Permit CITY OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00389
' III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/26/2004
SITE ADDRESS: 11513 SW PACIFIC HWY PARCEL: 1S136AD -04000
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: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B 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: 6 ft
Remarks: Repair approximately 6' of storm sewer.
FEES
Owner:
Description Date Amount
SMITH, EDITH M
833 NW 170TH DR [PLUMB] Permit Fee 8/26/2004 $72.50
BEAVERTON, OR 97006 [TAX] 8% State Surcharl 8/26/2004 $5.80
Total $78.30
Phone:
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone : 239 Storm Drain Insp
Final Inspection
Reg #: MET 00003082
LIC 49418
PLM 26 -533PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
95 ;'s -1' ! I. You may obtain copies of these rules or direct questions to OUNC by calling (503)
• 6 -6699.
I sued By: / � / Permittee Signature• ' - ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
FROM APOLLO DRAIN 503 - 669 - 9568 (THU)AUG 26 2004 11:47/ST.11:47/No.6812889409 P 1
4, • Plumbing Permit Application
Date roceiv°d
Cit of Tigard -'•
,>,j.` . �' Sewerpcnnit Building pdmltno.:
Address: 13125 SW Hall Blvd, Ti x: •• • • • 0 3
C`ry °n`gavd Phone: (503) 639 -4171 - ; Project/appLno.: Expire date:
Fax: (503) 598 -1960 Doc issued: `'^ Receipt no.:
Land use approval I AO Case file no.: Payment type:
I 1 I't. 01 t'►.tc\11 f
O 1 & 2 family dwelling or accessory r. • mmercialrndustrial 0 Multi - family 0 Tenant improvement
O New construction Iii(Addilion /alteration/replacement 0 Food service 0 Other: •
dllti.$) i i . I' I01011TI0 I l:I: s( III :1)1 I I ttnr•ln•rial infunn,iliini thechecl,li+t)
]fob address: 115 13 cS v3 'a_c_ i`1k t1 w li Dec '' ' ' ' I .. Pee(ea.) Tow
Bldg, no.: Suiteno.: New - and - ."x.11 , , _f1,, . ,:,
Tax map/tax lot/account no.: (includes 1100 & for �utility comedian) bath
Lot: Block: I Subdivision: SFR (1) bath
y Project name: ke. t ' 1 i _ e...4..- SFR (3) bath
City /county: • i • /MIN ZIP: ' - 7 2-2 3 Each additional bath/kitchen
Description a n d l • .. 'on of work on remises: F7r' t t1 r. r Skemilhles:
rcpt T r In yfp,2/y Catch basin/area drain
Est. date of compledon/inspection: ,, - -- • Urywells/leach line/trench drain
Footin: drain (no. lin. ft.)
PI l N1111 \l. t ()Nil( 1( I Olt Manufactured home utilities
Business name: Apo l IQ b ta x n .1- P 1 ULM lo 'in el Manholes
Address: ?;2,01 km) J : S rCASdt...k. --* R Rain drain connector
aty: & r 1 ; s h a V1n S t a t e l p V z I Z I P : C 3O - -
Phone :21 -170 r F a x : Co l o g - 5(D81 E-mail: Storm sewer (no. lin. ft.) -
CCB no.: 44 al• I $ [Plumb. bus. reg. no: 2A9 .5.35? P,3 Water service (no. hn. A.
City /metro lie. no.: ao $ a- Fixture or item:
Action valve
Contractor's representative signature: ..\ Back flowyreventer • •
Print name: Date: g 2 (p - (-4 Backwater valve •
Basinsllavatory
Name: Clothes washer
Address: _ Dishwasher
City: I State: ZIP: Drinkiag fountain(s)
Ejectors/sump
Phone: Fax: E-mail: Ex • • , ion tank
()11 NI it Fixture/sewer cap
Name (print): e'72, - r - /.9 (5,4 / Floor drains/floor sinks/hub
Mani: Garbage disposal
Bose bibb
City: State: 7113: Ice mailer
Phone: Fax: E-mail: Interne • • 1:1 • •
Owner installation/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 1 own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: _ Date: Sump
7lrb s/shpwer /shower pan •
Name: Urinal
tr oset
Address: - Water heater
City: _ I State: I ZIP: Other.
Phone: I Fax: I E -mail: Tobl -
alp, atria. r _ Notice: This permit application
Minimum fee $ 2. • �iC1 •
'�v�aa o tdas .--•
-. • - -c-7 - -: :_,.: _ _ _ _ , r • _ _ Plan review (at _ %) $
`� expire if eit i t bt d s a permit no obtained
eat cwd weer ;::' 0 5 State surcharge (8%) $
.yam II �. • within I80 days after • has been
Nos •r an mat clod .� accepted as complete. 'TOTAL $ a
Carr signature Aaauat 440.4616 (61)QCOtd)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 2 F MST
B P
Received Date Re nested F- �� AM PM BUP
Location 3 Suite MEC
Contact Person Ph ( ) 2 v? — Sgo ( PLM Do d O3g I
Contractor M i Ke Ph ( s -- 03 ) 511 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 C A 6 s (y , 1 � 4 � , p
Framing � f "-�l law a1 v g.-a kc�✓ Cc, rT s�a✓:
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Shower Pan
0 s.r:V
___
PART FAIL
M HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final U Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE fl Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA ) Approach/Sidewalk Date g )27) p' Inspector )" X - Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL