Permit ri
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2001 -00532
1� �). 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/25/01
SITE ADDRESS: 16095 SW KING CHARLES AVE PARCEL: 2S110CC 05900
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 033 JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install back flow preventer
FEES
Owner:
Type By Date Amount Receipt
ACKER PRMT JMT 10/25/01 $36.25 KING CITY
16095 SW KING CHARLES AVE SPOT JMT 10/25/01 $2.90 KING CITY
KING CITY, OR 97224
Total $39.15
Phone 1:
Contractor:
SEVEN DEES LANDSCAPING
7355 SE JOHNSON CREEK BLVD
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone 1: 777 -7777 RP /Backflow Preventer
Reg #: LIC 5009
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
�r
Issued By: Q� Permittee Signature I . / /1
Call (5�9 -4175 by 7:00 P.M. for an inspection needed the next business day
10/24/2001 12:26 ,.1, 5036393771 CITY OF KING CITY PAGE 02/02
TRCOUNTY_ P
SERVV ICE CENTIaI - �' P lum b ing Permit Application OITIC . USE ONLY
FLCLT.TC 'I° l 'l' O e 5)
;:�. , City of King City Date received: Permit no L /—
/ " x 13125 SW Hall Blvd. (, Sewer permit no Building permit no.:
O�T 2 5 ���)
Tigard, OR 97223 Project/appl. na.. Expire date:
Clackamas Phone: (503) 639 -4171, FAX: (5031 ;u7g97j �DEVE_LOPMEN Date issue
Multnomah By: Receipt no.:
Multnomah
Washington
C O U N T I E S Land use approval: C ase file no.: Payment type: •
TYPE OF PERMIT
a . 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family C] Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORNIA'1' FEE SCHEDULE Or special information use checklist)
Job address: / 6(")1,. 5,14 , t t/ WI Description Qty. Fee (ca.) Total
Bldg. no.:S , : New 1- and 2- family dwellings only
Tax map /tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: Block: 1 Subdivision: SFR (2) bath
Project name: J , • a SFR (3) bath . City /county: ' ti — .. _ ..
Ea c h ad batFi7kiiclien - --
Description and 1• , On of ark pre _ Site.utiliities:
/l 1 2 (--/R./ x-g- Catch basin/area drain .
Est. date of cotnpletion/inspec , on: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Business name: n �� Manufactured home utilities
Add IIILIJ� � L Rain drain connector
City: / Ma.�f idt7% r� PATMI Sanitary sewer (no. lin. ft.)
Phonlicl M ax.:777 3' E -mail: Storm sewer (no. lin. ft.) .
CCB t 4.: mo''' P lumb. bus. reg. no: Water service (no. lin. ft.)
' .t� I g r � Fixture or itenrt:
City /metro lie. no.: eoc0/ '7T / b j Absorption valve
Contractor's representative signature: � ,/. • ., .._.:; �, Back flow preventer •
Print name: ... . �i , i/t;?.fj' Date: ,L %L Backwater valve
. CONTACT PERSON Basins/lavatory
Name: c.3 a o j 1 1 i Clothes washer
Address: 6 f', re > i yo C , Dishwasher
City: ►" S tate J
Dr inking fountain(s)
�sartt AA. /•� I • /g E'ectors /sum
Phori • Anil - .41 Fax: E-mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): .. • Floor drains /floor sinks/hub
Mailing address: Garbage dis• •sal
: Hose bibb .
City: State: ZIP: • Ice maker
Phone: Fax: E -mail: interceptor /g rease trap
Owner installaiion/residential maintenance only: The actual installation Primer(s) -
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: Sump
• , k F t Tubs /shower /shower pan
Name: • renal j�
Address: Water closet •
Address: heater
City:_ State: Z IP: Other:
Phone: Fax: E - mail: T
'
Not all Jadedictiona accept credit cards, please call jurisdiction for more in formation.' Nonce: This permit clop
pplication Minimum-f $ 5 <" ZS
a Visa ❑ MasterCard , Plan review (at %) $
radii card number; expires if a permit is not obtaine
l / within 180 days after U has been State surcharge (8%) $ r�� jd
Ewires TOTAL $ .39.
Name of cardholder as shown on credit card accepted as complete.
$
-
Cardholder signature Araount
1Y
- -CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested // AM PM BLD
Location / c 9 6 1 , ek /tom g.d Suite " MEC
Contact Person `��' - Ph %6 I -3 r-e.) PLM 4 071 ` -' 3 Z
Contractor JJ Ph SWR •
BUILDING: .�� ° � � °, • Tenant/ i' ELC
Retaining Wall • ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL -
PLUMB.,INGw
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer • J
Rain IP rains
PART FAIL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final •
PASS PART FAIL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line • [ ] Please call for reinspection RE: _ [ ] Unable to inspect - no access
ADA
Approach /Sidewalk � �ns p ecor
Ext
iC� G �J J'2 . x
Other D a t e ` � Inspector
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.