Permit CITY OF TIGARD
PLUMBING PERMIT
44, 4 ,,\ . DEVELOPMENT SERVICES PERMIT #: PLM2004 -00249
— I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/2/2004
SITE ADDRESS: 07565 SW HERMOSO WAY PARCEL: 2S101AB -01502
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 022 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 0 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocate 1 lay, 1 water closet. Cap 1 tub /shower, 1 clothes washer.
FEES
Owner:
Description Date Amount
ANDERSON, ROY W ESTATE OF
7565 SW HERMOSO WAY [PLUMB] Permit Fee 6/2/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchan 6/2/2004 $5.80
Total $78.30
Phone:
Contractor:
NELSON PLUMBING
PO BOX 818
BATTLE GROUND, WA 98604 REQUIRED INSPECTIONS
Phone : 360 - 696 - 0876 T o Insp
Top p -oout ut Insp
Reg #: LIC 125759 Final Inspection
MET 00003463
PLM 37 -171PB
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 throug OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUN' by calling (503)
246 -6699. 1 • ;
Issued By: Ai . Permittee Signature: ,
TI
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne t bu ness day
EVEVERGREEN - - - -
PACIF. ••>'a-k NELSON PLUMB t J 002
- Building Fixtures aS /0 / m -0 �0 .---' -
Plumbine Permit Application
City of Turd 50 Raceivae
13125 SW Hell t31vd„ Tigard, OR 97223 A 1:436 Gj42--/d
Phone: Pest Na' 2441,000.9-- y9
e: 3.6394171 Fax: 503.596.1960 Non Review'
--II �. ' i f /
Da ba r
24. Hour Inspection Line: 503.639.4175 Orbec Rartnit Na; S�
Internet: Vlwev_ci.6gard•er.ut - -� m Readldtl
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New coostmaction ❑ Demoliriod y �f ' : f ' �••..: , a..,
Per IpegGrl i.t jorrwari e *sr elmelt(!sL
S(Addicou/al4aa>;odteplacemutt Other;
DescriptionQt r. Pa. 1 Total
„' r' Nee 1 .2- fancily dwellings (includes 100 ft. for each utility connection)
n)
• ,;:;•.:. , ,,,I "t41:"',
... .
.1.:' ,.! °.I,.,a: ! 1 rt. ' -:;!_ L SPR (1) bath ' rl
ID 1 -and 2- fatnrly dwelling '. Commaefal/5adushti . l 24920 SPR (2) bath -
350.00
• - _ 0 Accessory building El MO SFR (3) bath 399.00
❑ Masru builder CI Other: Each batlJldw3at - 45.00
Page 2
el t: }i 1.; .: I, a t. i, , F1tti - C•� ( BQ. t1)
Job site addres S Sibs angles
�4/A Catch basin or area drain 16.60
City/Sntorae: T/C7AizD op. /722.3 11. latch
�y� htto, or trench drain 16.60
Suite/bldg./apt. no.: No I Project name: , xq�BS J OW l[6 N 4., Footing drain (no, linear ft.: , ) Page 2
• Cross street/diroenons to job site: Manufactured home utilities 110.00 - -
Manholes - 16,60
Rain drain connecter 16.60
•
Sanitary sewer (no, linear ft.:, ) Page 2
Spvem sewer (no_ linear it: -_.) Page 2
Subdivision I Lot no.: Water service (no. linear ft.: ) Page 2
Tax arap/parccl nn,: Finure err item
• '
• :r . :W . : : 4 . ,, : J .1r y,.. t ' , r _ Absmptien li0
ti.� '• �.:. •'1• . t ` ?'� {'.l•:a. , •. . t::'11•11:'.`-'1' t' •'� { 1;4': l'•+fiy. rl�' . valve
16.
.:.1.?':';...!''
: !.:tree * ,.. ,_, ,!4b.,,. BaclQloWpreveptrr
animater valve 16.60
QOB washy J 16.60
Dishwasher 16.60
:: r,4 :1• /t , 19,4 r, •i ; 1, /•', :!C•,, •. I .II,, ''t'-. - ., t ,, - - �13riII ,
• i'., ,:: '�• r - Drinking 16.60
Name: �( -s,. wck � Ejectors/sump 16.60
kits 4 .W Eltpansiou tank 16.60
Address: `
Qty/Statc/Z1P; 114040 b Fixture/sewer cap 16,60
Floor dtaiNQovr sink/hub 16.60
Pbouc: (. ) O. . - 3 0 Fax: ( ) Garbage disposal 16.60
:I' :::‘ 1.11.' ; •. ;5 L , .1 , r' h ay ,..,:.0%." . 1 4 I Hose bib 16.60
1 '_ - .I'
Business name: e vela G- ► �� . B` - lee maker r 16.60
Comet frame: tatmccptodgtteaBe trap 16,60
Address. Medical gas (value: s ) : p� 2
r ?w4?4 4> rBrSI1JE Primer 16.60 '
City /SiatrlZ1r: e?S f�►&j, p 0 Q -1o3 s-- Roof drain (comtpe al) 16.60
Phony (�Q) ��S ( pate ■ ■ ( - I ) Sink/b • vato N 16 60
$ mnall:
Uri Tub/sluswa p /ahower pan Ca '
Y 16.60 .' .',: I: I 'I; ' , I r!y'Oru. ,, ; ;;5 'i „` .. •:i s ; nal Y
�_ .. Ij . t' 1 _ r ; . fly.' l' R •'.' 4.2 j' "L'. .., Water closet '(7 p 16.60
Businessoame: }JELSp/J P
e '8 /N[7 water heater ICV iTL, ,", 16.60
Address: I. 0, ■ i f. �'I Q D `Dt, O 16.60
City/Statr/Z P 4,rn. c!gouNp Subtotal
Phone (3400) �(� -��6 FIX ( ) Minimum permit fee: $72 ,50
' Residential becletlow minimum penult fee: 536.25 7„2,5
CCB Lie,: / If Plumbing Lie. no.:
Plan review (25}t; of'permit fee)
Authorized signature: „' 'I ` - State surcharge (B% of permit fee) l $0
Print name; OTALP'ERMTTFEE 7$, 3C7
s"-,�, L .. t6s t... / Date: 6- 21 0 4 1 This permit apphcedaa aspires if a permit I. nor obtained within
180 days alter it has been accepted as complete.
etaultemsl'ennb1P1.140.t>ainllApp doe t 'Fee methodology set by Tri- County Belding Wintry Service Board.
4eo-4stettioovcot 4wsni
Accumulative Sewer Tally Parcel # gi '.'' ' 1y44 `` v wK,Q a
rI a a W .m *� v �
. This SWR 0 1a a af',W' + s
' . s .. 5 , A ?�kfS may,, ji :AVI � Wi This PLM# 2O t1.. •. t s ; t I.
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 , K ,r.•;,i 0 I ., 0 0 0
Bath - Tub /Shower 4 k > , 0 , ' ; ,� ; 0 k ` ; 0 0 0
- Jacuzzi/Whirlpool 4 -
0 k 0 Kr.--M 0 0 0
Car Wash - Each Stall 6 k.. ., 0,• 0 ttariAM
- Drive through 16 ; ,,..,;, ,,'.; 0 Ifillg 0• z 0 0 0
Cuspidor/Water Aspirator 1 R , 4 0 , k , 4 0 ` s 0 0 0
Dishwasher Commercial 4 .4 :� ,, 0 > °;;' 0 t� m 0 0 0
- Domestic 2 Lai 0 ',i 0 Mn r: 0 0 0
Drinking Fountain 1 '', �f 0 'M ;? 0 �' .' 0 0 0
Eye Wash 1 0 X �v 0si` 0 0 0
f4? 3 fi
Floor Drain /Sink - 2 inch 2 c �wi �4 ' 0 * 4 4 0 a 0 0 0
3 inch 5 10.146:&t, 0 r ailatid 0 ` ilid 0 0 0
- 4 inch 6 s, 4 4'4
- Car Wash Drr 6 , �,, % 0 ` , ry, 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 l 0 �' 0 : ".. - 0 0 0
- Commercial (to 5 HP) 32 m4 0 . , : '
- Industrial (over 5 HP) 48 0 ° 0 F ht °. 0 0 0
Ice Machine /Refrigerator Drain Zia: 0 0 n < y 4 0 0 0
? w X? d s tJ ' T�r,
Oil Sep (Gas Station) 6 *4ti 0 t , 0 ttf 1 0 0 0
Rec. Vehicle Dump station 16 : '� `' 0 � 3 x 0 ri' 0 0 0
Shower - Gang (per head) 1 > ® 0 � �� „ � k 0 0 0 0
- Stall 2 0 . !& NI 2 . "ki140 0 -1 -2
Sink Bar /Lavatory 2 k '" � 0 ; i l 0 44::1:L 0 0 0
- Bradley 5 ` ` E �: 0 0 a t 0 0 0
- Commercial 3 At. 0 01,41C 0 0 0 0
- Service 3 > Af , : 0 0 0 0 0
Swimming Pool Filter 1 Vi " 0 0 .1 0 0 0
Washer Clothes 6 0 ,� ° + 6 0 - -
Water Extractor 6 '� F 4 :.• 0 z��' 0 ,`` , 0 0 0
Water Closet - Toilet 6 t k 0 0 '..
' 0 0 0
Urinal 6 y . :�” 0 0 � I2 0 0 0
Previous EDU Count 0 0
Capped EDU Credit , ' l 0
TOTALS 0 0 2 8 0 0 -2 -8
Current Fixture Value -8 divided by 16 = -0.5 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -8 divided by 16 = -0.5 over (under) $ (1,200.00)
Enter EDU Change Here,
Notes:
Name: &'j%4 4&f) Date:. /a /Q
Building Division
Note: The property owner shall retain this record for sewer credit purposes. In the event of a credit, this
document stamped "ORIGINAL" shall serve as a credit voucher and must be submitted to the City of
Tigard Building Division to redeem credit towards future system development charges.
, CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested R -1 AM PM BUP
Location • A I....! .4 Suite MEC
Contact Person .) Ph ( ) 5(9 8 g 7 PLM 60 - 66a
Contractor Ph ( ) 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
• 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 111 Please call for reinspection RE: ❑ Unable to inspect — no access
�� /� A Fire Supply Line 1/7')A
DA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL