Permit CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PL 19/200 -00023
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/
SITE ADDRESS: 12505 SW KAREN ST PARCEL: 2S103BB -03400
SUBDIVISION: BROOKWAY ZONING: R -4.5
BLOCK: LOT: 034 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Re- locate kitchen sink.
FEES
Owner:
Description Date Amount
HARSHFIELD, RUTH A
12505 SW KAREN ST [PLUMB] Permit Fee 1/19/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchan 1/19/2005 $5.80
Total $78.30
Phone :
Contractor:
MP (MILWAUKIE) PLUMBING CO
P.O. BOX 393
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone : 503 Top -out Insp
Final Inspection
Reg #: LIC 5002
PLM 3 -17PB
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: � Air Permittee Signature: .S_L .e_ (;), \ p
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
7 VAr -19 -05 15:27 FROM -MP Plumbing 5036551726 T-804 P.002/004 F -687
yr tiu.ucling i ,xtures
,.-. . .
Plumbing Permit A ire 6 . , : 1 _. NE® FOR OFFICE USE ONLY
City of Tigard Received _
1'�, O R 97223 Date/S �� iJ � Permi No.
13125 SWHallBlvd, Ti SA 19 2 00 5 Y'1 - 5- 060,,5
Phone: 503.639.4171 Fax: 503.598,19 r ,,
Flan
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24- hour Inspection Lice: 503.639.4175 1 � '1 � ;. �� Jf ���° Otter Permit No.:
Internet. www.cf ttgard or us • CITY OF TIGARD Date Ready/8y: ti
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special �orrriatiort use checklist
Addition/alteration/replacement OtIi Der_p ion _ Qry Ea 1 Total _
�,n�Y,- a ,• r tSx�ey"' .;• . ;Z . ,. ,�._ _ __ New 1 -2- family dwellings (includes 100 ft. for each utility )
= , IR-- _'7'' - g ..�- r - t 4'17 • Y .... , �T- - • R Tr r_ connection
• � j ' I ,;2 P.' i v ,..- -4.:: i '^r` , 4 , , { ',,�'.4' 1 �:`a.. y}!., �S „ �1 5 S ', - , F `.' " rtT "t'7• S ' . e d ^'`' �'�G � .
3ti�rtix t } s ii r;I " ,.t r °V .t�,k 7 •,'�J
:1 i.� s _..... _.�.. ._� �°� °�- .:.: `?:et ; : _�_� r, 5FR i bath'
74 1- and 2- family dwelling • ❑ Commercia fua.dustrial SFR (2) bath 350,00 .
❑ Accessory building ❑ Multi- family SFR (3) bath • 399.00
❑ Master builder . . , . • 0 Other: _ Each additional bat /kiteheu 45.00
,:,, `.� •r. ;it^,'lA y: r1<< r:. t . ::q."47,7-...7„,, ��• ,,.,. :'T".:.;r�: °r.1;:.+ R..rr. -r- Fire sprinkler ( s ft.
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, ; " ) Site utilities
Job site address: • -. _ a Catch basin or area drain 16.60
City/State/MP: - -v. C R 7 - 23 -1 Drywc ?cacti 1 ch line, or trench drain 16.60
_ Suite/bldgJapt no.: Project name. h ■ • Footing drain (no, linear ft: ) Page 2'
,. ..
Cross street/directions ■
Ln job sift Manufactured home utilities 1 10.00 -
• Manholes • 16.60 -
Rain drain connector 16.60
• Sanitary sewer (no. linear ft: ) Page 2
Storm sewer (no. linear ft.: ') Page 2
Subdivision: 1 Lot no.:
Water service (no. linear ft _7 ) Page 2
Fixture or item
Tax map/parcel no.: _ -
1:!t;: ,\\;, I t ,4 r;: a �^ :ti`- Fs.tla:rtc: 7 . ."7N ^� ,,Y ;I +;!l'617F42,71',, r ;+ : Absorption valve. • 16
', �l ti. % 4, i1 ti�7- -`,i j 4;', V t, 2,0 rG;4 W , tic k- 1,
. .�..�. - r�,_.v�ti' ...+ ,�.. �T. iw 'F�('.r�':.ic.i J.x +.i ^ y R' ±ti r $ackflow prcVentt1r
v im- �.1 � Page 2
`'e.. X�� \C C y\ ' la1 - 1V _ Backwater valve . ' ' . ' - 16.60
Clothes washer . 16,60
• Dishwasher 16.60
,' +rt' K; :i';i.: 2 ` ^ w - �y'^'JT,.; -' F:43.4:*, "w �`, .': j1f 1A-7,� : -: 'T� • Drinkr fountain
•-,'}; •c ¢y.14 !-- s' ti ti+ {.i, . '�•. , E , 1 - 1� t� - '=:,-. 5` �+ - "' S. 16.60
. L{, .J 1 1Y._ � _- .�..:� �E il- ;� +•:e� 'xi�,� r }t ..L�_� -.. a... ��C•' � i L o_�.:rk
-� i ° Ejectors/sump 16.60 '
Name . .-.\ \1 c,c \ r1
Expansion - lank ' 16.60
Address: \_5,::::,5 °vW • . ; o a, -�- • , Fixtunlsewer cap 16.60
C i t y / S t a t e J Z I P : 7 7 \ s G ` P (M q • 3 • Floor drain/floor sink/huh . 16.60
Phone: (, ) Fax: ( • • •) Garbage disposal 16.60
';iq :'i; i T. N. ^� M r.wG •.}t,;:r •.-r:3'a.: ' :ir�: tirT^ ��� j j. -' :' "51�:1;� '�'.i.��,f.� -" � w :S- �� „ 1- Hose bib
..
.i �pdL� k,r 6�,6r_ei 4 ' i ':. +r v 1'' i s :d i i t rr f 9 i! r L i , ' b 16.60
:.•' •.: i...3. .. , ?..L_,- 1. _ V? _'._ - .:e':�?2_s_s. us c� '2 S lce irmicer _ 16.60
Business name: 'c'-\_' \ tl .tr n.krA x \/`S -
Interceptor /grease trap • 16 -60
Contact name: am& . ,' . _. t ft s Medical gas (vsltle: S ) Page 2
Address: 0 l , 7, Primer . 1'6.60
City /State/ZIP: (h ` ' 2 -.�'zx .\ • ( l - x « ltoofdrain (commercial) _ 16.60
Phone: (S t.) �7_., - (CA Fax :: (51j) 7 S - S'-1 -17 (� Sink/basin/lavatory `� 16.fi0 L o Cro
E-mai Tub/shower /shower pan 16.60
}r4' i 5 t °l ri r L� w rte- - 3x ( ry y Urinal - 16.60
:; L', Y;: 4 . 4 ' - .! r".. r ...._w '- 41,a�'J� i l7. " 4 , ,JY j - ''L ^ � ,tt -
s.�� i� i ' a r,... t 9 Water closet 16.60
i .
Business name: ` ( \ - - \ - - ' c�1n("Co Water heater • 16.60
- - Afitness- fltht^._ .--,._."M-... -_ -____1. - .. -- _ - -- __ ..
City /State/21P: Subtotal \�O
C.arvkpC 0r g1O
Phone ($d ) F Minimum permit fee: $72.50 ' Sv
�(' - �> ,l•v ( �) la -1 ?._.p Residential back minimum permii fee: s36.25 'lZ -
CCB' Lia. :� Plumbing l ic_ oo Plan review (25% of permit fee)
Authorized sign C .�� State surcharge (896 of permit fee) 5 4a
TOTAL PERMIT FEE -\ ,.) 30
Print nat : in ^ a' fQ r,i ` s . r Date: \ - L' . OS This permit appnearion expires if a permit is not obtained within
180 days after it has been accepted as complete.
'Fee methodology set by 'Tti -County Building Industry Service Board.
iabi oinawermiommf- Pomilulpp.o. 12183 440.4616T(I0/02/cOM/wpa)
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (593) 639 -4171 MST A oet _,,./
Received Date Requested ; -- 7 AM /d J PM
Location / o5 xa Sir• Suite MEC ROC t O 3
Contact Person Ru's'e. g J 'eLd Ph ( ) 59 D — .361 LM 2DoS -ooc23
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain ACG @SS: ELR
Crawl Drain -`
Slab Inspection Notes: ` /I_ C _ - 0 /� SIT
Post & Beam Y (IJ�I. , �
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm 7 I 7 ?2 d S--- d 0 3 cJ
Susp'd Ceiling )) � A
Roof ,/ 6-∎,'∎ r G --- o / Cf �-___
Other: f
Final ��� `._ 7 J - 4 c- — a l e---
RT FAIL
" LUMBING -
hostm
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain y, e
Shower Pan e ,. �
O per: - r i
ina- .
i i PART FAIL
ANICAL ,, - , r : qi i.P' „ , i
Post & Beam
Rough -In t .
Gas Line
Smoke Dampers ,.. - T
'4F PART FAIL
ELECTRICAL
Service
Rough-1n
UG /Slab
Low Voltage
Fire Alarm
Anal D 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 / Inspector 1 � - - - --
ADA ` 0 Ext
Approach/Sidewalk Date 3/7
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL