Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00560
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/21/2004
SITE ADDRESS: 10200 SW GREENBURG RD 110 PARCEL: 1S135AB -00900
SUBDIVISION: FIVE LINCOLN ZONING: C -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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocate existing sink & add water heater.
FEES
Owner:
Description Date Amount
EQUITY OFFICE PROPERTIES TRUST
ONE SW COLUMBIA ST #300 [PLUMB] Permit Fee 12/21/2004 $72.50
PORTLAND, OR 97258 [TAX] 8% State Surcharl 12/21/2004 $5.80
Total $78.30
Phone:
Contractor:
MCKINSTRY CO
5400 NE COLUMBIA BLVD
PORTLAND, OR 97218 REQUIRED INSPECTIONS
Phone : 331 - 0234 Final Inspection
Reg #: LIC 40981
PLM 37 -22PB
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 questio o OUNC by calling (51 _
246 -6699.
Issued By: 2 , ��� Permittee Signatur- - �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business
N 't
l Pit Li g PerIl`Ill 111ll ) .. „1 , ] "� S r' FOR- OFFICE. :USE ONLY - '
City of Tigard nn ��rr Received , , Permit : \
ut o. 1 ,e�) / �/ f�
13125 SW Hall Blvd., Tigard, 011 �94?C 3 21 1 200 e [y Date/By:/ . 1" 11 °
. ( y /.�9 J� `-'
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
IV I I Date/By: Other Permit No.:
24- Hour Inspection Line: S� yR� ,�d 7 c .',I
Internet: www.ci.ti ard.or.uY I ` � 1 1GA� " Date Ready /By: �"r' ' ®See Page 2 for
1' Notified/Method: � Supplemental Information
V
_ „�'£.:" �i R .- ,, xxe. _ �.i ,- fi `:;9p �t c s 2 .. , ._ ..,¢.! � /T t�5 a?r.' . 14;14-40 e _ Fu _�', -� � �
':<k -I ,a,,,a `s $ -•A'Y '., " >.. ,, ',Y£"La _ V\ - a..( x...; , .< ''23¢'S: }
x n-° ,��• �" � � � =P k; F;�WORK t � , � ° £� "�'EE' SCIIEDiILE � , � � ,� =
#„�'' a _..., _�� a - - - X �- �a�r..�.- ' Y��'z, rx -.�: � -,.; a,l"��.x�w_ . ..�.u.,... _., ,, o- s.n, .a, ,_ ..., ,r acx- �mYf - as z�'mz �. _ ._. a�.�` _ .. _ "6
C .d
❑ New construction ❑ Demolition
For special information use checklist.
Description l Qty. Ea. Total
ig Addition/alteration/ replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
ii F k j 7 Ct4IEGQRY OF C O STRUCTIOIY - t , ' SFR (1) bath 24920
❑ I and 2- family dwelling x 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:
r r - a re ff,,; Fire sprinkler ( sq. ft.) Page 2
t� ., _.�, JOB SW�O ,ZtICA'TIOI4
_. -.> „ ,:., , ,..,.. " 3a .,.,...° °- >.... ,...� , , x ..... ..::. ... . _< _.. ...,41 Site utilities
Job site address: � 0 '7 e iC Sac...) Q Q. « &Newf. �f Catch basin or area drain 16.60
�
City/State /ZIP: ..r/.40.0..., p cy e_ i - 7 2 --, Drywell, leach line, or trench drain 16.60
uit dg. /apt. no.: j I O Project name: rtbtrL rry F" ("t,,,,r tG►A,c Footing drain (no. linear ft.: ) Page 2
L Manufactured home utilities 110.00
Cross street/directions to job site: I 1.3Cp( s Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) I Page 2
Fixture or item
Tax map /parcel no
Absorption valve 16.60
fint.g IP TIC)N OFD W O _ 4
- n �W. / . r..z _ agfr .: ......- _ .. _. , a,r�^iaata °. - Baclilow preventer Page 2
Y.CY `GLAZTC+ 8Xt 5"T1 - S, ' ► j» s - Backwater valve 16.60
t 1._ _ T � ,_ .�,r.� Clothes washer 16.60
CI�� Dishwasher 16.60
s Drinking fountain 16.60
�� PItQPE--I Y�0�11NER .: itt`" .. - ❑ `E4IA1�1T 7 e 4" .
a " Ej ectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) F ax: ( ) Garbage disposal 16.60
16.60
,, ..,esr ,i.a� �e �t. a _ Hose bib
16.60
f ®�PL'ICANT - CONTACT I'1 RSON� Ice maker
-V m
Business name: , C_. , . tuS C�
Interceptor /grease trap 16.60
��
Contact name: P- Medical gas (value: $ ) Page 2
Address: SL tzef- Cc:A.0.61 ,4r_ 19 11ip , Primer 16.60
City/State /ZIP: P ,,e__ 9721.18 Roof drain (commercial) 16.60
Phone: (,55 -g 31 _ vi 4D Fax: : ( )? Basin/ lavatory ( 16.60 •
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
R§ - ,,,^ Water closet 16.60
Business name: OA C,C.„L I..Aar fi...t.t e,C) Water heater I $ 16.60
Address: 5 - q 00 t 3 & C 0 1 , 1 - g,,l v D Other:
City/State /ZIP: Po �T 1D 0-4__ l 2.16 el Subtotal
Minimum permit fee: $72.5 t
0 79 2 7 (0
Phone: (t�'S) -g si .. bZ3 Lt Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: Plumbing g Lic. no.: �.-7 - 2Z P 6_ Plan review (25% of permit fee)
Authorized signature: . �
State surcharge (8% of permit fee) Y v
= TOTAL PERMIT FEE -73,,,3
Q
Print name: �--- • Date:/Z -21 -0 Thi 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.
i:\ 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
6.4 BUP
Received 1 b- Date Requested V \ ( AM PM BUP
Location '\ 7_00 �`r `'� Suite \ 0 MEC
Contact Person Ph ( ' ) ` ( r WC' at ?Of) V -106 S( d
Contractor Ph ( ) 7 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 � y.
Fire Sprinkler � -
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PAS PART FAIL
PL G
Pos • :earn
Under Slab
Rough -In - -
A o f Water Service
Sanitary Sewer
Rain Drains ® ��
Catch Basin / Manhole !� `"
Storm Drain
Shower Pan
Oth r:
•A 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 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 — �J Ext
Other:
Final . DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL