Permit CITY TIGARD PLUMBING PERMIT
l DEVELOPMENT SERVICES PERMIT #: PLM2004 -00509
c ' J I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/9/2004
SITE ADDRESS: 09900 SW GREENBURG RD "* PARCEL: 1S126DC -03300
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: OTR 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 12 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repair 12' of sewer service.
FEES
Owner:
Description Date Amount
ATHERTON REALTY PARTNERSHIP
MARTHA ATHERTON [PLUMB] Permit Fee 11/9/2004 $72.50
2100 S WOLF [TAX] 8% State Surchart 11/9/2004 $5.80
DES PLAINES, IL 60018 Total $78.30
Phone : 847 - 298 - 8600
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone : 239 Sewer Inspection
Final Inspection
Reg #: MET 00003082
LIC 49418
PLM 26 -533PB
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 -66 .
Issue By: Permittee Signature.- i " ., rimy
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
FROM APOLLO DRAIN 503 - 669 - 9568 (THU)NOV 4 2004 12: 44/ST.12:44/N0. 6812889895 P 1
Buitdi yixtures P�P�IC�D
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Plumbine Permit Applrtcation r()R (lrrici: USE (r1.1'
City OrTigard a `' 0 200 Received aty; / ! V' 6 T P curd: N o.: aL f7/ -oOSQ9
13125 SW H Tigard, OR 97223 V Plan Review r
Phone: 503. 639.4171 Fax: 503.598.19 Other Permit No.:
24 Hour Inspection Line: 503. 639.4175 V OF TI i i ii Date/By;
Internet: tirww,cI.tigard.or.us BUILDING DIVISIC�° - -� 16 Ready/8y: ! 21 See Paget for
Notified/Method: / Supplemental inrormatlon
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New construction ❑ Demolition For special Information use checklist.
Description I Qty. r Ea. I Total
Addition/alteration/replacement ❑ Other: New 1 -2- family dwellings (includes 100 ft. for each utility connection)
5 •...u71..,,z , :I:.. E ■:+ . ., .. ._,,, ._.. ; J ; . - i .. ••,!., : 1 ''` - ; Ih .. ,,.. SFR ( bath 249.20
■
❑ 1- and 2- family dwelling MCommercial/industrial SFR (2) bath 350,00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
,lY ,...... ,...._�_. -. _ . ..,,. Other: ire sprinkler sq. ft.) I age
a . hc, . t$. ... I > tS .:'d .. :: O - ,� , .7, � � .
F kler ( Page 2
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� � ,. 'Y,c ... ....... 1 ,. , ..• " . _- .,, ,. :�rlb.'.,.'� -.4a Site utilities
Job site address: CI CL 00 6KG11 Id it_ rq ..td Catch basin or area drain 16.60
City /State/ZIP: Po (1- 16...v1,11.- O% C rl 7,23 Drywell, leach line, or trench drain 16 -60
Suite/bldg. /apt. no.: 1 Project name: co L4.0,461 /1 S • t✓TI'� . Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 11) I Page 2
Storm sewer (no. linear ft.: Page 2
Subdivision: ' Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: .
p a � ✓�ii7 >7T1" Y "� Ipp �� r:ueUY' }tt4 . w- � 5y y Absorption valve 16.61)
' a ' .. t >r . , ' i !: Y p'� u iii_ t0 P_ ` . ; L : " . _ � 7 ., , .. ... r k � ) f !a .. fi Y. ! At •?� � k ( Backuow prcvcnter Page 2
t'. -r z.esv i r t'_r Y-t.()CLi r Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
... ,.,,: .
r:: : 1.,ii ,r ,,,:: t . + ' .W : ;, - F • Drinking fountain 16.60
•
V ,..., . :.t ', r r ! i - {, yl .�+ I 4 I i" .7., .. + vr.' : .: e I f K l �...l
:�...:, * i 1 1, : .: .. 1,.., s . fijcctors /sump 16 -60
Name: C us h u ..n I ( &tt-t'_`.c 1 t✓1a
Expansion tank 16.60
Address: l■A l_y f f■ilt_t>J C' Rfl t= Fixture/sewer cap 16.60
w
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: (`j ) 7'7 ! - ( '7 it i Fax: ( ) Garbage disposal - 16.60
r4 gI t . 72
_, . i : . r . ,. ,�.:,: , ^I , ":,r.. Hose °lb 16.60
cat, ptd,.. ... .n . ,. ' n iA .._ '. Y . • .. I ,' ,.:: r . .► . • � ; • _ :1-, '4,,. : :`'.as ` ,e l maker 16.60 •
BusineSS name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16,60
City/StateZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax_ : ( ) Sink/basin/lavatory 16.60
• - Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
r . �y wt ","•� .E • t - t 'AI raw; n.rl':..:': "!<- .+tP.. " n -x�! ,r. y.,,�"
4101 'k� ,� ryr..,::l.1•, 1 , ` t,,. .. o,. :; :' ,•.. -.t :''''? s . kat'.• ,, , .• �+ rs:. t, -, ; Water closet 16.60
Business name: Apt tlh 1) r r ,,, p I l l . (oI no) Water heater 16.60
Address: 210 7( ;rkS daIG A t Other:
City/State/ZIP; G. S h. LLVYI civL Cf O 30 Subtotal
Minimum permit fee: 572.50
Phone: ( c . � Q 3 ) .3C1 - ' ' O ` Fax: (IYi3 ) ( (cot - (a Residential backflow minimum pcimit fee: $36.25 / eX''D
� ( 3 3 P e) Plan review (25% of permit fee)
CCH Lk.: 4 1°1 q �- Plumbing Lic. nu.: � � _ v ...._
�� 7 /� /* State surcharge (8% of permit fee) 5 to
Authorized signature: TOTAL PERMIT FEE `ft., 3
Print name: Ca_1(I "1 t1 -t,_t lone V Date: 1 tl 4 - 4- r This permit application expires if a permit is not obtained within
1 180 days after it has been accepted as complete.
'Fee methodology set by Tri-Coumy Building Industry Service Board.
i' BruildlrI Y1Permi1nPLMF- PCrmirnpp.dac 12105 440 -4616T( Io10YCOMIWCa)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION VISION Business Line: (503) 639 -4171 MST
BUP
Received ' . � to Requested AM PM BUP
Location e)d / .QA/ 01, S.. Suite MEC
Contact Person '�✓ Ph ( ) d. ?od
Contractor Ph ( ) • SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: A „i. ) SIT
Post & Beam
Shear Anchors fi /'v C di7i
Ext Sheath/Shear `-
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
CI:E= FAIL !,
Post & Beam
Under Slab
Rough -In i./(///(77
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole 19e;t.
Storm Drain t'
Shower Pan
•
Oth ;!_ I'
) PART FAIL i $
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 El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 5 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL