Permit CITY TIGARD PLUMBING PERMIT
Awiti1 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00435
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/20/2004
SITE ADDRESS: 10260 SW GREENBURG RD 190 PARCEL: 1S135AB-03400
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING: C -P
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 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: Installation of rough & finish-plumbing for (1) breakroom sink w /hot tap.
FEES
Owner:
Description Date Amount
EQUITY OFFICE PROPERTIES TRUST
ONE SW COLUMBIA ST #300 [PLUMB] Permit Fee 9/20/2004 $72.50
PORTLAND, OR 97258 [TAX] 8% State Surcharl 9/20/2004 $5.80
Total $78.30
Phone :
Contractor:
PORTLAND MECHANICAL CONTRACTOR
2000 SE HANNA HARVESTER DR
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 151807
PLM 3 -425PB
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: - Zr Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next businss day
Plumbing Permit Application FOR OFFICE USE ONLY
•
Received 4 7 �� ` �ft J_� `�
City of Tigard ) V
13125 SW Hall Blvd., Tigard, OR 97223 Date /By:
Plan Review
Permit No �
Phone: 503.639.4171 Fax: 503.598.'1960 epl�n Other Permit No �noz /
* "NII f�l Date /By: ,� y �()
24- Hour Inspection Line: 503.639.4175 Date Read /B Juris: BI See Page 2 for
Internet: www.ci.tigard.or.us Ready /By: ' g
g Notified/Method: j 1( Supp Information
• ° = T� •EO
:�F �'OR
K"n 4 :,; ; ° " FEE SCHEDULE° '-' • ;'. 4
� a
- _,,: - ., _ - z� ,�"•u. ". •w , ,,S, S• ata - , „ wc tn°Kta't�' : i i ,- - .. ,..a l i,, n? .,:: ° ,-� ;, .. y .,, .e ,. ,..,,, •.ate
❑ New construction ❑ Demolition For special information use checklist:
Addition/alteration/replacement ❑ Other: New _ 2-family well[ g ( (includes 100 ft. for each utility onnectt )
!1. ,,, -'"`'/F' wy :` < >;�
'.•: , .w;>¢3,+*1 >;88'3 p ..
Description Qty. Ea. Total
N 1 dwellings s in h connection)
-
; CATEGORY'QIFa';GONSTR)GTIQN = = "" SFR 1 bath 249.20
❑ 1- and 2- family dwelling 6-Commercial /industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
'' I3 FPE ciiii AT N A I? L = a i �,F: u ' "
1'" - '•? -' - J0 'S a MI ` O N OCA TION 6 . - "C ,z _.. " ,
.,. ate.., � _�. � . , .d�:,.u.,,�. ��.:, ., Site utilities
Job site address: /C),24 d Sw Gpf'r t .A. iC Su,l� 19 b Catch basin or area drain 16.60
City/State /ZIP: '7 A r a t of , el r7 1 Z 3 / Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l q c Project name: K4 i -,, Q S � N Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: / (� Manufactured home utilities 110.00
/ ` � J �,/ P pj�ti/ Td W l��S jag ...r. [AST Manholes 16.60
cc I a t I ] e `� /`•t,e - bu 12 c C - I r l per Rain drain connector 16.60
Z £A5 EA1 C ie pYt'1" at Tb dF S ors �•� Sanitary sewer (no. linear ft.: ) Page 2
(K e 1lS . St vie. ) 9 6 / Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: •
Absorption valve 16.60
'�,
' DESCRIP.TIONOF' WORK': ;: -'`'
�`'� °`,r. r° . �.:r<•>: ,r;��. 3,.... � - r .E .,„ , .� �a Backflow preventer Page 2
� /) S-rz - -1 A.1 Df Ko WS 14- . ...0-it's) , , Ak..M l b• Backwater valve 16.60
I - l'r � ro a Si.,�t I< Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60 •
' PROEERTY R:. '; % TENANT : = z i
, ��� ••_��• , OWNE �•.,r,,. ,�, , ❑,,... .a._. ». �a :,�;�7�zo jectors /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: ( ) Fax: ( ) Garbage disposal 16.60
•<,:,:,,,._ „ Hose bib 16.60
APPLICANT,: CONTACT' ER ;0X,; ,° . „
�s Y: rl :,,;' " - -a W._., ,A� ai,a.>• Ice maker 16.60
Business name:. 1 kAl_ /0 e..4.�k N/ iA 1 (���rA CTbt Interceptor /grease trap 16.60
Contact name: 5 l/t. Pia_u_ l d RAJ Medical gas (value: $ ) Page 2
Address:
7606 St� Ae u�tl/4 N A c U �S-r¢.•- Tr Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
t /�� , l 1 �� Sink/basin /lavatory / 16.60 /'6, Go
Phone: (SOT ) 44 - 4_ 7 Fax: :(50T)e., SS - 06Z,O
E -mail: ST-.G�rn g d� �✓ i 4AN'� COy� Urinal Tub/shower/shower pan T b r a 16.60
°w: ,-
U 16 60
-
; -v, ,..,,, , ,;r.::;:..: - ,�GONTRACTQR, ' �: .. _ « Water closet 16.60
e;� Business name: 'Tl
ReA, / 'e -10& mil 013,7 M C7'5 r . Water heater f 16.60 /C, Lc) ) Address: 2460 S6 ttliVillil /ArVto.S'r Dr, Other:
s''° City/State /ZIP: t I) ) iA.k_1-1. oe- -I ) 2Z Z Subtotal �, Zb
.r... t t Minimum permit fee: $72.50 ��
Phone: (S3 ) 6,56 - 7 goo Fax: ( 503 ) 655 - p‘,2,0 Residential backflow minimum permit fee: $36.25
Plan review (25% of permit fee)
�1 C Lic.: i s f8(3 7 Plumbing Lic. no.: 96 State surcharge (8% of permit fee) 5
Authorized signature:
L ,' ltv TOTAL PERMIT FEE �830
Print name: 57`tej).e A �� jL/ Date: 9_ / 7...4 7 This permit application expires if a permit is not obtained within
7 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Building \Permits \PLM- PermitApp.doc 12/03 440-461 6T( I 0 /02 /COM /WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:, (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
p BUP
Received Date Requested ` — AM PM BUP
Location Ca ���!1i - tite / d MEC
Contact Person • ( a *33/ 3 787 pLM av 7 q 2 4 /3$
Contractor Ph ( ) SWR
BUILDING . Tenant/Owner KJJ<- SUC5. 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 W./
Roof
Other:
Final CO,
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
s 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 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date g I L Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL