Permit C ITY OF TIGARD PLUMBING PERMIT
�� DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2004 -00390
J y" ..� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/26/2004
SITE ADDRESS: 08915 SW O'MARA ST PARCEL: 2S102DB -00602
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: I CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1 tub /shower and valve, 1 shower with valve.
FEES
Owner:
Description Date Amount
ZINDA, TODD
14875 SW 103RD. [PLUMB] Permit Fee 8/26/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchan 8/26/2004 $5.80
Total $78.30
Phone : 503 314 - 6888
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 - 7619 Rough -in Insp
Top -out Insp
Reg #: LIC 128892 Final Inspection
PLM 34 - 4PB
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 Signatur
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed ale next business day
liUiiuing r lx�,nreS ;
Plumbing Permit Application ' V :4"'. - FOR OFFICE USE ONLY
C Receive Plumbing Q
Date/By: Vii Permit No.: l � --eV eqD
Clt of Ti and ® ®� Plannin: A Sewer
y g 1 ■ �� �' V O° ® Date/By: Permit No.:
. 13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 ��±± cc�� �, DateQ3y: Permit No.:
Phone: 503- 639 -4171 Fax: t 146 ° Post - Review Land Use
Gm,d N , ��"iii'" �N ' Contact -
Case No.:
Internet: www.ci.tigard.or.us � I i y , r. __� Contact kris.: ® See Page 2 for
24 -hour Inspection Request: 1- Y>411t�AR l I Name/Method: rf ci l Supplemental Information.
BUILDING DIVISION
d: . -,! ',TYPR,OFAVORIC. . ••, . • . ' FEE * - SCHEDULE (for special information use checklist)1•; y :..:
El New construction ❑ Demolition Description • -1 Qty. I Fee(ea.) I Total
[ddition/alteration/replacement ❑ Other: • ` • New I- & 2 - family :dwellings
::' " " / "` CATEGOR':OF.;CONSTRUCTION (includes 100 ft. for each Utility Connection): � ••
1 & 2-Family dwelling SFR (I) bath 249.20
❑ y g ❑ Commercial/Industrial SFR (2) bath 350.00
❑Accessory Building El Multi-Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
r;-JOB'SITE and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: s it,et l S St.J OH AZJa ' Site Utilities • 'k - • , : w•;
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Zt 1.(. -
Drywell/leach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax mad /parcel #: Water service (no. linear ft.) Page 2
.:, , ;;ID•; '. -OF WORK • ` Fixture or.Item, , 4'7. 5 ', 4 ' , !,,Y , - ' , . - ''' ''
C S Z \ p � � 14D Absorption valve Page 2 -
V Backflow preventer Page 2
5 4 4:-.A0 2 CL. \ . Backwater valve 16.60
1 - "TuaISN '1/4.)kikW. V4►■aD Clothes washer 16.60
-TVZ ` Dishwasher 1 6.60
Drinking fountain 16.60
PROPERTY oWNERx,/,'4i': •' ['El TENANT% ` Ejectors/sump 16.60
Name: Z I•w� - Expansion tank 16.60
Address: 4j e _
City /State /Zip:
Fixture/sewer cap 16.60
�,, Fa
J Floor drain /floor sink/hub 16.60
Phone: ft-3/1 - 4 SICD x Garbage disposal 16.60
Hose bib 16.60
16.60
[]'PI,IC�►1VT' r" ti; d ;f `^ s�, ^ f' _7 � 'CONTA,CT PERSON Ice maker
Name: "SISC -�b� i Y ` X�b2 Interceptor /grease trap 16.60
Address: 13qcya Stn TUtPF'L.i(kTtr4 vy4u.s °o Medical gas - value: $ Page 2
City/State/Zip: +�, ,� ' Primer 16.60
Cit
Y p• Cev - tt,t' I O Z CO cos Roof drain (commercial) 16.60
Phone: 503 (43 ? (plc I Fax: SO3 C043'7 (o ZA5 Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower. pan `L 16.60 '55 24)
"� : '• : . . CONTRACTOR . . Urinal 16.60
Business Name: . 3C4w Ei l - ,uEM--6111G, Water closet 16.60
39873 SLO `Tt� sft L-011 1 p M 141.1 4 ? Water heater f 16.60 f, La Address• l `ul Other:
City /State /Zip: e 2Tbt ; OR c 1° S Other:
Phone:563 L4, 7(an Fax: 503 (43 - 1(o1Ct .. - Plumbing•Perntit Fees *. ' •
Subtotal $ 15'3 -Zt;
CCB Lic. #: i2 t• 4,4 a _ Plumb. Lic. #: 4 -4ap Minimum Permit Fee $72.50 $
Authorized it b Sal O b Z t � Residential Backflow Minimum Fee $36.25 T . S
Signature: (k `AM 6 Dater - 1 � 6 Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ 5 -
(Please print name) TOTAL PERMIT FEE $ °7 $, 7 0
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
I
CITY OF TIGARD 24 -Hour -4,_.
BUILDING Inspection Line: (503) 63'
INSPECTION DIVISION Business Line: (503) • MST
BUP
Received Date Requested /e --"Z AM PM BUP
Location g'' /5 0 ' (h A J Suite MEC
Contact Person The Ph ( ) 3i y - 6?Fectip a a o y- 00 39
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
Ina Sheath/Shear //r/Vt O / � ,C,— --(--O - / / (. q Framing Yr vv
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
1
Roof
Other:
Final
PASS PART FAIL 6/it/ „,.., 4
Post & Beam r
Under Slab
Rough -In 1 A, '`
Water Service 1r `t.
•
Sanitary Sewe��l�> Hv , Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
��, " ""
Other:
i ;'
PART FAIL
NICAL
- ost & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line I
ADAoach/Si Dat 1 d 4 Inspector y L, `' Ext
pp dewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL