Permit C ITY OF TIGARD PLUMBING PERMIT
AA DEVELOPMENT SERVICES PERMIT #: PLM2003 -00483
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/7/04
SITE ADDRESS: 14565 PACIFIC HWY PARCEL: 2S102CC -00600
SUBDIVISION: 135'45 ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: S3 FLOOR DRAINS; 2 TRAPS:
STORIES: 1 WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 4 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 12
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Building Fixtures. (4) sinks, (2) lays, (2) water closets, (2) floor drains, (1) water heater. Other fixtures include
(1)primer, (1)ice maker, (1)Expansion tank, (1)oil separator, (4)roof drains, (4)hose bibbs,
FEES
Owner:
Description Date Amount
DDHK VENTURES, LLC
12604 SW 60TH CT [PLUMB] Permit Fee 1/7/04 $381.80
PORTLAND, OR 97219 [PLMPLN] Plan Review 1/7/04 $95.45
[TAX] 8% State Tax 1/7/04 $30.54
Phone : 503 - 977 - 0578
Total $507.79
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED INSPECTIONS
Rough -in Insp
Phone : 503 639 - 5296 Top -out Insp
Reg #: L[C 2439 Rain Drain Insp
PLM 34 - 29PB 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 By: Permittee Signature: Y 9 I, ...ter./
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
i
• FOR O1'1+ICI: ONLY
Pllmbing Permit Application 4 , l , jam- Permit N� )c = -. O "7
•, Rece / Plumbin
`, Date/By:
City of Tigard RECEIVED ' Planning ApprcrAl Fewer ��05_ova
Date/By: Permit No
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 S"503-5'98'-11W ,, P 1 C Inng Date/By: 91 1•x103 Permit No.:
Phone: 503- 639 -4171 Fax: Post - Review Land Use O
, ,,, m4,, tit' I t \ Date/By: Case No.:
Internet: ar.or.
www.ci.ti d
g g 1 � aj,�,, el I Contact J�eis.: ®See Page 2 for 24 -hour Inspection Reques 517 �� ARD Name/Method: (/6 Supplemental Information. t3ILDING DIVISION w
. §r :e .
TYP,E'OF WORK;,:_;'. •••� ~:z , . , ;'`�; SCI- IED;[ J�:) �.((( pr ,peclOilnfoT(iia4lon`.ru'se ctieckl[st) e t
❑ New construction ❑ Demolition Description LQty. J Fee(ea.) I Total /
„,,...:'( e 1= '' -f II llin § " '` �
❑ Addition/alteration/replacement ❑Other: i;;�:. : ; •. a. i'..dmr 3.:P,w:.q 1 0 1 g �_ ' :
::r' '::,'- 'sE;'r' (Iueludes'1001f connec
GA'I!EGORY;OF.', @ONSTRUCTION ' :;; ti SFR (1) bath 249.20
E 1 & 2- Family dwelling Commercial/Industrial S FR (2) b ath 350.00
A ccessory Building Multi- Family SF (3) bath 399.00
Master Builder 'Other: Each additional bath/kitchen 45.00
. '•JOB :SITE',INFORMATION 'add (LOCATION` ;c',. Fire sprinkler - s ft.: Page 2
Job site address: /j5(..S SL✓.Qie /f.0 the ' : t t `' : ' >'" f eS 1;.' .;, ,: .
_ -�li.�t;�..�..$;�.>. R;��[tc.:Ut 1111 �.: . , •�;�:_�.
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 -®-
Drywell /leach line/trench drain 16.60
Project Name: 00c,eadi Footing drain (no. linear fl.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft) Page 2-
map/parcel t ' a'•, ;�a it :iii k'i `!" IC:ediiItelptst3A'zI•h .Y ',"•t; 3.ii:;' k'' � \
Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
•
Clothes washer 16.60 \\
Dishwasher 16.60 r,
PROPERITsY�OWNER f Drinking fountain 16.60 `d.
• ,
❑. • I TENANT:.. ., T; Y; : :. Ejectors/sump 16.60
Name: Expansion tank / 16.60
Address: Fixture/sewer cap 16.60
City /State /Zip: 1,/ Floor drain/floor sink/hub 1 16.60 -'
Garbage disposal . 16.60
Phone: Fax: ✓ Hose bib q 16.60
❑ APP.LICANT ❑ CONTACT.PERSON. . ✓ Ice maker i 16.60
Name: ✓Interceptor /grease trap p /Lhof .•' / 16.60 6
_ Address: Medical gas - value: $ Page 2
City /State /Zip: ✓Primer 16.60
I/ Roof drain commercial 16.60
Phone: Fax: ✓ Sink/basin/lavatory -,R a 16.60
E -mail: Tub /shower /shower pan 16.60
; ••••' ,::- f :: . :- • .• •:CONTRACTOR: ' • ... :: t:!•; '`: Urinal 16.60
Business Name: /4/tSi eA/ "�'G'�. ieZ ✓ Water closet 16.60
Address: w6, SwTJG,Q(��°/.,{ f" /�� v Water heater 16.60
Other:
City /State /Zip: 774440 9 Von Other:
Phone: 639- !..cam.9 Fax: 6,$60--9GXs :,,, , ,r,-,. -.1 • t? -Plumbing Eermit;F,ees *.':t' • •• ' • . ,
CCB Lic. #:,,N7/ Plumb. Lic. #:3y.29 Subtotal $
- Minimum Permit Fee $72.50 $
Authorized j i 47 / /s /s Residential Ba Minimum Fee $36.25
Signature: i,6� Date: � Review (5
Plan Review (25 /o of Permit Fee) $
-E/ a alei, i., State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $ -I
Notice: This permit application expires If a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
•Fee methodology set by Tri- County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 .
6
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
/
Received CP A Requeste• �j� AM ® BUP
Location ite MEC
Contact Person Ph ( 3 ' 39 5 ?9(p PLM ,20 3 --V3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 2 k.eGa ELC
Footing
ELC
Foundation
Access:
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 4
pASS ��RT F AIL
/
Under Slab
Rough -In
Water Service
• Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
i
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 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: fl Unable to inspect — no access
Fire Supply Line V ` ,r; >77
pq
Approach/Sidewalk Inspector �✓
pp oach/Sidewalk Date Ins actor if:xt
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL