Permit CITY TIGARD PLUMBING PERMIT
A 4- A DEVELOPMENT SERVICES PERMIT #: PLM2004 -00042
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -417 DATE ISSUED: 1/28/04
SITE ADDRESS: 11945 SW PACIFIC HY PARCEL: 1S135DD -03301
W
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
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: 400 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace leaking waterservice, located in parking lot on the Greenburg Road side
FEES
Owner:
Description Date Amount
TIGARD PROPERTIES INC
2106 SE OCHOCO ST [PLUMB] Permit Fee 1/28/04 $220.00
MILWAUKIE, OR 97222 [TAX] 8% State Surchari 1/28/04 $17.60
Total $237.60
Phone :
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 691 - 6166 Final Inspection
Reg #: MET 00002486
LIC 87906
PLM 34 -250PB
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 By: / Permittee Signature: ,OYI.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b siness day
01/26,12004 13:21 5036916771 MODERN PLUMBING PAGE 01
. .65/16/2003 13:50 FAX 5035961960 CITY OF TIGARD 1004
Building Fixtures • .
Plumbing. ermit A uulicat ' ion 17 _ r nf: OFFICE I Plumbing AA aNL
City RECEIVED P'
13125 SW Hall Blvd.
Tigard, Oregon 97223 ' JAN 2 6 22 • ' 414 •
p I 503439-4171 FY3�IGARD l�d
Inspection Requ •1l -�1'I S I -' NOAH Iori�: ,gee Page s for
24-hour I
e , ,.:. : . u • Itsmoetai Information.
IIEREETA.SOMIT "' 'fl 'I i ! .. Y . Tnn n , 11_ 17:.:� a7 Pi h.
• New construction • Demolition Demi • on Qty. Fee(es.) Taal
)f` Addition/alt .. , wizen_ ❑ othen : 'R '' . • ! ; 1 ?., ' ,'_"' 0' ''' `� i ��l ij3 i. . - ' -.. 1 � i� 1 � ! ,1
'
s Ar.;. r': r ' r ,'� �nI,t1�."ri�LE.r•oNO ai; MERE ,� ✓r ,. 1T " {: �iiL ) x9 ►; ',.:r
si:R 1 bath
Ii & - - y dw 1'A Cotumcroial/bndustria1 ME 35o 20
:
�,,__� .. ' 0R bath MOM
�,:�- ,_:.�._ �'tt , � Multi-F- 399.00
tri Mister Builder ❑ Other. Each additional bath/kitchen 4600
y 5 A gJ 1 +itlII , i 4 • I_:i s `. 0IIL1A ''''1O 1, ■ L . .: _ �{� ��
�
lob site address: (q4 �) etc . vv.) '_ �` a I �,,
� U9(�'!lL�iih'r� :, c .7 �YF ._E�CI'='...._I
Suite it: I IdglApt#: _ _ ) Catd+ hasb/ates drain 16•60 i
Prjoot Name: D Meath lindacnch drain lo.GO
Footin; drnin , O. Jitters. ft, � •
Cross street/Directions to job site: � �� Manholes
�� 1
n I P - Mes home Militias t
dCin-e1/11/11-WIt 10.00
.�J*,O�C.. i {1
�7 �� ` ' Rain drain nor 16.60
o _ sewer no.l>aearft. i�
J Lot #: S sewer no. linear P. 2 -
Ta x . � , a •'. ce linear $ . do "
Tax #: ! �, -� >4Z6
'� 'I G • i , i ... {. a,.. •,. 111 'i�'C J r �.
Waiter � �! •
,•-�L O : afi
, IrJi.�If :La1. L t ��r /r����l' I, 11. ,.' ,,.��_ ti
,tiAR.FAt. , i �,J_._ ;lc},a,:u. • u 'ilT;'4` ,. 1660
• T. __ ._-_-: re p \acs - , • BackO,aw venter . Milwr2i1 —
v.) c s re. `ie. is J c.ier __ Backwater valve 16.60
Clothes washer 16,60
Dishwasher 16,60
DIrinlin • t +am • _60 ,
, -�,f_ . i iL _ t: r. li__ RE !1 M'i ..'i_`1 � 'ili�'� a i^9r •1W / 16-60 -
; Name: _ •. •. ion tank 16.60 -- j
Address: Fixture/sewer 1660
City /State/Zig: Floor drain/floor sink/hub - • 16.60 : •
_:�_ r 16.60
Phone: Fax. - .: ., . MN '16.60 -
FL ii,,,,,v;,,:';,R :PSI, ui - I' ge!co• IAr ;1 :'. r I 1 Iee traker 16.60 .
Name. F , I �.,. ,II „1 _, -: - ,
• Address: Medical : ° -valax 3 � 164 Min
Cl /S r iI • ; - I _ 16.60
Phone: Fax: - i._ __ _�1.... - 16.60
H•-m : Tub/ebower /shower NM 16.60 -
rs'cb: '1.1gF '
l.,-. Lt!' `Frii, u; : .al ' ?, .. Urinal 16.60
, a'' 16.60
Busllnness Name: W1 US'I P r n 1 U w.. • wa er he
16.6o
Alddress: 1 \ \ Ao t n • U5 a _ •:,. other:
City / State /Zip: 1'uct ( cr'v' Q `f )C)b2 Otb _[
Phone: 50'5 to R 1 to l U to F- 5153 -f, f i 6 71) _. s abbsat ER . 6.00
CCB Lisc. #: e 7 `1 O (' 4 ' umb. Lic.#: 3 W� Sa'P13 Minimum-remit Fee ubto *TWO a
Authorized I ( � y / Residential Back:ow Minimum•Fec $36.25
Sissue: e: ,11 . _ flu te: I I210 Plan Review 14 of l it Fen S
- .cal K- � _o r. _ tats •:r!e t.Eriziti=limiEMIEFEIVI
Wlaee printname) tstf 0 1'4:46 +,IMh1;1 - - d
Nothe 7'Ifls permit appfraGon exptrrs Ira parfait it not obtained within All sea shd 6ntlein5, require x sass of pium ie nr
ltill days altar• u bMa bean accepted as aompleus riser diagram torpr a review.
•Fee metbadetogy set try'flt.County Bonding Industry Servke Board.
isIOstt\Permit Fcme FbuPemdtApp,doc 01103
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date ReAiested o (7 AM PM BUP
Location // q 47 / 5 &MU i L ..A�; MEC
Contact Person Ph ( ) `' PLM Dco �
Contractor Ph ( ) 6 6/ {O 4 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access - ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 4 �� / // SIT
Post & Beam l� �
Ext Sr Sh ea Anchrs
th / ear � / C�itK�
Ext eah/h
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PI :T FAIL
Post & Beam
Under Slab
Rough -In 41111
Water Service
Sanitary Sewer
40/
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
• PART FAIL
CHANICAL
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 I=1 Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Q� 7 f Inspector Est
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL