Permit CI TY OF TIGARD PLUMBING PERMIT
: , Ik DEVELOPMENT SERVICES PERMIT #: PLM2004 -00539
+� a,�l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/3/2004
SITE ADDRESS: 10260 SW GREENBURG RD 118 PARCEL: 1S135AB-03400
0
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: B 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: Add 1 new lunch room sink.
FEES
Owner:
Description Date Amount
EQUITY OFFICE PROPERTIES TRUST
ONE SW COLUMBIA ST #300 [PLUMB] Permit Fee 12/3/2004 $72.50
PORTLAND, OR 97258 [TAX] 8% State Surcharl 12/3/2004 $5.80
Total $78.30
Phone : 503 412 - 4800
Contractor:
MCKINSTRY CO
5400 NE COLUMBIA BLVD
PORTLAND, OR 97218 REQUIRED INSPECTIONS
Phone : 331 - 0234 Rough -in Insp
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 952-0001-00 I through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct q -stions to OUNC b g (503
246 -6699.
Issued By: cti1:� G� Permittee Signatu e: ��
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bus
Id
Piaimiiin . Permit A DTI '- !: V FO OFFI USE ONLY
Received
City of Tigard 0 3 c055
13125 SW Hall Blvd., Tigard, OR 9722DEC, 200% Pla R e t 3 I �� Permit No.: 1. / �`'� �7 -��
Y , + t\ Date/By: c // Review
Phone: 503.639.4171 Fax: 503.598.1960 C ull Other Permit No. � - 137 /
� „�i/ :
24- Hour Inspection Line: 503.639.4175�. ■ )I ' � Date Ready/By: I `� I "' / r /N Jam: H See Pa e 2 for
g
OF
Internet: www.ci.tigard.or.us � TIGAAD Notified/Method: � Supplemental Information
'i r �- � .rte °:v.,, � .flrsr ..�. , . °._._. � p� - �=� � � -'�' - -
t �, «' .� �<Y. i y 1 id tVt f -at t` -y.- L 4. st .al 3
. � `.' �� . T] 'I;,.,U' r ii �t .. ,w,;;;-: , EE SGftH,DLJLE � b„ .. ,.°° , � . -
For special information use checklist
❑ New construction ❑ Demolition
Description I Qty. I Ea. I Total
Addition/alteration /replacement ❑ Other: New 1- 2 -family dwellings (includes 100 ft. for each utility connection)
� - F C ,E+� R]' 4: C�PISTRTICT 1ONt `� ( )
x A SFR I bath
..... �. ,__, 24920
❑ 1- and 2- family dwelling N 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: Fire sprinkle ( q ft) g
r sq. Page
cgj,i6 a 1 lJ ,ION AN) I,OCATIUN „N �A1 Site utilities
Job site address: /0 Z (, (..,,_.) C T batch basin or area drain 16.60
City/State /ZIP: P L- -L . ® 2, 9 7 zZ,J Drywell, leach line, or trench drain 16.60
S u^ ldg. /apt. no.: I1 en I Project name: �Q���, CA KIC,1 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.: ) 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
Absorption valve 16.60
''Wa'�,� k y �t' `I)E SGRIP'CION OF , �'
= -_ . - , °3 ., _ sa - Backflow preventer Page
:-.N - I - L.L I A JtL Si N K Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
•
g I?ROPERTY ift5Ti - .,: _ ®' XE nc_ °
- ._ - ; Drinking fountain 16.60
=°� , ° , „__ ... _ - ° ° ii ti ° t � Ejectors /sump 16.60
Name: & CP? „g,,,_ -p2-O ( pb'$TI �T' Expansion tank 16.60
Address: C J Fixture /sewer cap 16.60
City/State /ZIP: • Floor drain/floor sink/hub 16.60
Phone: ( ) Fax ( ) Garbage disposal 16.60
�c Hose bib 16.60
[ (°, 0.,&T.GAI� ii , g C C1 P P 3 IV1
3
° 7 1 C.0 , Ice maker 16.60
Business name: 4I � l yJSZ 0._, Interceptor /grease trap 16.60
1_ 1..�1G.i �
Contact name: �1� Medical gas (value: $ ) Page 2
Address: s'�ap Primer i6.60
City/State /ZIP: P L L. 4� Zi g Roof drain (commercial) 16.60
(� .g� t ^ 2_9 r) Fax: ( ) asin/lavatory / 16.60
Phone:
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
�'� _ CONTRACTOR t o . �� :
<�,. °.. .. �`,., X3,..0,,. ...: �a � •� .,__ � �a -: ����,��. Water closet 16.60
Business name: /rt t , - Q C-6. Water heater 16.60
Address: s[./ C /` C� CD I OW. G mt- -N t/(S , Other:
•
City/State /ZIP: Po €_ LhNL 97Z(C� Q - Subtotal
Minimum permit fee: $72.50
Phone: (67:&) ? 7 ( - 2_11, 9,D Fax: ( ) _ Residential backflow minimum permit fee: $36.25 '7 .'z
CCB Lic.: / 9 ,/ Plumbing Lic.no.:37 -ZZQ Plan review (25% of permit fee)
State surcharge (8% of permit fee) G? ,�
Authorized signature: �
TOTAL PERMIT FEE -7 y "x./
Print name: c�- ca.A. pf t� Date: ( I .- O C( 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 -County Building Industry Service Board.
i:\Building\Permits\PLM- PermitApp.doc 12/03 440- 4616T(10 /02 /COMNJEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP ;?
Received - Date Requested / 2 J �' 7 AM _ PM BUP
Location d - 0 Suite / / � MEC
Contact Person foaca - I Ph ) 3�0 � PLM Zoo 4 - 66 537
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access; // ELR
Crawl Drain ( , � i �� '
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 idAL
PLUMBING°
Post & Beam
Under Slab
Rough -In
Al
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain /
Shower Pan
Other:
AS PART FAIL
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: El Unable to inspect — no access
Fire Supply Line M7---)/; ADA Approach /Sidewalk Date I Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL •