Permit CITY TIGARD PLUMBING PERMIT
'AO" DEVELOPMENT SERVICES PERMIT #: PLM2005 -00032
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/27/2005
SITE ADDRESS: 07555 SW HERMOSO WAY PARCEL: 2S101AB -01501
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 021 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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Ejector sewaage pump install.
FEES
Owner:
Description Date Amount
GRAY PURCELL
PO BOX 23516 [PLUMB] Permit Fee 1/27/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 1/27/2005 $5.80
Total $78.30
Phone : 503 639 - 6127
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 503 Misc. Inspection
Final Inspection
Reg #: LIC 2439
PLM 34 -29PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699. __ �'�
Issued By: " ).,u Permittee Signature: �L. \n.D
N
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
WESTERN PLUMBING S09BB4901S• 01/27/OS 11:11am P. 001
t Pi imbin Permit �;�� ° o��i FOR OFFICE, USE ONLY
D 4 - , Received i Plumbing
Date /By. /� . O 3b Permit No,' Lft e 6k9 7. -.
Cit of Tigaard pp � Planning Approval Sewer
y b �Mltl 2 7 200; Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
T�(F TlG ' D Post - Review Land Use
Phone: 503-639-4171 Fax: 503 I: _, � Date/B
Internet: www ci.ti ard.or.us L DI }; ! y: Case No.:
g G .-7! • -- .�.r Contact luris : ®Sec Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name /Method: T/ Supplemental Information. 1
TYPE`OF WORK... ; ". • , ::. •
.., :. FEE *,;'SCFiEDULE$(fir':'spe'cialllIn'fo ;rrntlori`.;iase;clieckllst)•
New construction ,__
U Other: Netvi1 Y _ Demolition Descrption Qty. Fec(ea.) Total
X Addition/alteration/replace &12;family d "elli►i s •
:<. g
:,.;
.. CATEGORY O.F CONSTRUCTION ,:-.,.•-•.'',: '. "i ::'i(includ`eS ;40'0'?ft;)for each' it1 Ity, connection) T :: .
SFR (1) bath 249.20
E 1 & 2- Family dwelling X Commercial /Industrial SFR (2) bath 350,00 -
R Accessory Building Multi- Family SFR (3) bath 399.00
-
Master Builder _ 'Other: Each additional bath/kitchen 45.00
.` JOA: SITE,INFORMA.TION•and'LOCAT ': Fire sprinkler - sq. ft.: Page 2
Job site address �,tflt4c wit ' r ''', .� Ut r
` Catch basin /area drain
• t :_ `� � ' +�' � • � � 1 Beach line /trench drain 16.60
t tlities;',;;;: �;, °,:-.: . �' ` , `
Suite #: - 7555 Bld /A t. #: Dr well / 16.60
Project Name: Al i ill'fi b /1/1 f 7- a Footing drain (no. linear R.) Page 2
Cross street/Directions to job site: Manufactured home utilities 1 10.00
Manholes 16.60 _
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page. 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 -' -
Tax map /parcel #: Water service (no. linear ft. Page 2
t
r , ° f i r !' t i„ r;(; „y�• -a �t, �a r..-'.:',:'''',I.:!: . 'I
s : i' 1.. DESCRIPTION OF: WORK � ... ;;d;i ,,. ; ; _' �:I x3.u're:,o.r I 'elil ; : ; :. ,
Absorption valve 16.60
/1 •S Ci1 1f6j% - - :Tt l h o0V Pi-14P Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16,60
Dishwasher 16.60
Drinking fountain 16.60 • ' Q PRO'PE'RIPY/O WNER . ' :- TENANT.:_ ::•' :':.';::::.'.;` „;. -1 Ejectors /sump 16.60
_ Name: Pi,,..,,e.4.St -(_ _ Expansion tank 16.60 '
Address : a 3�7 to Fixture /sewer cap 16.60
City /State /Zip:T( C• J ` OK- g 7.). cr/ Floor drain/floor sink/hub 16.60
Garbage disposal 16.60 1
Phone: SZybC - / D.7 Fax: Hose bib 16.60
§4rAI'P.LICANT'.` :', ''...D CQNTACT4ERS.ON ;''. Ice maker 16.60 j
Name: Interceptor/grease trap 16.60 i
Address: eivc0 ,14/ 776, -Qo five '4 /,Q Medical gas - value: $ Page 2
City /State /Zip: "77 j o.D • ?_-3 Ro mer 16.60 _
1 2 - c � � ~ Ro
drain (commercial) 1 6.60 i
Phone: "t� , 6c3 -..5z Fax: .. f f,y: _'TO /S Sink/basin /lavatory 16.60 1
E-mail: Tub /shower /shower pan 16.60
_. ,it.:-.;'.,'.. . ::.. Urinal - 16.60
Business Name: G✓ES .'</At//t7,6:ht 41-.C- Water closet 16.60
Water heater 16.60
Address: `', (�,SkJ - 77641v , 915 /a/ oilier: �5 1tif6 Punt) P
City /State /Zip: •764,&.0 OO<' 4 7 2,1,21 Other.
Phone: , -.5,96 Fax: s3`I'_ ?a/c : ; ; t = {'..`Pluintiing P.ermit * ;: ;:" , ,•.1.' ,, , , 5' .
CCB Lic. #: y,3q Plumb. Lic. #:350 S u 50
9
Minimum Permit Fee $72.50 $ 7-
Authorized Backflow Minimum Fee $36.25
Signature /_, • �' - Date: /., • 4`'--'C,rj"
Plan Review (25% of Permit Fed $ _
R/041 �- )GTHO (-� - _� State Surcharge (8% of Permit Fee) $ 5, AO
(Please print name) TOTAL PERMIT FEE $ 78. 0 J
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 \P1mPemitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re•uested AM PM BUP
Location \ • • Suite MEC
Contact Person Ph ( ) PLM dap 5 ` act 0 3Z
Contractor Ph ( ) � 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
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:
maw.
PART FAIL
t " 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: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date s _ 5 Inspector ; Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
;ITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INPEe ON DIVISION Business Line: (503) 639 -4171 MST
'
BUP
3eceived Date Requeste I I AM PM BUP •
_ocatiori Suite MEC
Dontact Person Ph ( ) G j 52-1 6 PLM
k)e /44 Ph ( ) X7.5 ci 2 SWR
< BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ft Drain
g - ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing DUO I P U w. C 0 f u er,� ✓� 1 p
`.C.et P -;?.,! -cA
Insulation
C
Drywall Nailing RJy- e.cs�.� S - ft, e l ti i w � S 'I ; --}; j cote
Firewall
Fire Sprinkler
Fire Alarm ' z c. - i'Ur � a- Pu N-.o � � G rt e ✓ 7 a .? j,, e wei l 1, C.kir+ ,
Susp'd Ceiling U
Roof t, a I I tic, rx M i v; vv. 1 Tin nL (, 3 ) 1 c. r> >, -e J :V c.) . Wre�—e 1
Other:
Final ( 0; PA , SecfJbi-) 7,?o e 3.
PASS PART FAIL
APLUIIABINGT' ax. I° Sp e,d'c l i C�Ie, .
Post & Beam } �
Under Slab
Water I� e r , e ,, i �a u �, L 1 Pi �� .1 l tae ✓ i,. (`—�v�c+,.i.� f;-) 1/14. ,J
Water Service � •
Sanitary Sewer ' a� (,
Rain Drains
Catch Basin / Manhole
Storm Drain /
Shower Pan Cc, �.Z bo.. - t �. Sow.; ,k w � %}r ,J-c-44 'c� co f
Other:
PART '
MECHANICAL ;:
Post -& Beam
Rough -In P.' �* J . A D P .ma y t t_, �� c�� �. e S � 6
Gas Line
Smoke Dampers OP �C �' �; 'f e
Final
PASS PART FAIL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date 1) 'Z)) 0,C Inspector C311. A' Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL