Permit •
C ITY OF TIGARD PLUMBING PERMIT
AI DEVELOPMENT SERVICES PERMIT #: PLM2004 -00124
Ail SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/4/2005
SITE ADDRESS: 13680 SW PACIFIC HWY PARCEL: 2S102CC -01100
SUBDIVISION: 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: 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: 90 ft
Remarks: Site utilities for new cell tower
FEES
Owner:
Description Date Amount
TIGARD LODGE #207
PO BOX 230184 [PLUMB] Permit Fee 3/25/2004 $72.50
TIGARD, OR 97281 [PLMPLN] Plan Review 3/25/2004 $18.13
[TAX] 8% State Surcharl 3/25/2004 $5.80
Phone : 503 625 - 4084 Total $96.43
Contractor:
D & D CONCRETE & UTILITIES, INC.
21765 SW 78TH AVE.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 Storm Drain Insp
Final Inspection
Reg #: PLM 63594
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 calli • • 503)
246 -6699.
Issued By P ermittee Signatur - - j =am
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi . ess day
03/o1/2004 15:30 FAX 5035981 _ CITY OE_TIGARD ) IZ 010
-. C•C('k L
. . si6uekties IVED
PlumbingYermit Alafe •
FOR OFFICE USE ONLY
City of Tigard KR Z 5 200 A =iv. ffilraf..41M117--•/- •
13125 SW liall Blvd., Tigard, OR 97223t4 1=1
rl '
Phone: 503.639.4171 Fax: .503.598.1960 ,,, , ,,. ,.\ Da l' tc/B . ';' ' e , in i fl i Other PerrnitNa.:
24- Hour bispection Line: 503.639A175ccry OF TIG :14: ! A I Dote Ready/By: 71.i • RI Sot Page 2 for
Internet unvw.ci.ligard.or U ' ".us , nNG DIN/IV . ''--- Notmcam i ehod: 6 Supplemental toformadon
..S. .., .. .. 4 1, • . ; :....•.- . '.4.:. "...! : .". e: : .....;:.7: • ..: .., TEE... scikEnt*::
IT•P: :. ilii,;:!:T:::;.:! ': :...,:. ;.::::::::i:::;:: :.: . ::-;.,......-IP A i: . . .:.:.. . .. ........ ...., ... . . :.. .. . •
For special information use checklist.
af ErNew construction 0 Demolition
Description 1 Qty. 1 Ea. 1 Total
0 Addition/alteration/replacement 0 Other New 1- 2-family dwellings (includes 100 ft. fbr each utility connection)
e
4 ir•S:!': !!': !
I ;:i •::::: •: '., :-: S
FR (1) bath 249.20 _
0 1 - and 2-family dwelling A Commercial/industrial SFR (2) bath 350.00
SFR (3) bath
0 Accessory building In Muld-family 399.00
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
. . . Fire sprinkler ( sq. ft.) Page 2
4:71 K r illiqiiiiiRMOrW I E_ 1 0.040.P . ; :' 0 1 ) ; 4 ; .*: . : 16 .0 i .1*..qii :j . il iait . ::: '. Site utilities
Job site address: 1756f150 SLD casr....C%C.-- 104‘4.7%1 Catch basin or area drain 16.60 I
City/Statn/Z11rya 1 042.. . %'22 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ___) Page 2
Suite/bldgJapt. no.: I Project name: 6,,,,, 0 pi
Manufactured home utilities _I 110.00
Cross street/directions to job sitar i
- - Manholes 16.60
1, 4 SJ 1150)006-16 51- - Rain drain connector 16.60
uorkvi
c /11■40avAct oz reD .63 042, DC- 91 '4' Sanitary sewer (no. linear ft.: ___.) Page 2 1
Storm sewer (no. linear ft.: YO) Page 2 550
Subdivision: no.:
Water service (no. linear ft.: __) Page 2
J
Fixture or Item
T a rn ap/parcel no.1.; 102. C. 01 % 00 ... ,..,.... .: ..::. ,,..: ... . . . ..,,, ., Absorption valve 16.60
. D* - 40* 4 .0.b..ter:•9•01Y.R.*1...:. ::::'::;': i : .. .'. .'.::••• : Bae.kflow preventer Page 2
F eLTV/124U23/ M*34 XS I 0.AV " 711 i CkYY PrSa■ Backwater valve 16.60
in 40 LOA 1 1 . Sivoin 1v-vz- LCrt.- Clothes washer. 16.60
Dishwasher 16.60
• • -, :: _....._ zz .. . • • • • .. .• ... Drinking fountain 16.60
•. '.......;;;.?•1 ... ;:,,, :..:,•... 11,,,j) 9 .' TiF . 1 . : ' '..:hii It Eimordsump 16.60
NUM Tte.an 1.170twe__ o 2P1 Expansion tank 16.60
Address: PeJC7IC. Fixture/sewer cap 16.60
City/State/ZIP: ezetkiA23 i C.e..... ell "bl, t
a Pima drain/floor sink/hub
16.60
Phone: 1E03 bZ .... 1
. 0 . ..e ..._ ..,.,
Fa ( i al trildik) Garbage disposal 16.60
16.60
Business "A " : - . 40 : 6 4.Wkil ' . : 1 ; .:: ..1: ii.d1A.■;. :V,:l11.0 1 . T• •• WC '.. _....!!';':!:'' k ma
.. • ... • ,•:- - •. . .. •• . .. 16.60
net= U% L-11
n
- 2.10 to la' ` ' *-- Intereititorinrcasc trap 16.60
Contact name: 000e. c,,,o4S,4ge_ ail )•ot • woofs Medical gas (value: $ _ ) Page 2
Address:) Oe.. I rUlk.IS S.It re- 530 Primer 16.60
City/StaterCIP:Pb(ilA,a o e- cri2.5 z_. Roof drain (commercial)
16.60
P1ovc V9 • al 11 I Fax! 505)40141'1..5014 Sink/basin/lavatory
Tub/shower/shower pan 16.60
16.60
B-mail: OM,. c1§N2e ±/41rOca 19... c...Cal .... ..,....,_ . Urinal 16.60
.. • c •: •• • 1.1-......:..;:!"••- • ip• 'Aft•ek • I- -i ii.: :;!; t;;10 1 1
: ::: ,•....• :•::- , . ':, 0 ;. :.:1•: water ow
d I ::.!.iiiI,V. : i•ilq:14 :....t. . . ....1. • 16.60
Water heater 16.60
Address:
Business num .0 l 0 Ccrne,-4- f /ZX't% Ai
7., 7 6 5 4. 513 s 74 .1.---- bfk."7
i ...
Other:
City/State/ZIP: 7/ i 0 Z 910 f; 2-- Subtotat '
:r permit fee: $7230
Phone: ( . ) 6..ff? - 7 2-z 1 Residential -2 Icflow minimum permit fee: $36.25 !".' __
co; Lie.: ing Lie. no.:
Plan review (25% of pennit fee) IS
43 ‘c/
hilla11110 State surcharge (8% of Permit fee) 5 80 ,
Authorized signature: 7 TOTAL PERMIT FEE 96 • ci 3
Print name: .4 11---c.c I Date: 00 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
-/ a -"7 *Fee methodology set by Tri-County Building industry Service Board.
iNsw Med 44046167(l n/a7/COM/WES)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received _ Date Redy9sted I' — AM PM BUP
Location ■1 Suite MEC
Contact Person Ph ( ) / 9'3Ss(a ` °?may -o0 / a
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ' ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain 1 '� 1 ! L I , . ' G � ekti
Slab Inspection Notes: ) �, e _ ,,
Post & Beam �l ""v `
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PAT' FAIL
LUMBINC'
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
i iraurDT -
- c -asin / Manhole
(Storm Drai
Shower Pan
Other:
Fi
A 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 ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / /)
f Inspector / Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
V _