Permit C ITY OF TIGARD PLUMBING PERMIT
Ai DEVELOPMENT SERVICES PERMIT #: PLM2004 -00473
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V III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/13/2004
SITE ADDRESS: 08865 SW CENTER ST PARCEL: 1S135DD-04600
SUBDIVISION: ZONING: C -P
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: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace existing sewer line.
FEES
Owner:
Description Date Amount
ANDERSON, PHYLLIS M +
ROGER F TRS [PLUMB] Permit Fee 10/13/2004 $72.50
c/o ANDERSON, ROGER F [TAX] 8% State Surchar1 10/13/2004 $5.80
TIGARD, OR 97224 Total $78.30
Phone : 503 639 - 1121
Contractor:
3 MOUNTAINS PLUMBING
PO BOX 386
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone : 503 925 1342
Final Inspection
Reg #: LIC 141187
PLM 34 -368PB
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: f , ^ Permittee Signature: S' \ p ,p
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
. 09/24/2004 15:„1.8 _FAR 5035981960 CITY OF TIGARD Igloo].
Il'lumbine PgrmitApplication i•ok OFFICE l: SE ONLY
City of Tigard tO -)3.av 1% PtxlaiiNu::� _pd`/ .
13125 SW Half Bhal., Tigard. OR 97223 rtaaReview
Phanc 503.639.4171 Fax: 503598.1960 Datygy: OLoQPeseritN0.
z4- I•Iourinapeedonliae: 503.639A175 `_■.& . .l I!, Daa;gA�IB�r. 3 0. 7 ] el SeePapua for I e *+en�t lefer madan
ItrRrrnee waw.aatfgcdonus lrottlrSedRrtetLOd ��
y Sr � ( X}- �r1�7 i , .A r i 9. ` ' e d}i�tc* ' .- " : • - •oU�< ~ Q ; ! � 1 r`�c+ x •e- - .
a Y My.i"J-0Y e<vt4. tic r : r - . . i;'^•.3.� .. r. - • ,e,:�3n .Y;. "' r ,,.
Q New eonstraetion 0 Demolition For sprrciat ale dierT
p 1 . [ Ea- 1 Total
Ill dwelll
New t- 1 includes 100 R. for each udli connection)
A�itianolaitaatioaFreplaceutcsu 0 Other: New <' tY
e X� #� 4 ..'�' - • • � �. ~•r.;
^, ..i:.
' : , . . " I ::- I'/ I :7 . I� ••_ i ,:...:s...-;;P14•
:. .,r r, _ r• 4-114.4-7-3-
g ..
.. S R(1) bat11 249.20 -
0 I- and - #sadly dwellinc y ' n SFR (2) 350.00
2, Aoeessorybeading ❑Mniti- loyally sFR(3)batlt , 599.00
Each additional bath/tritelten , 45 OD
(] Matta Ocher Pinecp:intla (_ sq.11) - Page 2 '
�' : _ - ;E. S 33:5 K Fli. i
.r} b ~ {. R` �n .I i ..:dl� 1 i - . . a. �. - fc • • f " -Y- "� '4 . Site utilities
LL fG9�� riY•3sC "7� . N +•••.
lob sits: oddment RA S S . ( �R 57- Qua, basin or area drab, 16.60
C ity/stantrlTh Ti 6-,4 ,ef) ! Q Ej,'1 77.s.2 3 thyself, leech line. or trench drain 16.60
Suite/bldg./1 and I Prooect mm�rx / 9-4/4 ,t? AA/ Footing drain (no. linear R: �� Page 2
Manufactured home dairies 110.00
Cross street/directions to job niter -
Manholes 16.60
Ruin drain connector 15.60
Sanitary seder (no. linear ft.: ,IQ ) Page 2 S 1) 0
Storm sewer (no. /incur It: jr Page 2
Subdivision ,Lot nog Wav _
er service (no. linear R.: , Page 2
Tax �:
Fixture or item
n . •r�. . ^tt. o .\ ,v.. a -�., - .:m y � •a�, ; �i.
Absorption valve 16.60
r %` sK me .> o-+.4 a.. .. ?ct`'; ^ •'S i :1; _C - - 13/denim preventer Paget
f Re /? /a t' e' P j( /7 .Sr, ,A) e /' ,<-[(✓ Backwater valve 16.60
6 Clothes washer 16.60
Dishwasher 16.60
t • �� • s tirr r .. • . w, ...2�n�¢ ��y�$ I s±1' ;-1,-.1.-- Thinking / Fountain 16.60
• n.. i ttF 9 . . . . tray - 7x•': .�•'{- �• %, .. • A r'CTT � K � Ci �"• i• .X Ej RWIys m p ..
_n tT� 16.60
Nan= C.Ll� E/ S n4 + Expansion tank 16.60
Address: �/l 6n S & j/4/ Ce f fey, \v Faso mrserrar cap 16.60
Cit r wz,P : 7 9 e1 ti e rro v 9 7d 3 Floor drain/Boor sink/hub 16.60
Phone: (6 3) 6 - / / a I Fax: ( ) Garbage disposal 16.60 .
..g }7l.���"..,�y• • • : r.�• ' c - „Y �sr imbue bib 16.60
kl4 "rrt. - nl ry : ::A r +- 'af •'T Q 06:00 a -,.1 i.i im ebib r 16.60
B u s i n e s s n a n t C 3 / / ' I it,.i n 74 7/ /4,5 P.4 G/./rl ,13: j • -l[/G Mterceptorlgrease trap 16.60
Canna prime: r 5. ' ,� - , :l - i7 epP c .l-d. Medical gas (value: s ) Page 2
Address: 2 Q , / ., ,&gyp Primer 16.60
City/StathzlP: Sh e f' u)v e, e/ �2 � O 9 7 / dram (eounneniel) 16.60
i SinWbasin/iavawry 16.60
(503 9 s- 43'5'(,2 Fax:: (5 3) 9i5- y , Tub/showerhhowetpan 16
Urinal 16.60
��gg V r\ �� . r , tl ;�> ��'! =�i4 is �i r..• i T
qrJ:;: a,. s.:•%:3 .mow 3 iw '."g_ v , ,, -,.`.: 3.: ~•`ei'f• - : '^ t Witt= closet 16 -60
Business nwr f3 /n 6 !•tip') 71 ns �� in /7/ / G -471 -k: � heater 16.60
Address P , U E 6 ✓ .-- -
Sabtutal
m1°�' ,,.5i) e nl wood , ��f y D M; »;munape nnitfe 6350 ;2 t sp
Ph� (s03) 9015 -431:2 Fax: ( 523) 90?-5 - 9 / . / Residential backilow minimum pcnnit fee 536.25
CCB Lic.: / 4 /cr 7 PI b Lae' ,roti j"1 ‘ fr P Plan review (23% of pernrit fee) ..--- ()
Avt>toriaxd��� State surcharge (8%ofpermitfee) 2 - -
_ TOTAL PERMIT FEE •7_$- ; -50-
r ?nnt ammo: •//99 C/ ^ / /Y Fp /e) --/,7 -OA This 1$ days t xpi m if permit is not obtained within ` 2
�+ c accepted as somplest. J
'Fee methodology set by Tri- County Building Industry Service Board.
c itneW ..+Irrm.Powie vwauc 12'10.3 4e0.sn67pora?oommEal
Trd eL2 OT 'O I'T '400
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
MST
INSPECTION DIVISION Business Line: (503) 639 -4171
// BUP
Received / � Date Re uested ' 7 AM v PM BUP
Location O Vl c ( 4,'Z ` Suite MEC
Contact Person Ph ( ) S l 9 - a 5 4 PLM 4173
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
Framing
Insulation
Drywall Nailing
Fi rewall
Fire Sprinkler ��� ! !�!� - I���
Fire Alarm
Susp'd Ceiling '
Roof
Other:
Final
PASS PART FAIL
'., PLUMBING ,
Post & Beam
Under Slab ! " / ! M _—
Rough-In
Water Service
Sanitary Sewer / Ad 7
Rain Drains /
Catch Basin / Manhole -
Storm Drain
Shower Pan
Other: —
PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
. Low Voltage
Fire Alarm
Final El 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 _ Inspector / Ext
Other: f
Final DO NO REMOVE this inspection re - rd from the job site.
PASS PART FAIL