADA
Approach /Sidewalk Date J 1 .0 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL