Permit T
A CITY OF T I GA R Dn
PLUMBING PERMIT
l& DEVELOPMENT SERVICES PERMIT #: PLM2002 -00056
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/22/2002
SITE ADDRESS: 12785 SW PACIFIC HY PARCEL: 2S102BD -00701
W
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: C -G
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 2 commercial backflow prevention devices.
FEES
Owner:
Type By Date Amount Receipt
SPADA, FRED TRUSTEE PRMT CTR 2/22/2002 $92.80 27200200000
WIENER, NORMAN J TRUSTEE 5PCT CTR 2/22/2002 $7.43 27200200000
72907 BEL AIR RD
PALM DESERT, CA 92260 Total $100.23
Phone 1:
Contractor:
METRO ROOTER + PLUMBING
BARRICH INC
5008 SE WOODWARD ST #3 REQUIRED INSPECTIONS
PORTLAND, OR 97206
Phone 1: 652 -2626 RP /Backflow Preventer
Reg #: LIC 106824 Final Inspection
PLM 3 -265PB
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: �) 1 Permittee Signature: Dec./ „9, /e( -77,0A
Call (50 -4175 by 7:00 P.M. for an inspection needed the next business day
02/19/2002 18:04 5036501912 MRP PAGE 02
Plumbing Permit Application
Datereccived: _ > o� 00 Fermium - P 020/ eg ..056,
^'"r � x' City of Tigard R C I D Sewer permit no Building permit no :
Address: 13125 S W Ha B y r 9 2
Ct ofTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 FEB 2 0 2002 Date issued: By :��I Receipt no.:
Land use approval: CITY OF TICiARD Case file no.: Payment type:
0 1 & 2 family dwelling or accessory ® Comtnercial/iindustrial C] Multi- family ❑ Tenant improvement
O New construction O Addition/alteration/replacement O Food service O Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: /o? 7/5 o,7 d!) PQ 4? 4 G Az-44)y Description Qty. Fee (et.) Total
Suite no.: New 1- and 2-family dwellings only:
Bldg. no.: (includes 100 ft. for each utility connection)
Tax map/tax lot/account no.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath .
Project name: , _ ` - SFR (3) bath
City/county: 77 4 rr/ ZIP:.. 9 74202 .4 Each additional bath/kitchen
Description and ideation of work on premises: _ Site u lities:
. a = l GE.s /rOs!> / r u7 r' /S Catch basin/area drain
Dtywellslleach line/trench drain
Est. date of completion/inspection: a.0 DA,-
Footing drain (no lin, ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: Ma-Tr ,eOD /V f Redc�74-�,�' Manholes
Address: A, , . a,� Rain drain connector
City: I , f , i Sanitary sewer (no. lin. ft.)
Phone: i3 A. A? 4 ,1., Fax: /570../.9/ E-mail: Storm sewer (no. lin. ft.)
CCB no.: Plumb. bus. reg. no: 3 7 ,2 4,6 Ate Water ery
service (no. lin- ft.)
/Q G �� Fixture or item: •
City /metro lie. no.: •/ ,#_,,,,,,. ^ 577 Abso s tion valve
Contractor's representative signature: qtr ., .. ,1.-_,,,,-.. ,_ l Back flow preventer
Print name: Cr ' 1 - •d i Date: % •1 ' 'dZ Backwater valve
CONTACT PERSON Basins/lavatory ,
Clothes washer
Name: i/ ,, d X 1 1 - - ,,
• Dishwasher
Address: Q 3 .6 S ' . Drinking fountain(s) _
City' �� 2,,ar State: pie' ZIP:97a -9j - Ejectors/sump
Phone: - , Fax: 49.5 - E -mail: Expansion tank
OWNER Fixture/sewer cap
• Floor drains/floor sinks/hub
Name (print): aigoded Garba ge disposal
Mailing address: Hose bibb
City: I State: I ZIP: Ice maker
Phone: 6„2O- /3.1.2- [Fax: _ E-mail: interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primers)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Think(s), basin(s), lays(s) _
Owner's signature: Date: Sum
Tubs/shower/shower pan
Urinal
Name: Water closet
Address: • .Water heater •
City: State: ZIP: ' Other. • ,
Phone: — 1 Fax: E -mail: Total
Minimum fee $ 902- de
Not ad imit&c tic na accept (=di%dads. please cad jU,isdialon for mem iotarmnnon. Notice: This permit application Plan review (at _ %) $
glVisa ❑ M -L. , ., _ -- - - expires if a permit is not obtained , ��
Credit card number_ within 180 days after it has been State surcharge (8 °do) $
40111116--''111111( +s ►1In TOTAL . $ ADO • •t/
, I-1. r cigpernre Ammar 440 - 4616 WOO/COM)
— '
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line:. (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Location - S � A • Suite MEC
Contact Person / r9 --��"' Ph ( ) PLM 4 ,9-DD oZ dGL7
Contractor Ph ( _) SWR
BUILDING t/Owner r�CJ ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
at 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
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan z ip,
Other: k en
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 ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA D
ate - Z(0 '0 L Inspector // � /^ - Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL