Permit 4 , . CITY OF TIGARD PLUMBING PERMIT
^ DEVELOPMENT SERVICES PERMIT #: PLM2003 -00075
I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3113/03
SITE ADDRESS: 11571 SW PACIFIC HY PARCEL: 1S136D6 -00201
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SUBDIVISION: FRED MEYER ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 3 - TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: 5 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement. Capping (1) lay, (1) sink & (1) water closet,.adding (3) 2" floor drains, (1) ice
maker, (4) lays, (2) sinks, (2) water closets and replace (1) water heater.
FEES
Owner:
Description Date Amount
WILMINGTON TRUST CO, TRUSTEE
BY FRED MEYER, INC [PLUMB] Permit Fee 3/13/03 $265.60
3800 SE 22ND AVE [ PLMPLN] Plan Review 3/13/03 $66.40
PORTLAND, OR 97242 [TAX] 8% State Tax 3/13/03 $21.25
Phone : Total $353.25
Contractor:
R D PLUMBING INC
13900 NW SPRINGVILLE RD •
PORTLAND, OR 97229 REQUIRED INSPECTIONS
Phone : 503- 297 -7422 Sewer Inspection
Water Service Insp
Reg #: LIC 73913 Top -out Insp
PLM • 26 -313pb Final Inspection
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
Issued = y: ] , , �� , i , ,L; � , _ Permittee Signature: , �--
-- Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Af.; 05 -04013
s '‘ , 1 `' . t P lumbiig Peat Application - - _ - - �:�F «:�:: �_� =� __- - =__ = -
Date received: 3003 Permit no.: .i ,. ect97
t L� City of Tigard
- . ° '�! Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
Ci(v of Tigard Ph one: (503) 639 -4171 Projectlappl. no.: Expire date:
Fax: (503) 598 -1960 n �/� Date issued: By: Receipt no.:
Land use approval: J111 O 5. -000O� Case file no.: Payment type:
-- -- ------ - - - - -- -----------------
TYPE OFF -I'I ROtl I'
U I & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family ArTenant improvement
0 New construction t' Addition/alteration /replacement 0 Food service 0 Other:
___________ . ___ _JOB SI "1= 1_1 \PU1t \1: \tION 1= 1_F =_5( III_ Ill. 1. 1;(fiir.pccial= in(orunaiitno.i cheiklia) =
Job address: /).5.-"/ S41 PA0- IFI 4- 11,4-Y Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
Tax maphax lot/account no.: (fides 180 ft. for each utility connection)
SFR (1) bath
Lot: !Block: I Subdivision: SFR (2) bath
Project namc: d /G 'Tv,,,., /� no SFR (3) hath
City /county: -r ZIP: 7-7 2 - 7 - 3 Each additional bath/kitchen •
Description and location of work on premises: � 1 pq i - a i>, Site utilities:
f/LL -� Jr) 0 y. ,t Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Foottngdram(no.lin.R.) `
Manufactured home utilities
Business name: R .1. iahri iRI,/ 3„, c Manholes
Address: i., / /J.z /2•;') Rain drain connector
City: p MN State: I ZIP: 977,7_9 Sanitary sewer (no. lin. ft.)
Phone: 5r3-,917 ;f y 3 ax: I E -mail: Storm sewer (no. lin. ft.)
C(B no.: 73 9/3 'Plumb. bus. reg. no: Ab- l 3 Pt) Water service (no. lin. ft.)
City /metro lie. no.: Fixture o ritem:
Contractor's representative signature: Absorption valve
Print name: Date: Back flow presenter
Backwater valve
— - _ - -- CO 'EACT = — — Basins/lavatory I
Name: S T , -r 7 N E Clothes washer I
Address: y Dishwasher
�°� `� / 7,9 Drinking fountain(s)
City: A E702,1C - r24„4._ State01 I ZIP: '7E4 Ejectors/sump
Phone , „ , - Fax: E -mail: Expansion tank
--- - - - - -- -- - - -- -0 NER---- - - - - -- - - -- Fixture/sewercap . /(o 6 ',8O
Name (print): 5 j - 7, 7 ,N ` Floor drains /floor sinks/hub )4 / 4940 �1�, gQ
Mailing address: ev Sw /y 9ifs- Garbage disposal
Hose bibb •
City:,3 , .q .I I Stated Imo: g7007 Ice maker / ✓((•!6G //r.42
Phone503,6 yypb 9/ 1 Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only. The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular rain (commercial) /^
employee on the property I own as per ORS Chapter 447. in ), basin(s), lays(s) pZ - / -L, (Q 99,/
Owner's signature: Date: ump .
--- ____ -- -------- I: NCGINEER _ — _ - - -_ -- Tubs/shower /shower pan
Name: Urinal
Water closet 3344
Address: Water heater /(0,(0
City: I State: I ZIP: Other: — — - —
Phone: IFax: 1E- mail: — — Total /(Q 1 0/464C
-
Not all jurisdictions accept credit cards, please call jurisdiction for more information Minimum fee $ v` (p5 • 100
Notice: This permit application u $
0 visa 0 MasterCard Plan review (at /o)
expires if a permit is not obtained
Credit cad number: F a i within 180 days after it has been State surcharge (8 ° %) .... $ $ 1
p TOTAL $ ��3, AS
Name of cardholder as shoam on credit card
accepted as complete. Cardholder signature Amount 440-4616 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• A
•
Received Date Requested 9 1 7 AM PM BUP
Location / / g 7/ f Suite MEC
Contact Person / - i Ph ( ) F 9 v PLM 3 000 75
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
FAIL
, LUMBIN
eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
l PART FAIL
ANICAL
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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA ( 0 5
Approach/Sidewalk Date L / / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL