Permit CITY TIGARD PLUMBING PERMIT
P ERMIT #: PLM2003 -00132
,1 � DEVELOPMENT SERVICES
L
� � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/9/03
SITE ADDRESS: 16682 SW QUEEN ANNE AVE PARCEL: 2S115BC -17800
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Modify vent pipe under kitchen sink.
FEES
Owner:
Description Date Amount
WINDECKER, ROBERT D AND
REEVES, MAE [PLUMB] Permit Fee 4/9/03 $72.50
16682 SW QUEEN ANNE AVENUE [TAX] 8% State Tax 4/9/03 $5.80
TIGARD, OR 97223 Total $78.30
Phone : 503 620 - 8057
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223
REQUIRED INSPECTIONS
Phone : 503 639 - 5296 Final Inspection
Reg #: MET 00001703
LIC 2439
PLM 34 -29PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued By: AAINd � . , � / � Permittee Signature: 0) a ,)
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
04/08/2003 12:34 5036393771 CITY OF KING CITY PAGE 02/02
TRI- COUNTY
SERVICE CENTElt Plumbing Permit Application FICF USE ONLY
�: r \ 1 F � Date received: C' f . .03 Permit no.: daps - (,t��,
f = 1 City of King I V `
ii (3'25 SW Hall Blvd. Sewer permit no.: Building permit no.:
Tigard. OR 97223 Si 2003 ct/
Projeappl. no.: Expire date:
Clackamas Phone: (503) 6394171. FA �O�)138� - 72 7 /
Multnomah F ?`GAR ' Date issued: 8y:, Receipt no.:
o h N n � o x s Land use approval: gV�L�o 0 OW1SION Case ale no.: Payment type: •
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement ❑ Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (fur special information use checklist)
Job address: f 66$ 2• gG)r v /91/19e _ Deseritaim Qty. Fee (ea.) , Total
Bldg. no.: S wire no.: New I and 2 family dwellings only:
C wcludes 100 ft. for eadt utilily ma tecttnn)
Tax map /tax lot/account no.: SFR (1) bath •
Lot: I Block: ) Subdivision: SFR (2) bath
Project name: ' SFR (3) bath
City /county: fif �r ZIP: R' Za/( Each additional bath/kitchen
De ' don and location of work on remises: '/�� ,Ze i Site utilities: -
i (J UI /L At t teriax / c Jn/,t[,. Catch basin/area drain
•t. date of completion/inspection: 'Drywells/leach line/trench drain
Footing drain (no. lin. ft.) _
PLUMBING CONTRACTOR Manufactured home utilities
Business name: /Jes trey g / a "..- .i y • Manholes
Address: l{6 b . w ^/ /014 5 r j f e f / ' Rain drain connector •
City:
y: 1 ') / State: 0 X ZIP: • 2. Sanitary sewer (no. lin. ft.)
Phone: 4v3- b 5.q_ 4 ax: E -mail: Storm sewer (no. lin. ft.) •
CCB no.: 7.113 Q I Plumb. bus. reg. no: 3 Lf ,2 9 nos Water service (no. lin. ft)
City/metro lit. no.: ZO a Fixture or item:
.
Contractor's representative signature:
Back B .don valve
Back flow preventer
Print name: Date: ' % Ave Backwater valve •
CONTACT PERSON Basins/lavatory
Name: Clothes wash
Address: — Dishwasher
City: [State: 17,Ip Drinking fountain(s) .�.
Ejectors/sump
Phone: I Fax: E -mail: Ex . - ion tank •
OWNER Fixture/sewer cap
Name (print): j P i dl , 47 - Lep►' Floor drains/floor sirtks/ttub •
Garbage disposal
Mailing address: d 6 fl 5-14)• OrJeitoh / OX a Hose bibb
City: -(, ` /• /)t State ZIP: - 24 Ice maker '
Phone:, 620- ;,',:, ' :: x: E -mail: Interceptor /grease trap .
Owner installation/residential maintenance only: The actual installation Primer(s)
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. Sink(s), basin(s). lays(s) • I -
Owner's si nature: Date: Sump _ .
Tubs/shower /shower part
Name: Urinal —
Address: Water closet _
Water heater
City: State: ZIP: Other.
Phone: Fax: E -mail: Total
„„ ntl jurisdictions accept credit cards, please call jurisdiction for more Infortttatlon) Minimum fee $ -7a Notice: Thts permit applicacon
l visa 0 MasterCard aspires ija permit is not obtained Plan review (at %) $ e)
-edit card number. / / within 180 days after It has been State surcharge ($ %) S -
EXpirm TOTAL }} S /h . U''CJ
Nome of cardholder as shown on credit card acce as complete �I ^3
$
b 0
Cardholder signature Amount
4404616 16A0rCOM 1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 75
INSPECTION DIVISION Business Line: (503) - 171 MST
171-16 BUP
Received Date Requested AM PM BUP
Location / 62 Co Oa ate►. a /v\. Suite ME
Contact Person Ph ( ) PL 3
Contractor Ph ( ' , / ) SWR
BUILDING Tenant/Owner vV • ELC
Footing CoaZ0 —F05i
Foundation ELC
Access:
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: / ��; _I t 1u
SIT
v (�
Post & Beam i) Q 4 "i
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof •
Other:
Final
PAS$ . 2 FAIL
MBIIZG )
'V ,
osr&Beam
Unde •
- = ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain (
Shower Pan
Ot
04 0 p ,
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 1=I Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line kA C/a - ADA S
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL