Permit t " { CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00328
414- DATE ISSUED: 9/13/2004
� f II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13125 SW HALL BLVD PARCEL: 2S102DA -00401
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: 2 GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 7
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 5 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Other Fixtures: 1 drinking fountain, 1 expansion tank, 2 hose bibbs, 1 ice maker, 2 primers.
FEES
Owner:
Description Date Amount
•
TIGARD, CITY OF
13125 SW HALL [PLUMB] Permit Fee 8/19/2004 $381.80
TIGARD, OR 97223 [TAX] 8% State Surcharl 8/19/2004 $30.54
[PLMPLN] Plan Review 8/19/2004 $95.45
Phone : Total $507.79
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 503 Underfloor /Underslab
Top -out Insp
Reg #: LIC 2439 Final Inspection
PLM 34 -29PB
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: 24 .12 Permittee Signature: ,.t. p ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
I: WESTERN PLUMBING 503684901S 09/09/04 11:4Sam P. 002
f P FOR 0i +'F1CF, r1S1': oN1,
P�t11�llxlb>Eng Permit Application Received . , Piumbin
Date/By: Permit No ( ' / 0;70 .
Ci S of Tigard Planning Approval Sewer
13125 SW Hall Blvd. Plan Dante/By: Review Other Permit No,:
Tigard, Oregon 9722 LV Post Review Land Use
D Date/By: PermitNo.:
Phone: 503- 639 4171 8 1 0 4 1 rv.,;rhF IIVi , t ti Date/By: CASC No.:
Internet: www.ci.tigard.or.us Contact Juris.: See Page 2 for It 0. 24 - hour Inspection Requestsg8 - 0g4 A I ; L� Name/Method: Supplemental Information. •
- � ,:;:: GITY ° A RQ�. X • ,� :.r , �:.• � l ��• -F• �;:.
• '' `'" _ _1 � t1 - '. `F;�1'd i ' ? _`'., �; - "1`(3 ��'u4 1 ' Lli3 1 E $ -!: sii4'I1eGiom'.;a '
� `:`f li �:drro r +;��a;, ' ..1 . TIG 6d, o r.:;�.i. I' b
New construction Demolition Description Qty. Fee(ea.) Total
'Addi ion/alte d i +( ' t, 4, •(:+, ,'1 1 . i
t rationhe lacemen Other: y r . p i 1., ! F ' " s ' S ' ;; E € t(rl :;k ..t . ,; ':; i'' [. �, O y >!f' G{ '1 ?' igli '3,'�alp (lnel - �F-Fl1 .t�` Ale I 1. fonneetlo.n) ".t2t)if,,3tt:.:.. =
..F
4 : :iki ;•i -tF i�AA .0,,OR,'}t++ CI,Ql'?IS`P.a*j,..c X l�l:?,;�M',RI ±:o_ >;:: SFR (1)bath 249.20
1 & 2- Family dwelling 7 Commercial/Industrial SFR (2) bath 350.00
Accessory Building Multi- Family SFR (3) bath 399.00
Master Builder 'Other: Each additional bath kitchen 45.00
ir' ¢: MMa r '' ° ` ° Fire s ft.: Pa: e 2
. .:, . "�:�JQ'�S1(Fi~E$�NFORIV1tA�1 „� .. "aii"11',, 11.0 tik;f�k�rx ?;t .!i���3 rinkler - s•. '
Job site address: Si . , \dt /OIL u 59cl.lia tnnl 1E
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Drywell/leach line /trench drain 16.60
Project Name: G17 2 7ZZ,44 9 - �2^:�,?:' ; J 6::,
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: • ` Lot #: Storm sewer (no. linear ft.) Page 2
t T _ i ax map/ parcel #: Wate service no. linear ft: � ar e �{ • 1 _,'�"' : 2 ,{
#,.T `t .01:0IH �%S?> N..0 �.5' ON ,0Fv:CiTnQAS�i��k 4 ' +t i'3f ,�!uvIFiSSi;r ..` f ,, c1T jF S�.FPu`t.��3 � �xAl`WStW �ial��',. AMEMitt,.s'::.r3N;tbkl i�JS•'t'fi '� ..: . ` i
Absorption valve 16.60
• Backflow preventer Page 2
• Backwater valve 16.60
. Clothes washer 16.60
Dishwasher • 16.60
����(( Drinking fountain --' ,/ 16.60 A, 4 ' °
in iP�, O ,�P•] s ')24�.'1Dz�1!TF1F2�,,, ;. -. Ai`s0 .,TON!i�3!1!140410,1,4ka:� �. Ejectors /sump 16.60
Name: Expansion tank / 16.60 / /,, 60
Address: . Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor sink/hub 16.60 ,.,,3/4
Garbage disposal . 16.60
Phone: Fax: Hose bib / 16.60
:�$ .9;1�t�',�li,isF ._. - ;';s:,..:. 10 '�4t1`�'A0.�',•�5;4vFk:� ice maker , 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer / f 16.60 /6, ‘'2 City /State /Zip: Roof drain (commercial) �` 16.60 33,.»
Phone: Fax: • Sink/basin/lavatory ( ' 16.60 '
•
E -mail: y Tub /shower / showe pan 16.60 •
s, y ' i' r µ �}` 4-l 14r;•i
+'y'p:g�y/'�7�T.fWpt' retO l a' t rN:;"� 1:,,,,... - Urinal -t 16.60 _3.3 . 1
--
• ��.�tti�t•. .�� '. ti:.;'J,i: \iii+kw.'A4i' �( �Fne.• ?�;i >W.�:,,,�n..:�i 't 'iai , :
1 �' Water closet 5 16.60 53, =x
+• Business Name• /1$7 i/p� _. ,� 16.60 /� ,,
Water heater
Address: 9V.40,5 4/0/ Oilier: .
City /State /Zip: -7764.1.17 1' 2,42Y Other: S
Phone: • 9 _5 4 Fax: i l -9'4r xar, t v x.i'iia ;;;,:._., .
6iR' .'� �: ' s�:;tct��{�as iI' � _ �•I;erWt+ `4s.e • rt.:.�" � , <. o-•:�.. _ .
, CCB Lic. #:35,39 Plumb. Lic. #:39;,
subtotal $ ,MT r
l� . M i n i mum Permit Fee $72.50 $
Authorized ^�
�`� - �, . ; �e Residential Backflow Minimum Fee $36.25 •
Signature: - . ,t'.- `' Date: / Plan Review (25% of Permit Fee) $ , f
ej . -' State Surcharge (8% of Permit Fee) $ <22P , q -
(Please print name) TOTAL PERMIT FEE $ y63. 4
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
- *Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doe 01 /03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested AM PM BUP
Location / _ 3 a 5 Suite MEC
Contact Person Ph ( ) PLM °766 V'b63
Contractor Ph ( )�,j� ���� SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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
Post & Beam
Under Slab -
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
• 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: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector ) h 7 / 7 6 Ext
Other:
Final DO NO REMOVE this inspection record from the job site.
PASS PART FAIL