Permit " CITY OF TIGARD PLUMBING PERMIT
dp �e 1'� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00548
X 111 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/812004
SITE ADDRESS: 10055 SW INEZ ST PARCEL: 2S111 BC - 00500
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R - 3.5
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 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: 1 RAIN DRAIN: ft
Remarks: Relocate kitchen sink, install sink, disposal & dishwasher.
FEES
Owner:
Description Date Amount
JOHNSON, MELISSA & ED
10055 SW INEZ ST [PLUMB] Permit Fee 12/8/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharp 12/8/2004 $5.80
Total $78.30
Phone : 503 624 - 5003
Contractor:
CROUCHLEY PLUMBING
8717 N LOMBARD ST
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 00001184
PLM 26 -21PB
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: Permittee Signature: s--
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
- 12/07/2004 16:12 5032864432 CROUCHLEV PLUMBING PAGE 02
12/06;2 04 18 :40 FAX 5039981.960 CITY OF TIGARD
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13125 9 i 18Nd., Tigard, OR 97323 2 tar
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Phone: S :,639.4171 Ftx: $03.595.19 SEC 0 I 2 O " P ' ADada - don Line: 601639.41 TPop Z4 Hour �
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' i i 0, ()Mar: _ , Now 1.2- family dwellings (includes 100 ft, for each ust:fy emneetitm)
.I T i' SER (I) 249.20 i
ENO .n 4 o ,ti.Y.,: !'. ". ' I' '{ Irt� ;,.i ; :I:. !, ; ; , :,iJ.,, ,:, ; ;!. tali
�,�• ,, ; u� ;�I � 'e.. - °, rr-w i , .. :. g�� (2) bath iso.on
Fa dwelling CI (,omttteaoiallndwtsval SFR (3) bath { • 39 9,00
• Ace .: building 0 M' nitti fitnily --I treat+ addi.ion:II bath/kitchen as.00
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Q Mu builder 0 Othe Flt Winkler ( sq. it) 1111111 Page 2
. > :•• ?rii's '''I'i' i. 4 R,i IP Li , 4'ri:•! " l' i' Slit utilltiel • ''''a
Job site , - , i Q Q 5, ,� S vJ o t Catch basin or area drain
a a- Drywall, web line, or=nob drain pm 16.60 16-60
Q. y /Sta t^ r RC (a 1 Po oling their (no, litter R.; ,,,
e
3triti�lbl ht>n roe: Pr name: Pooling
hoine utilities 110 OD
Cruets 5 • . directions. to job sits: S v.) . M C h al. '5 i " - _.. Manholes 16.60
.4--- ) 0 3rd _Ithit.- Rain drain connector _ 16.60
Sattltt Peer no. iintrtr R.. __ ) Page 2
r I , fitotm sewer (no. linear R.: _,-,__,) Page 2
•
La ao Water tervise 00. linear IV __ page 2
SubdlV!• di: — Fixture or slam
' Tax ma. • vet no.: Absorption vain 1111 16.80
I; ,., 1•j''I''• :i1t: • :i ,b t < ✓n:1'M' : ', ;- Z: ; 1! Bardtil6w FrC','CntGr - 111.1 Pap 2 _
• k t) n r R - t it ci ..,__ i-
J .C- 13 ,..1.0.- valve 6-f
L e--"" — — ► ( / 0 A Clethas waslbir 16.60 F j
_ ter: �' I i}ishwasA e� 16,60 1 LLgt.!'" 1)
(
�. u,:, Drinking fountain 10.60 IIP
u ,r , . , ; : , ,i•,
!1':: I ',;:{' u' ,.._ t:. t` .Halt j i . , ',. '; .. +•,.:...:•;.!r . .4!:T .. ' EjectorsidUraP 16,60
Natnb: >> (4\,-v--.Z PN^- -.. lank b.dG
Fisfurc/scwcr sap 16, Ci - - I.
City /S ^ • 21P: — Floor aralnMoot sink/nub _ 16,60 '
P 1
� ,f) 2 -' d / Fax:( ? Garbage diepoial ; 6.00 � L? ( t'
bane:
.1;. 16,60
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G 21 • .... e; r >10 N- 1 ` 4 P I to W1 V2 r() H 0/ Interceptor/ :.- t trap -- 1 6.60 1
�Atic .' • win: a 4 Medical yes (value; 5 ) • Page 2
lr
- oa ! - • ._ . / J • Plntnar _ :6.0(1 -
— Q 1 ? •Z Roof drain (commerc ' s 6,60
• � ZZIP: b(' L I- ' / O-, ! E.'_.,..._. Roof
: 6.60 I � (, � G u
Pia • V 5 ) Z 4i 7 1 � - 7 L pax:.: (5 Z ( i ), Tuhrahower /alwwar pan ' i ,
Tymatl: Urinal 1
I i' :' 1 • 1 .,I. 6S' 1 ' , i',...:14: h • J I" ' 1 .. , Wham elOtet .. 8.60
Basin • mama: ,A. l VL 66- ,! I water hnter :6.60
agar -- L o ly 5`1r other: IIMI
F elty/S p r — • — $ubtoni I A9.86
ZIP! d r I �� p3 Minimum permit fee: $72.50
Phone: • (r) ) Z . - Fax: (Sr ) 2-. Residential back minimum permit lee: $ 1„,.___ O
CC$ I. .: f 1 Plumbing L +'a no.: .�Y --02J �� .. - Plan tm tnw c25% ofpetrttit Ale) / J 1 y Scent surcharge (8% of permit feel •
Atttbo signature; ` .2 P131tM1f Erf:6 O
P N� 4 I �. �- � � _ Date . - 7 ` - T)tia permit application expire. ifp parrots Is not obtained within
/ 1 ®0 days after It has been accepted as complete -
*FFe rnethadology sot by Tri•Coonty Building Indesery Service Board.
ims,d sreose xi. emio.ae.das II103 4484111 :(ta
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
`` BUP
Received Date Requested !2 2-3 AM PM BUP
Location / 0 OS '- Suite MEC
Contact Person Ph ( ) 1 !� _ / 3 / PLM .6 y' O 65
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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:
• AIL
'os -& Beam
Rough -In
Gas Line
S sue- Dampers
� +II PART FAIL
CTRICAL
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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /7 O 3 )�j % '
ADA /'
Date / v l i Ins ecto Ext
Approach /Sidewalk P
Other: •
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL