Permit CITY OF TIGARD PLUMBING PERMIT
��� DEVELOPMENT SERVICES PLUMBING
PLM2002 -00311
�' II 13 S H all B lvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/6/02
SITE ADDRESS: 09802 SW SHADY LN PARCEL: 1 S135BD -01200
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement, moving (2) lays, (2) water closets and installing (1) new sink.
FEES
Owner:
Type By Date Amount Receipt
FORBES, DONALD CAROLYN PRMT CTR 8/6/02 $83.00 27200200000
BURDICK, DONALD LINDA 5PCT CTR 8/6/02 $6.64 27200200000
434 RID
434 RIDGEWAY RD
LAKE OSWEGO, OR 97034 Total $89.64
Phone 1:
Contractor:
CASCADE MECHANICAL SYSTEMS INC
PO BOX 399
ESTACADA, OR 97023 REQUIRED INSPECTIONS
Phone 1: 630 -4492 Rough -in Insp
F
Reg #: LIC 127012 Insp
PLM 3 -324PB Final nal In spection
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
Notific iatr6—en er. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
Yo may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987:
Is ued By: , ,,,4 A _ / � ' Permittee Signature:
Call (503) 63' -4175 by 7:00 P.M. for an inspection needed the next business day
F#40M FAX N0. : Jul. 30 2002 09:11AM P1
J .4. �c ur_ ilte4p , HPMmingson Construction 50334160123 p.4
T r .
Building Fixtures A,e -coA
Plumbing Permit Application - - ; ; -
City c due received. N4A Permit no. . .' /,
r ' , II I(`. �jlt� of Tigard Sewer permit no.. I Building p.trnur nu..
' Address: 1)125 SW Hell Alv'c Tigard. OR 97213 Proectts ! so: •lix•i:e date.
Ciq o; Tigard ?hone: (303) 639.4171 i pP
Fax: (503) 59S -1960 pine hued: By: I Receipt no:
Lard use approval: _ �__ �" Mr co l P ayment type:
- • ... • - i-IPt :rri; PERMIT- . .
0 1 & 2 family dwelling or accessory 0 Carnntercialfindustral 0Multi-family I Tenant improvement
Q New chnsuvctiott O Addition /alteration /replacement D Food service 0 Other:
J.00 ±ITF: 1NFOl..'�IATION FEF S CHM 'DI; LL(furip t tiliiefurmatiufii erhs`ciclr.t) ••
lob add 0 �w j -, Description Q • Total
` __ _ '0, -Mu - . ,, y dwe 1t age o • y:
Bldg. no.: Suite no.: 1
(includes 100 ft. for each u coa I
I Tax map/tax lo,a :count no.: SFR (1 bath
1 Lot: 'Block: Subdivision. • SPA ( I
Projeu name: _ SFF. (Math _.... ---_.t___ -
C . ey /county: j ZIP: — teach additional bal./kitchen
Description and location of work on premises: SiteutWdes: •
-_ _ Catchbasinlaread;ain ,
Est. date of completion/inspection: — cut -
Dr� w•ells/leach line /tie: ch d• ' _ _ ��
Footing din rno !i• '1.) -' • .• `Y1:L'RlBIM, (i-..- R:'CTOlt !►1sa_faeturd home mi :ities
Business mama: • • ; ' S , Idsnholes
Adders: Pe_ _wry ' stn chain connector — •
City_ a f- capx.ft 1 Sea::: ,l I ZIP: ' 7a23 Sanitary sewer (no. Fin. fr. ? 1
2htme: 6 3 3o- IY2 1,4x: 6 ssLa 1 El ot: , ,,, j ,_ 3 _.& m y /r ►• Storm sewer (no. lin ft) I .
j CCB no.: Bf.� Plumb. bus. rag. Re. {o Water service (no. in.
Fixture or Item: I
Ciylmctro lic.mo.: / 3 / -4 Abets .tio:valve
Cot aactoi s representative signature: � - j _ _ c ow prevcnter
Print name: nth ante: Cr L4-44-14 Date: 7 )O 02 1 aeirwater valve
f ..
Clot
1. !'U :fttiUN Basinsllavat was et�r
Name Dishwasher • -� •
' Addrese: Drinking tbuntilin(til _ I I
City: state: Zit': F,, :ectu:s/surtp '
Fhoire: Fax: E -mail: Expansion tank _ � �
t)i ''. :. Ftxttue%rewer cap i I
Nome (print): r_,_ Floor drailu flo hub I
Garbage eisposa?
C D : acing sedates. _ ice maker T Host bibb I 1 I
it : l State ZIP: ,J
I
I y Phone: _ I Fax: ; 2-mail: Interceptor /grease trap t •
- I
Ourcr installation/re:Idcntia! rna3tenanee onl The actual installation r rtrler(s) I j l
will be made by me or the maintensn:s and repc:r made by try regular Roof drain (comrrercia!) _
employee ar. h own OS property I ow as per ORS Chapter 441. S:n'.c(e), btuin(s),. ievs(s) -- -471 ' 7- 7 3- 40
I Owner's signature: - -- Slap
lsho e i I r-1
Dz:te:
Ty shown w r ar. i
Urinal _ _ ' 1.
I Name: Water closet ! �a
Adder ss: Water heater ! -
City: ► Stetc: 11 ?. Other: I ..
Phone: t Fax: �E -mail: Total .
MI :in:un f ^ S • •
�..ct ac iurtielcttes, ecrcpt tredlt ertu,. pew. n!i ;..ird.rue• air [116 t•rett'euerl N,,,,,,.. i his ?,Knit tppticecion
Plum rcvic.r (at — Qua) :
o Visa 0 MuterCUa ex pires f a permit is rat oltattted
• d r,_.uprt•
--- within 18D Usys after it has been State sure!tt-ge (8' /0) ....
tve, - 1 J WI
e e!1t cu
l�aem l uisciaer as iklwn us rRtl: WO p I accepted as ooh plere. TOTAL
4.� :oian rije,tur �• •...
S gmouet , 11OJ616 14tar;.LM)
FROM " n'.,+, �Ud 741;U1 Jul y 0 2002 09:12AM P2 •
PLUMBING PERMIT FEES:
PRICE T TAL New 1 and 24amlly dwellings Only: 1
FIXTURES pndlvtdual) QTY tee) AMOUNT (Includes ell plumbing fixtures In PRICE TOTAL
Oink / 16.60 /6, , (' the dweltInO:and the flret100 ft. QTY Me) • AMOUNT
for each uUIItfoonneetlOnl. S?i920
�va�ry te.6o 33 ?� I One (1) bath
^Tub o 7. ub /Shower C 16.60 TWO (2' um 5350.00
1 Three 3 bath 5399.00 1
i Shower Only 16.60 ! � � 1
Yy er Cheat 16.60 .33 ' % BUaTOTAL .. _
Urinal ! 16.60 t BY. STATE SURCHARGE
- Dstiwasner 18.80 J l * PaN REVIEW 25% OF SUBTOTAL ' • I
TOTAL ' I
Geroage Dispose) ' :8.60
' Laundry Tray - 18.60
*shoo Martlin 18.6
Floor OraINFl0orSink 2' 1680 PL EASE COMPLETE: •
'3• ^ 16.60
q• 1 I
ty y
Nate= Heater G mmcrelon 0 50 kind 19.60 Chianti b
Wort Performed
3es piping requ e6 a separate mechanical Fixture Type: New , Moved Replaced .Removed!
Permit, Capped 1
; " G Home New warn SeM® a6.a0 Sink / , ,
' NFG Home New 34r/Storm Sewer 46.40 ' ` lavatory
Tub or Tub/Shower
SOP Bibs 18.60 Cofnbinau8n
Roof Grains 16.60 Shower Only 1
Drinking Founta!n 16.60 Wafer Closet r _
Urinal O nor =inures (Specify) 16. _ • Dishwasher •
i - Gerbig* Dianesal
` I Laundry Room`rrav
t 1 Waehinq Machine r
FloorPralN6lnk: 2` .
Sewer • hat 100' 65.00 I 3�
Sewer • each edd'aonal .00' I 46.40 a�
' W ater Service • 121 100' i I 55.00 Water Heater j
86.40
Other Fixtures I
' W ater Serv:Ce - each adCitioral 200' S Pe YL
Slam 6 Rein Drain -1st 100' 55.00 It
- .. 46.40 - - J
ComrnerCal aims Flo Prevention De vks
16 . 40
Residenti.I BaeknaN Prevention Device' 2 �` -1 f
Oa tch Basin 16.80
inopeelion ar Esbufnp Plumbing or epode) 82.50
Requested inspections A Berm= _ _ COMMENTS REGARDING ABOVE:
'Train Drain. single =amity dweling - 85.25 -
Grease T.. pe 16.80 -
QUANTITY TOTAL .
leonrub or Char dlaorarn It reeulree If _
Want' told M s a
I 'SUBTOTAL .
1 8% STATE SURCHARGE . . ' I
"PLAN REVIEW 25% OF SUBTOTAL I
Roeoired Or If ben ow. eere to i
TOTAL r I 5
'641nImura ps-Il tea le S72.90 • a% sI. a swanwy4 view W sidenllal 6aekWE"
Provsmim' 05 010 is 371.26. 696 state metals.
"'ea =saw Cc .+name= Bullelnno roeehe 2 eats er plena wise Itoreaule or OM
dlaornn Car plan ravtwr.
- i:IdeIIeVO'mS1D1m • fee$AOC 12126/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPEOTIOk DIVISIQ - Business Line: (503) 639 -4171 MST o
7 /
BUP -
Received >' Date Requested t 7 AM PM BUP
Location n Suite MEC
Contact Person ry 4 Ph ( ) 6 VC, % CD 2 +C9a31)
Contr Ph ( ) SWR
(BUILDING Tenant/Owner ELC
Foundation ELC
Access:
Ftg Drain 7_� ELR
Crawl Drain 60-4 �- <�`'� E "
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
701%
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation / l'' L�` /`�` /v
Drywall Nailing
Firewall
6 -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
�r:
PART FAIL
4 ING
Post & Beam
Under Slab
Rough -In �-�
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
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 / / d Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARO- , ` , -Hour •
BUILDING '" (.. inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 - 4171 , UP
Received Date Requested . S /, AM PM �BUP e7 — GO3 ( e
Location C1C4 ° / de • / iV1 Suite MEC
Contact Person ( ) J- V .150 PLM - 3 / I
9 iji
Contractor Ph ( ) SWR
"Or. p . Tenant/Owner ELC
Footing ELC •
Foundation ACCgSS: d O 71
Ftg Drain � ' Q o T) � C./ ELR
Crawl Drain - SIT
Slab Inspection Notes:
Post & Beam
Shear Anchors - E-7—& 4-
Ext Sheath/Shear ,
Int heath/Shear
1'
_al in
iris
Fire Sprinkler
Fire Alarm
I Susp'd Ceiling
Roof
Other:
F�:r■In,
Lt t •• RT FAIL
p
I Post & Beam
' Under Slab
ough-
Water Service
Sanitary Sewer .
Rain Drains
Catch Basin / Manhole
Storm Drain •
-.-------
Shower Pan
Other:
Fin
>tt RT FAIL
Post & Beam
Rough -In •
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service ,
Rough -In
UG/Slab
Low Voltage
Fire Alarm •
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line A l /0
ADA
71----
Approach/Sidewalk Date 0 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested r 3() AM PM BUP
Location f c Z . S Si ciy 6 ■-• Suite MEC
Contact Person Ph ( ) (v c/ ( / 510 PLM Zt. z--0O 3 / f
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain . ! /q _ ELR
Crawl Drain U U 1
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 /
PASS PART FAIL 1
<PLUMBI
Post & Biam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin
4104 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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Q'/3( Approach/Sidewalk Date / If Z Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL