Permit to CITY OF TIGARD PLUMBING PERMIT
�� Ic�I'' DEVELOPMENT SERVICES PERMIT #: PLM2004 -00513
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/15/2004
SITE ADDRESS: 10775 SW CASCADE AVE PARCEL: 1S135BC -00600
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: New (1) water closet (1) lay.
FEES
Owner:
Description Date Amount
AMB PROPERTY L P
BY TRAMELL CROW NW INC [PLUMB] Permit Fee 11/15/2004 $72.50
8930 SW GEMINI DR [TAX] 8% State Surcharp 11/15/2004 $5.80
BEAVERTON, OR 97008 Total $78.30
Phone :
Contractor:
POWER PLUMBING CO
PO BOX 19418
PORTLAND, OR 97280 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 52378
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: � Permittee Signature: 71,i34_a_i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Nov 05 2004 12:41 HP LASERJET 3200 p.2
ti
Plumbing Permit Application
City of Ti al•a „may /�- JS', y 7CV 4/ -cvf/.
g Permit Na.:
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax; 503.595.1960 a
t itan Review 5 � ,�. ( r , a ti _ `y t 3/V
24 -Hour Inspection Line: 503.639.4175 nr• Allh,,,,. ! i.; ?lair . \�O( /N
P'74 y Other Permit No 1
-a Date Ready/By: r" �� H See Page 2 for
Internet: www.ci.tigard.or.us Notifie J
Supplemental Information
5 d. Me[hod:
ft!� 3 63 a: 3,.
l l �..,.e"1's=.Cre i s ` hit • 1 t =1 i 6 .:, :: , G f�i ,.. :1 1�3 t 13 $ € cif, . W ��=== ∎ r
y ... g {t p�p!g�y @ p
ll t �. e d� �am=v:w..x-an: > >�a: >- 1 e 1 . ,� 1.. .- !,1! ° =:uw' ._...." . �..., � I . .t.i! 41!1 II Il't� .. - '%_ 'p t -... I S� rv l;..
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Li New construction ❑ Demolition For specie! information use checklist
Description I QTY. I Es. I Total
❑ Addition /alteration/replacement CI Other:
�, s et r � t r � � t:a i c New 1- 2- family dwellings (includes 100 [L fur each utility uannecliou)
°t' 8 l t: 9
�Ei:. ;s't� a r ' i i ,. +all et ! t l op,., i /,. :.::;8`:= z: „'. - > S FR 1 bath 299.20
t=. 7 .L c .: r I1iE1f, �,Url r a tt¢ a/ l; , litltl., .._._ ____ 4 ; . :i . . M : : " " : " _ : ,,,, _ �<: ( )
El 1- and 2- family dwelling tis .mmer cial /industrial SFR(2) bath 350.00
El Accessory building El Multi-fami ly 5FR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
,_ _�._,... ,.! :,•:, --. „ t. , slf81 Pii �i ❑ r1a�i ., �� ire sprinkler ( sq. ft.) Page 2
Other
g i (( ( (( F r
: i,llr - t it y, > r i-, ,. ! 'i .. ,, I t 10 S ite utilities
�_�: °;.:.�: .= ,_,, -�" nt�_.hfiuh4;t , s+_- .�5...
Job site address: 10116 s +.� e .5 , , „ • C Catch basin or area drain 16.60
City /State /ZIP: ' - "1'"" -` ) ay' Of --lam 3 Drywell, leach line, nrtrench drain 16.60
Suite/bldg. /apt. no.: I Project name: Sr pi) o r.../c) in,.....) Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manitulcs 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _-) Pagc 2
Storm sewer (no. linear ft.; ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: • pia. 'S
Fixture item
or item
�rC �QI Absorption
_ - _ :, ,st =da t tat a e te,ravrnui w� ua. -_ F B t ', aru Bi. Absorptio valve 16.60
........ ......z.... °` - $r I d a ri .: i t a I $!I t Y -id t
, :...... -,:: :rs ; , ,,:: -: .Y• ; I rr 'izi;: - ,„,hi r • ' ,A _. . . ! I , • _.,. Bcckflow preventer Page 2
.Q.t..c, ..
►t. - - -- _ - -- --
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
; ;T c - y ni fg _ .. ➢;8
; F' :48A: �k : a ; ..,. a ,; �.�i� _ ,ItirEt��l �i' � �i � " $f $i!id�Idieli =`I!'sa _; Drinkingfuuntain 16.60
. ♦ � t �.SF i t!ax x�,= �:: :;e:, �_::::_!,' .- . I t:...=B;.w:_...:" -__._
-- Ejectors /sump 16.60
Name: --
Expansion lank I 6.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/9oor sink/hub 16.60
Phone: ( ) - Fax: ( ) Garbage disposal 16.60
- -- - ; I t ,I a t l ici t f acka r !.1 r - a 11 li ' Hose bib 16.60
:- iia.:. t r�sa�.!.,.L, t S,. ... 3 t . � t.. .:.: .= BStll t,. ., "�"t: _:' Yn t I maker 16.60
Business name: Pocu e" • l 1I k
c�`1 '- Citi Interceptor /grrase trap 16.60
Contact name: ,10{a h 6 Medical gas (value: $ ) Page 2
Address: f D hc . o f ` ct j i ' Primer 16.60
City /State /ZIP: P isy 4- ((Lod (51/ 4 7 a k 0 Roof dram (c onunercial) 16.60
Phone: Sink/basin/lavatory 16.60
c �,y y I Fax: = ( ) � " "��' Sink/basin/lavatory
pan 16.60
E -mail:
Ce: c�,i1tHz. t^^ hli:ddf fiti.p!i'iiaili=i - e.=
. 3 in !'1 { . l:.r.! 1(1. , . .>... 0 = - �., $. . J•111C95 7 . .._. _.._ ..._.... _..i i1t15Pf $ M'$li it
..w.e�rn rr,-- ..r. oii•- Kt 3'S" '_. - f� :,. ' .t+te, Filled ^;il: t . .
. -. ... -:.'' "$Ill'
Urinal
. ,a,i , �;._: _ - r at'�+ 4 ;!o'�lidtiilij' . t 1 .-:.!. '� iilata4r ; � i itinar, - _ Water closet / 16.60
• ....,.,t, »..a,n�:a =,arse _.. IBa'a;ilar.�.. , ....�__. l ;,,...... .. ,• .r......::: -.
Business name: i t . . 1! 1 Water healer 1660
Address: Let' bi
Q 3 S� /• ue n �� £JL, Other'.
�� 1 Subtotal
_
Minimum permit fee: $72.50
Phone: ( ) ,, 4 1 43 p o } Fax: ( ) . _ ?e Residential back minimum permit fee: $3625
COB Lie,: 5 a- Plumbing Lie. no.: 34...4 szlpy, Plan review (25% of permit fee)
Authorized signature „► State surcharge (R% of permit fee)
;
TOTAL PERMIT FEE , 7,/,.."
Print name: ) '4, ,,,,,, S , Date: f l / 5 I O U This permit application expires if a permit is not obtained within
f IRO days after it has heen accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i \Building\Pet nu[dPLM- PermitApp,doc i 2/03 440- 4616T(10 /021COM/WEa)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 '
SPECTION DIVISION Business Line: (503) 639 -4171 MST
( i / 2 BUP
Received (29.47 ' / Date equested AM PM BUP
Location /id 7 ?S S Clio" Suite MEC
Contact Person 1 AL Ph ( ) 0 /y(/ . /gad 43V,10d V--CO Si 3
Contractor P ( ) SWR
BUILDING . Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain 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
ART FAIL
. :earn
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O
!• PART FAIL
HANI
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 Dat Inspector Ext
Other: -
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL