Permit 4 CITY OF TIGARD PLUMBING PERMIT
4 DEVELOPMENT SERVICES PERMIT #: PLM2002 -00484
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/5/03
SITE ADDRESS: 14800 SW SEQUOIA PKWY PARCEL: 2S112AD -00900
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS: 0
LAVATORIES: OTHER FIXTURES: 5
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: D ft .�! c
Remarks: P / / ys ` ° ,/ ` J1¢� c-('
( FEES
Owner:
Description Date Amount
HOME DEPOT USA INC
370 CORPORATE DRIVE [PLUMB] Permit Fee 2/5/03 $129.40
TUKWILA, WA 98188 [PLMPLN] Plan Review 2/5/03 $32.35
[TAX] 8% State Tax • 2/5/03 $10.36
Phone : 1 - 206 - 574 - 3567 Total $172.11
Contractor:
COMFORT SYSTEMS USA
12300 SW 69TH AVE
TIGARD, OR 97223 •
REQUIRED INSPECTIONS
Phone : 503 - 598 - 4798 Water Line Insp
RP /Backflow Preventer
Reg #: LIC 137663 Final Inspection
PLM 34 -356PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: /'` .,� �� l Permittee Signature: ALI
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busines
t.
I '.
.. cog -co 35 l
' Plumbing Permit Application OFFICE USE ONLY
Application
received: f BrQ$- Permit no.: _■�, .C15 t; '
Tigard City of g and
Q pEp Sewer permit no.: Building permit no.:
' Address: 13125 SW Hall Blvd,11
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: x ' e date:
Fax: (503) 598 -1960
DEC 1 3 ion Date issued: Receipt no.:
Land use approval: coos Case file no.: Payment type:
\
❑ 1 & 2 family dwelling or accessory IR /industrial D Multi- family ❑ Tenant improvement
U New construction t Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: )40 SW SF 4 U 0 \ 01 - r Description Qty. Fee (ea.) Total
N ew 1 - an 2 - family dwellings only:
Bldg. no.: I Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot /account no.: Z S 112. A-V- Db900l iz--Z•oc 440 l SFR (1) bath
Z.
Lot: , 'Block: I Subdivision:I p • GD 1:4.4.• G'f1.nSs SFR (2) bath
Project name: ,Sf 14Vc,l `T7bl.) SFR (3) bath
City/county: 1. ' I ZIP: y(Z ,Z, 3 Each additional bath/kitchen
Description and location of work on premises: v? pI_ Site utilities:
Pap_r l t rt.) e<1,311 IA 6.. fIi^ g- V E __C — Catch basin/area drain
Est. date of completion/inspection: • t b 3 Drywells /leach line /trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR _ Manufactured home utilities
Business name: - r p $e. (� ►E
,J F1 V - Manholes
Address: Rain drain connector
City: I State: I ZIP: Sanitary sewer (no. lin. ft.)
Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
Fixture or item:
City/metro lie. no.:
Absorption valve
Contractor's representative signature: Back flow preventer 1
Print name: �..,,, Date: Backwater valve
CONTACT PERSON • • Basins /lavatory
Name: '' -, Clothes washer
Dishwasher
Address: Drinking fountain(s)
• City: I State: f I ZIP: Ejectors /sump
Phone: "�__ Fax: • E- mail- Expansion tank
OWNER Fixture /sewer cap
Sy . D U S,A 1 Floor drains/floor sinks/hub
Name (pri nt): Ii-t ‘p C.
T Garbage disposal
Mailing address:31 o Go ft, - Vital - Hose bibb 2.
_ City: .ELI JUS State:L.)pri ZIP: 9'8I $8 Ice maker
Phone.2DLS 71 3561 I Fax: 2D(oS'/40J -mail: Interceptor /grease trap — 1
Owner installation/residential maintenance orify: The actual installation Primer(s)
will be made by me or the maintenance andiepair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs /shower /shower pan
Urinal
Name: Y 70- 1 p Water closet
Address: 2.4 3,0 ( ,tivF., 1J.E 1 Su ) • Zap Water heater
City: 6LL )Ut. State:WA• IZIP: 'iitb 4 Other: 1 .h t, w c..Q I
Phone 0 , 3= IF ax. 33 i E - mail: 1 Total J •
Minimum fee $ /R9 • y0
Not all jurisdictions accept credit cards, please call jurisdiction for more information. $.:' . ";Notice: This permit application
Plan review ( at o ) $ 8a • 3S
❑ visa ❑ MasterCard expires if a permit is not obtained (8%) $ /0 . 8!0
/o
Credit card number: Expir / State surcharge (8 /o within 180 days after it has been TOTAL $ /72 •
Name of cardholder as shown on credit card accepted as complete.
$ .-
Cardholder signature Amount .+.' 440 -4616 (6/00 /COM)
s
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
y MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Ft nested ` � AM PM BUP
(/ffi
Location J(.1 �✓ Suite
p / MEC
Contact Person Ph ( ) , �Z L(718 zoo
Contractor S' R boYec�
Ph( ) /
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: a ti S/ SIL
Post & Beam
Shear Anchors Q ��
Ext Sheath/Shear (_ o a t m
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PAS RT FAIL
P MBING
Po beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
' 'ASS PART FAIL
M 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 ❑ Please call for reinspection RE: [] Unable to inspect — no access
Fire Supply Line
ADA Date 3 1 2 6 /0 3 I ns ector Ext
P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL