Permit •Y CITY OF TIGARD PLUMBING PERMIT
r DEVELOPMENT SERVICES PERMIT #: PLM2004 -00408
,.� I � 13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/7/2004
SITE ADDRESS: 11505 SW PACIFIC HWY B PARCEL: 1SI36AD -04000
W
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 0 BACKFLOW PREVNTRS:
OCCUPANCY GRP: UNK 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: Relocate clothes washer.
FEES
Owner:
Description Date Amount
SMITH, EDITH M
833 NW 170TH DR [PLUMB] Permit Fee 9/7/2004 $72.50
BEAVERTON, OR 97006 [TAX] 8% State Surchan 9/7/2004 $5.80
Total $78.30
•
Phone:
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W HISTORIC COLUMBIA HWY
TROUTDALE, OR 97060 REQUIRED INSPECTIONS
Phone : 503 - 235 - 8784 Rough -in Insp
Final Inspection
Reg #: LIC 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
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: ` % t/' ?�f.C) Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plum£YnaYermft A lice ' '" i'oi; 11FI IC ti 11st: i)NI.\
City 'of Tigard � `Y Permit Ne.: , L�, f�Q' O� v '4
13125 SW Hall Blvd.,1 n . a 't '„ ,_. ' v plan Review
Phone: 503.639.4171 Fax: G ` 98.1960 10 .r», ;)., . '{ i°•. Dale/BY. Otbr permit No.:
24- Hour inspection Line: 503.639A 17I, ! 6 r. • r� See Pone 2 nor
�K rp ; ,� : � � Dune Raady/By: / I GI
Imam: www.ci.tigard.or.ns (, v � �voo@ad/Mabort 1 f k/ Supplemental Info
TYPE O3c.W • \cN FEE' SCHEDULE
❑ New construction GO 0 N6 Ci Demolition For mid in ormatioa use checklist.
Addition/aheratiottheplacatnent ' - ❑ O ther X00 �' C n Total
New 1- 2- family dwellings (includes 100 & for each ut3liutility - tiechi ®)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
and 2- fl1xcu7y.dwelling 2kit ommercial/industriol SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family $FR (3) bath 399.00
❑ Master builder Each additional barb/kitchen 45.00
Other: Five sprinkle (-_.- sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: jC I 575%15
/ /" V I as/ Catch basin or area drain 16.60
City/State/ZIP: aQ V / Drywell, leach line, or trench drain 16.60
/ � Footing drain (no. linear f1.: �) Page 2 it
Suite/bldg./apt. no :: Project name: L-1�/ / /
Manufactured home utilities 110.00
Cross strcei/direetions to job silo:
_ _ Manholes 16.60
Rain drain ccnneoror 16.60
Sanitary sewer (no. linear 8.: ) Page 2
Stone sewer (no. linear ft.: _j Page 2
Subdivision: I Lot no.: Water service (no. linear 8.: _ ) f Page 2
Future or item
Tax map/parcel ni.: (#& 9 _ Absorption valve 16.60 1
DESCRIPTION OF WORT Backflow practicer Page 2
Backwater valve 16.60
om _ \ _ Clothes washer ( 16.60 ) 17beag
� Dishwasher 16.60
❑ PROPERTY OWNER I keTENANT wing fountain 16.60
Ejectors/sump 16.60
Name: Wert! expansion rank _ 1 6.6 0
Address: . / % Fixture/sewer cap 16.60 i
_ `7� "�' 1 � . � . �� ill . _
City/SiateJZIP: : 1144_,r412117. � Floor Maim/Boor sink/hub 16.60
Phone: ii. Fax: ( ) Garbage disposal 16.60
I. _� - Hose bib 16.60
APPLICANT ❑ CONTACT PER.N
Ice make 16.60
Easiness name: oleott Plumbing dba Jack Hawk Plumbing interceptor /grease Imp 16.60
Contact name: ► O e ... n5 Medical gas (value: S ) Page 2
Address; 1075 W' Hlstorit Columbia River Hwy Primer 16.60
City/State/ZIP: Troutdale, OR 97060 Roof dram (commercial) 16.60
Phone: (503) 235 •5784 I Fax:: (503) 49l 2932 Sink/basin/lavatory 16.60
Tub/ahower /shower pan 16.60
E-mail: _ Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Wolcott Plumbing dba Jack Howk Plumbing Water hone 16.60
Address: 1075 W Historic Columbia River Hwy Other. _
Subtotal , a
City/Slate/ZIP: Troutdale, OR 97060 Minimum permit Ike: $72.50
Phone: (503) 235 -5784 Fax: (503) 491.2932 Residential backftow minimum permit fca $36.25
CCB Lic.: 23842 Plumbing Lio. no.: 26-208 PB Plan review (25% of permit fee) y
State surcharge (8% of permit fee) `Ir ���
= i` 1� ,L i� TOTAL PERMIT : d IF/
Authorized 5 �� -_
Print name: f / Dete4 6, Lt/ This permit application expires if a permit is not o . d . . a
�1� , �i �. i 180 days after it has been accepted as corn . -
*Fee inethodoloav set by Tri- County 9uidinc lndustry • = 'cc Board.
I • d 17L8 914 I HW1l1d MOH >101:31' Wd9E : L 17002 ' 9 ' d3S
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION , Line: (503) 639 -4171 P
�j BUP
Received / Date queste ���
1 AM PM BUP
Location / 15 t �j' 4 / Suite f MEC
Contact Person PA9. Ph () � °4 7g i- / PLM
Contractor f Ph ( ) / SWR
BUILDING Tenant/Owner 1 — � � G � � 50 3 75 - 3 7 (0'6 ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: , / i � 1.01.7 �t/t� e - SIT
Post & Beam �/V
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
U lab
• ough -I
- ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
•, .._ '
Fi
PAS PART FAIL
MECHANICAL
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: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date &J)22) a y Inspector 01. 1J,n. -'► t I 1 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL