Permit CITY TIGARD PLUMBING PERMIT
*wow PERMIT #: PLM2005 -00008
. j ib" DEV W H BMENg r S � E R V 2CES 639 -4171 DATE ISSUED: 1/10/2005
SITE ADDRESS: 13500 SW PACIFIC HY 50 ONE HOUR PARCEL: 2S102CC -00500
W
SUBDIVISION: PHOTO 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: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Fixture replacement. No sewer tally required.
FEES
Owner:
Description Date Amount
13500 PACIFIC CORP
BY CAP ADVISORS [PLUMB] Permit Fee 1/10/2005 $72.50 •
38345 W TEN MILE RD, STE 170 [TAX] 8% State Surchari 1/10/2005 $5.80
FARMINGTON HILLS, MI 48335 Total $78.30
Phone:
Contractor:
ATI PLUMBING & HEATING
15630 S BRADLEY RD
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Phone : 503 - 771 - 1867 Final Inspection
Reg #: LIC 148770
PLM 26 -509PB
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: / Ar ,(' Permittee Signature: Gz .p Cot-
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Jan 10 05 11:47a 503 - 657 -5375 p.1
• Permit Ctlra o ?EPVED roll o1FI(I: 151: O \I
Plumabin2 P pU _
t JAN 10 200: Dat e/sy: Received
City of Tigard I - I -OS Permit No. )j j}1 -OO') -O( .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 � fr �` Date/By:
24- Hour Inspection Line: 503.639.4175 CITY OF TI _ra. �. --- Date Ready/BY: t RI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / /G Supplemental Information
. DIVISION FEE• SCHEDULE
El New construction ❑ Demolition
Description For special information use checklist
P i Qty. i Ea. i Total
❑ Addition/alteration/replacement Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath . I 249.20 I
❑ I- and 2- family dwelling Corr SFR (2) bath 350.00
mercial /industrial 399.00 �
SFR (3) bath
❑ Accessory building ❑ Multi family Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /3.70() $ r) PA[ I F c /4 C.J r Catch basin or area drain 16.60
City/State/ZIP: - 4r,,i , 0 �, - Drywell, leach line, or trench drain 16.60
/� I 6ur6er �Sti0 Footing drain (no. linear R: ) Page 2
Suite/bldgJapt. no.: h Project name:
Manufactured home utilities 1 10.00
Cross street/directions to job site: 7, 'd f7o v/re+p /e (-Q. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R: ) Page 2
Water service (no. linear ft.: __) Page 2
Subdivision: 1 Lot no.:
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
f e-p/ !.t C e 4,40.-ier close id4 VI Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I 0 TENANT Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/ State/ZIP: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: ( ) Fax: ( ) Hose bib 16.60
APPLICANT
,, �, cONTACT PERSON
Ice maker 16.60
/
Business name: A rx ' / t , w „,h r r� / '.,1C Interceptor /grease trap 16.60
Contact name: ( s o . Medical gas (value: $ ) _ Page 2
Address: / S4, 3o 5 . g need e { J7 Primer 16.60 • ' 0 I q 7o Y 5- Roof drain (commercial) 16.60 4_,c City/ State/Z1P: OY'(�►� C -[
_ Sink/basin/lavatory I /� ,
Phone: (�rf3) k S 5 37_ I Fax : : ( Sod & O.- n r Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet / 16.60 /C, , &
Business name: h T _ r /2/ uJ / . ih t -- Water heater 16.60
Address: J 5-(c) 3 0 5. 43 rza P R d Other.
Subtotal 3��
Cit State/ZIP: (ce O n (' r -{- p 9 7 og s Minimum permit fee: $72.50 ,, 1
Phone: ( $b3 ) � 5 - S ` Fax: ( • ) L -n - 7 S', / r Residential backtlow minimum permit fee: $36.25 1 __•4!
- , (�� Plan review (25% of permit fee)
CCB Lic.: � 7 7 (] .? /- Plumbing Liu no.: oL J _ - cb(/
�� - / --0 State surcharge (8% of permit fee)
Authorized signature: i .. TOTAL PERMIT FEE 1 q , 3()
I permit er mit a lication expires if a permit is not obtained within
I Print name: 4/j �� n I Date: - 0, _ �`� I 180 days after it has been accepted as complete.
• L n methodology set by Tri- Countv Buildine Industry Service Board.
3 -e e. ' iS/� G1f4fhc 1r 1 ZC&+ le r' 1r Y\r)
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / .a AM PM BUP
Location 6 ??SOU Z Suite A -6 MEC
�r�
Contact Person r2) Ph ( ) ui / 6 l - 44:1 g? PLM , --06100
Contractor Ph ( ) SWR
BUILDING Tenant/Owner d2//2„,2.. 6 ) � ELC
Footing ELC
Foundation Access:
Ftg Drain L3 O yr 6 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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
HANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA c
Approach/Sidewalk Date 1 / / l / /C5 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL