Permit )
A - CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00305
E, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/26/03
SITE ADDRESS: 12220 SW JAMES ST PARCEL: 2S103CB 02000
SUBDIVISION: WILLAMETTE ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: 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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 30 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 30 ft. water service.
FEES
Owner:
Description Date Amount
IVERSON, LARRY
12220 SW JAMES ST [PLUMB] Permit Fee 6/26/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 6/26/03 $5.80
Total $78.30
Phone : 503 - 521 - 0921
Contractor:
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone : 667 Water Line Insp
Final Inspection
Reg #: L1C 23847
PLM 26 -208PB
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
Issued By: '' LLv�.GL � JL.J Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Datereceived6 1„, -03 Permit no.: ?I) Lz7 • r 5
} ,, i . A City o f Tigard
. ty Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd. Tigard, OR 97223
City ofTigard Phone: (503) 639 -4171 Project/appl.no.: Expire date:
a , Fax: (503) 598 -1960 Date issued: By: bi3, Receipt no.:
•
Land use approval: Case file no.: Payment type:
1 l Pk; (11; 1'1:RIN11l' J
K. 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family ❑ Tenant improvement i
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB sr' INI!:(11t11A I ION U ICI St I I. I/1'1 I ( for special info's Mimi use checklist)
lob address: a a ' 5 ) 4,, . . Description [l Fee (ea. Total
ew 1- a , i , - family dwellings only:
Bldg. no.: Suite no.: (Includes 108 ft. for each agility connection)
Tax map/tax lot/account no.: SFR (1) bath
Lot: Block: Subdivision: S - 2) bath
Project name: i/. • _ to FR (3 n
City /coun : - sue _∎ ZIP:'' '7a D Each additional bath/kitchen
D= 'do , 10 • of ark on premises: Site utilities:
_ ' , • L t • - - , A sub basin/area drain
Est. date of completion/inspecdon: I we s/teac me . nch drain
Footin: drain (no. lin. ft.)
` i N ( e t anufacture • home utilities
Business name: S) I Co v i T—" s (t".a^1, '001, ' , oles
Address: 19 (0 All1J � � : � •,', •, nector
' ` A - 4 Er :MI gv • Sanit sewer (no. lin. ft.)
G' Phone:agg -t7 1 1 Fax: iiiirm, E -mail: X 3 1 -c21 torm sewer no. lin, ft.) ater ai
`p i a CCB rio.: ` ;1 Plumb. bus. reg. no:a . ` a r ► 1Platthrre service 010. in. " r /�.� ,_
PO )`
City /metro lic. no.: Abso • ' on valve
Contractor's representative signature: t♦ / err ". IrM ow •reverter
Print name: c 4,', , ' 0 • D - a 7 I Backwater valve
"2.. (' ONI 1(. "1 1'1 it.kJiN Basin;. avato
Name: „ ;f I re N 6 Clothes w as h e r
6 shwas er
Address: �i ��� . . `_ • D shwas fountain s
[ r iit ....._
I- .411 ZIP: • M : ' e ctors/sum.
Phone :? - ? Ma Fax: 491 - - ac ., Exp - on ,
I )11'Nlit ix sewer cap
Floor drains/floor sinks/hub
Name (print):
Garbage disposal
Mailing address:
Hose Bibb
City: I State: I ZIP: Ice maker ,
Phone: Fax: E -mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primers)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) .
Owner's signature: Date: Sum
_. . .. �� I M INI l:it shower /shower pan
#' Urin
Name: ---:
Water closet
Address: Water heater
City: I State: I ZIP: Other:
Pone: I Fax: 1 E -mail: Total �-y '
N all Jurisdictions accept credit cards, please cull jurisdlet)ort roe arose ink lemadaa. Notice: This permit appiication Minimum fee $ . _/ / �-
Visa O Masse • oa o t o5 expires if a permit is notobtained Plan review (at %) $ .
•.'
Credit card toe: f,. ' - i 40.5 4- 1()W . / / State surcharge (8%) $ 4 .
a 4. �.i - Expires within 180 days after it has been TOTAL $ 1 A •
N■,, •.r ow•ouc .itc , —/e accepted as complete,
i.► / ■ 4 i - ',.. WisLaii. � _u.. $ l o'1
.-i Cardhot•rr ;,'. ■ arum Amount 440 - 4616 (6 /00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION " Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 -it AM PM BUP
Location 12 z 2 a Suite MEC
Contact Person Ph ( ) (-61( PLM 3 ---°° 30-5
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
r e ice
Sanitary ewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi
A 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: El Unable to inspect — no.access
Fire Supply Line
ADA
Approach /Sidewalk Date /r I nspector /./ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503•639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — 0 7 AM PM BUP
Location aan 92.4 Suite MEC •
Contact Person Ph ( ) PLM - 3 o O 36
Contractor Ph ( ) 0 &7 ?7 SWR
BUILDING Tenant/Owner ELC
Footing J
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspec fro . 1 1 1 es: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
• Susp'd Ceiling -
Roofi
Other: r�T
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In /
er ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan 7 44,
Other
Fi,'
FAIL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRIC ALA
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal 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 f 7/ 0� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL