Permit A CITY OFTIGARD PLUMBING PERMIT
PERMIT #: PLM2004 -00441
•�Lj
- 13125 DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 9/22/2004
SITE ADDRESS: 10441 SW PARK ST PARCEL: 2S102CB -07200
SUBDIVISION: PP1993 -105 ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 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: 15 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repair approx 10 -15 ft. of water service under paved driveway.
FEES
Owner:
Description Date Amount
MISKA, EDWARD P + PHYLLIS MAE
745 3RD ST [TAX] 8% State Surcharl 9/22/2004 $5.80
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 9/22/2004 $72.50
Total $78.30
Phone:
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone : 503 - 771 - 9449 Water Line Insp
Final Inspection
Reg #: LIC 42671
PLM 34 -70PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: :7/2 Permittee Signature: q \
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
09f21/2004 16:37 503 - 771 -9454 CROWN PLUMBING PAGE 01
Mist/ 11 pitaxPermit , ,H ,
City •/ 4 If ED 1.Ont ( )I IA( 'L: t s-, F. (1 \'I.1
�'lgard Rexet;.ed L , �
13175 S174 4a11 Blvd, Tigard, OR 97223
Phone: O. DateB g v� i 1 Permit No.: �1 " \0 0 09 yy /
1 0:.639.4171 Fax; 503.59 1 2004 Plan Review
24 llou '1r 2 1 ° ,::: f ,.. . l
specnoa Line: 503 639 41 1, I Et y: other Permit
Inte[net w uw Ce n$atd Or tr6 t No.: • „ y� + r r 1 a ■ NoEficd/stethod ru�lr ® pee Page 2 for ~�
! ) } 4 y ,11 rr' 1 �,� t� f t . �f r P v _r .T f �'L' ` i i 1 I Supplemental ' '
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+
F or s,pcc &formation use checklist
drt on alteration/replacement 0 Otter
'Description
New 1.2 -fam dwellings I ' I I nec
® Ad i
S S a, F � i �c " r -7''� t 2-family ellings (includes 100 R. fnr IN 'L ar ". i n �. ✓' ... y a� 4 .l... '; 6 i urP t- • ,f'''� L Y! I i 1 t , { r d' 4 FR(1)� each utility connection)
_ate, >:". �d .,,ti f � 5 24
® 1 - and .Z . airily dwelling V 0 Catnmerciavindusfrial 0
SFR (2) bath 350.00
❑ Aeons or r building O Mu !ti- family SFR (3) bath 399.00
❑ Mastel bt ilder 0 t7tt:� Each additional bath/kitchen 45.00
} rr ,�P
,'
' f 4 E !.,I.� 1P Iti+ ,.�. . e., t�v7�i�1•Gl n `, , rpirr ' ; ri''1! Flre sprmklc';( �•�)
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�+_...,>Zq_u... -' :, ;.. e rl Ac yr l 1` •, l,• <. / r . ?,. ,r. ! fit Paget
Job site ac :Ire ss: 10441 SW PARK '' : S atilfties
AItIC STREET Catch basin or area drain
City/State, .M': TIGARD, OR 97223 - 16.60
Drywell, leach line, or trench drain 16.60
Suite/bldg , 'trI t. no.: I Project name: Footing drain (no, linear ft.: Page 2
Cross stree lid irections to job site; Manufactured home utilities 1 10,00
- -
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisio; I I Lot Water service (no. linear ft.: 15) Page 2 mi
Tax rce l no.: Fixture or item
r' '� Absorption valve
i1 c{ r1'f fp �yf 1 r Cikc1��� 16.60 ._
t..i.:. �i3..r •;_ i -- )t�a r a :�$ _.Zz Z . : '.•,or ' ' r l,.:..;:22:�.._ I ,� r. ' 7 Y a 1,
' r
, r.: ` ,` a, Baelcflow preveaeter Page 2
REPAIR A PI ROX 10 -15 FEET OF WATER SERVICE UNDER PAVED
Backwater valve 16.60
DRIVEWi ,y
- Clothes washer 16.60
j��`' 1 ti k11 ,T c '.e.,,,,,77.4 Dishwasher 16.60
,'"1N' , Vti-� ;..r sI d :710', 3!' } o r Diinlcfug nntain
i 2' ? aY ,a a h; ,',41 .1.,1/4,;', , • • , ,19 . r.', J i; " ; � S I .. n s c,,. 1660
Name: ED , .1E SKE _ Ejexrors/ 16.60 _
Address: 10114" SW PARK STREET - Expansion tank 16.60
•
City /State/2 IP: TIGARD, OR 97233 Fixture/sewer pp 16.60
Floor drain/floor sink/hub 16.60
Phone: (503 63 6 -6052 F ( ) Garbage disposal 16.60
�4� `'''' ' 'i��" ,'j K - % - 2ir v ti ' ...' 1 rrrr,77,1:4 T - lbw bib
Ym._.•3..Ild> .. w ...,._,s...:;cid i,2a;i, +yI 'l .i t j •±~ a s I , i , 16.60
Business nal re: _ `: ` y Ice ma
Contact Hard ; :: ante rctptorlgreasc nap 16.60
Medical gas (value: $ ) Page 2
Address:
Primer 16.60
City/State/Z1 P: Roof drain (commercial)
Phone: ( )
I . Fax:: ( ) _ 16.60
Sink/basin/Iavato y 16.60
marl Tub/shower/shower r
pan - 16.60
... fiT T r7
r r
r. ti � a . } (- y '�'.r �f�'D++A' S t" y r 1.,�•a - -7 r r Urinal
' a r eN. ' ..J5 � �' I /'l y te. � ,. ,, `'ter, :i, � v:v. 1i?",'"iq :.,:. ` ?:.:1,.1?'% � .Q `r y - "` ::; 16.60 ■
Business Harr rROWN PLUMBING
r � Water closet 16.60
ING Water heater
Address: 429 SE FRANCIS STREET 16.60
Other:
city /State/Zli': PORTLAND, OR 97206 - Subtotal
-
Phone: (503) 1 7] -3443 Fax: (503) 771A454 Minimum permit fee: $72-50 ,
ho Li 421.71 Residential baelctlow minimum permit fee: $36.25 7z .5 Plumb'. _ &e. no.: '34 -70PB Plan review (25% of permit fee)
Authorized at .nature: .I i° surcharge (8% of permit fee) S _
1 TOTAL PERMIT FBE
I Print name: D tnr ;8 Underwood r f ' ?.�
I Dom: 5/ Z/ i 1 permit application expires ifs permit is not obtain ed within
r * 180 days after it has been accepted as complete.
t: d ecru 1.111 IPeastApp.see 12103 Fee methodology set by Tri -County mty Budding Industry Service Board.
s4o4 s t 6 rp aavoor trwEe>
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION I#usiness Line: (503) 639 - 4171 MST
/3/9 BUP
Received 1 Date eques d I DI AM PM BUP
Location / 0' ( l G4 Suite MEC
Contact Person �%}�yL,i.o Ph ( ) Z 7 / I ( t L 9 PLM ea T �l
Contractor C1Vfina, pltiAt,c,insvt.�/ Ph ( ) SWR
BUILDING Tenant/Owner �J ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 1 Kobe .' r . SIT
Post & Beam V�
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear �J
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: -
Final
PASS PART FAIL J ��
( UMBII
osi S'Beam
Under Slab
Ro.•. -•
ewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O Pfd
i
44 7 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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL