Permit CITY TIGARD PLUMBING PERMIT
`AI' DEVELOPMENT SERVICES PERMIT #: PLM2003 -00440
x ` VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/19/03
SITE ADDRESS: 10220 SW GREENBURG RD 201 PARCEL: 1S135AB-01002
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R -12
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Cap 1 floor drain, cap 1 sink and move fixtures, install new water heater
FEES
Owner:
Description Date Amount
EOP LINCOLN LLC
10260 SW GREENBURG RD [PLUMB] Permit Fee 8/19/03 $72.50
SUITE 100 [TAX] 8% State Tax 8/19/03 $5.80
PORTLAND, OR 97223 Total $78.30
Phone :
Contractor:
MCKINSTRY CO
5400 NE COLUMBIA BLVD
PORTLAND, OR 97218
REQUIRED INSPECTIONS
Phone : 331-0234 Rough -in Insp
Top -out Insp
Reg #: LIC 40981 Final Inspection
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 questions to OUNC by calling (503) 246 -6699.
7
Issued By: «yh Permittee Signature: 4 j
Call (5 3) 639 -4175 by 7:00 P.M. for an inspection needed the n 'xt business day
•
•
"e t Plumbing Permit App OFFICE USE ONLY
I 1 I 's>
C of Tigard Date received: Permit no.: � ...elf) e/ye)
{ Sewer permit no,: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT •
❑ 1 & 2 family dwelling or accessory ErCommercial /industrial ❑ Multi- family Tenant improvement
❑ New construction ❑ Addition /alteration /replacement ❑ Food service ❑ Other:
. JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) •
Job address: 1OZ20 �) (�(ZEem ( ( (a.D Description Qty. Fee(ea.) Total
Bldg. no.: LI N(ALN THeEE I Suite no.: 201
New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (I) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Project name:.C..14-1E1.0- SU IT - ZD1 SFR (3) bath
City /county: I J IV D I ZIP: 'i '712_3 Each additional bath /kitchen
Description and location of work on premises: 11VST? -LL (J, ) Site utilities:
C l •lZ — W &TE2 14 (I) Catch basin /area drain
Est. date of completion /inspection: Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: KC.1LI N STi2y CO. Manholes
Address: 5 j`(E GOLU M L31 P 5 Lkl3 Rain drain connector
City: POeTLFtiVb I State:oia ZIP: G( 7z Sanitary sewer (no. lin. ft.)
Phone: '31,p7 ?��IFax: 331 -(oE -mail: Storm sewer (no. lin. ft.)
CCB no.: `-105 8 ( I Plumb. bus. reg. no: 37- 2Zi713 Water service (no. lin. ft.)
City/metro lie. no.: ill Fixture or item:
Absorption valve
Contractor's representative signature: Back flow preventer
Print name: CLIP': 1¢- 1422 Date: 0 Backwater valve
CONTACT PERSON • Basins /lavatory
Name: CL(F g-A-ZEN Clothes washer
Address: 5 N6' C.OLUM(31I'N l3LVb Dishwasher
ty: .P OI2-�AIUc I Q2 ' 72 J Drinking fountain(s)
Ci State: ZIP: Ejectors /sump
Phone: 33C OZ Fax: 331_C0PlO6E -mail: Expansion tank
. OWNER Fixture /sewer cap
Name (print): Floor drains /floor sinks /hub
Mailing address: Garbage disposal
Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) /
Owner's signature: Date: Sump
Tubs /shower /shower pan
Name:
' Urinal
Water closet
Address: Water heater
City: State: ZIP: Other:
Phone: I Fax: E -mail: Total q''
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ '-/a .
Notice: This permit application at %) _
❑visa ❑ MasterCard expires if a permit
after is s not obtained Plan review ( o ) $ O
Credit card number: / / within 180 days it has been State surcharge (8%) .... $ .'J. 0
Expires TOTAL $ 1 . go
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6 /00 /COM)
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MCKINSTRY CO
5400 NE COLUMBIA BLVD
PORTLAND, OR 97218
Plumbing Signature Form
Permit #: PLM2003 -00440
Date Issued: 8%19/03
Parcel: 1 S135AB -01002
Site Address: 10220 SW GREENBURG RD 201
Subdivision: THREE LINCOLN -TOWN OF METZGEF
Block: Lot: 009
Jurisdiction: R - 12
Zoning: TIG
Remarks: Cap 1 floor drain, cap 1 sink and move fixtures, install new water heater
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
EOP LINCOLN LLC MCKINSTRY CO
10260 SW GREENBURG RD 5400 NE COLUMBIA BLVD
SUITE 100 PORTLAND, OR 97218
PORTLAND, OR 97223
Phone #: Phone #: 331 -0234
Reg #: LIC 40981
PLM 37 -22PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X p_ J�
Signature of Authorized Plumber
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 17 AM PM BUP
Location / ; �' 41 _ 41d 1 '_.. Lam , L Suite 2i) ( MEC //
Contact Pers • it eig �i .�.�� ' w Ph �) . 3/ — 023 54LM On ye-
Contractor _ Ph (CO-S4 21) 3 SWR
BUILDING Tenant/Owner f g,fi 3 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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING 1
Post & Beam
Under Slab •
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
•
• 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 0 Please c-Il for re'. spection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
/ i
Approach /Sidewalk Date Inspector Fact
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL