Permit I A CITY OF TIGARD PLUMBING PERMIT
r' DEVELOPMENT SERVICES PERMIT #: PLM2004 -00247
-'J I I 131 SW Hall Blvd., Tigard, OR 97223 (503) 6 39 -4 DATE ISSUED: 6/3/2004
SITE ADDRESS: 11355 SW TIGARD ST PARCEL: 1S134DC -00600
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
Remarks: Install Irrigation Backflow
FEES
Owner:
Description Date Amount
ANDERSON, LARRY R AND
CYNTHIA M [PLUMB] Permit Fee 6/3/2004 $72.50
11355 SW TIGARD ST [TAX] 8% State Surchari 6/3/2004 $5.80
TIGARD, OR 97223 Total $78.30
Phone :
Contractor:
BIZON LANDSCAPE MAINTENCANCE C
25935 SW GRAHAM FERRY RD
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone : 682 2424 RP /Backflow Preventer
Final Inspection
Reg #: LIC 6131
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: �� /di
Permittee Signature: d'1 cP- .
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
F P 'ON LANDSCAPE� (TUE)JUN 1 2004 10:43/ST. 10:42/NO. 6336807779 P 4
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D
- - � - .tAy of iRard G \ G `` P ' D�1 " , � Permit No.: FLMzo e y - ® 2 ( -II
13125 SW Hall Blvd., Tigard, OR 9 0, `S Plan Revtuw
Phone: 503.639.4171 Fax, 503.59 �) � \ NG % • • �: D Other Parrot No..
24- Hour Inspection Lute. 503.639.4 t_„t4. •ii' DateReady/By a" r"' 65 see Page 2 for
Iatemet. www.ci.tigard_or.us Notified/Method: supplementumtormatlon
TYPE OF WORK FEE* SCHEDULE
Ncw construction ❑ Demolition For special inyjormaAO1 use checklist
Description I Qty. I Ea I -- . total
❑ Addition /alteration/replacement 0 Other: N 1- E -
Family dwellings (includes 100 fat each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) both 249.20
❑ 1- and 2- amity dwelling Commercial/industrial SFR (2) bath 350.00
LI Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other.
Fire sprinkler ( sq. ft.) Page 2
- JOB SITE INFORMATION AND LOCATION Site tomes
Job site address; i t-.55 .....) t,! - {
5 ' Catch basin orarea drain 16.60
City /State/ZIP: - f U (_ r � C -7 a a 3 Ihywcll, leach line, or trench drain 16.60
Suite/bldg./apt. no„ I Project name:
pez u et- („,,...)//€6,4,0 Footing drain (no. linear 1t : ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site; a ( ) _ p, ,,,", t `� . ` n t X44* Manholes 16.60
h k l� reQ r = tip- i - 114 , ed. Rain drain connector 16.60
P 4 _ I [ 6 . Sanitary sewer (no. linear R.: _ _) Page 2
(fn- . 1 /4 4 p K�L �1 cr`�1"`��� Stolen sewer (no. linear It: ) Page 2
Subdivision: f L ot no.: Water service (no. linear f ,: ) Page 2
Fixture or Item
fax map/parcel no.: Absorption valve 16.6U
DESCRIPTION OF WORK / 11 13ackflow presenter 1 I Page 2 Lf 6, 4 ()
I £ r....... G l L . or - __ -be Backwater valve 16.60
- Ra■ V. I _ -.,)) Clothes washer 16.60
• , Dishwasher 16.60
0 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
`� n ,, l'� . - Ejectors/sump 16.60
V
Name: pJle'r�..> (r.) ■r-e_A -S CJ F.,tlrareanntank 16.60
Addr eas: S Li 3 0 I,3 L. I2'2 ^ a( I'i:durc/scwer cap 16.60
Ciry /State ZIP: 9 - I ci, Of-- 9Th "-3 3 Floor drain/floor sink/huh 16.60
Phone: (5O Li V ? 3 31 Fax: ( (j3) qt* '' 3q Fj 1 Garbage disposal 16.60
al APPLICANT ❑ CONTACT 1 T P RRON Hose bib 16.60
Ice maker 16.60
Business name: -So el - Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16,60
Phone: ( ) Fax : ( ) Sink/basin/lavatory 16.60
Tuh/ahower /shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 12 ,0 lid -sQ Water heater 16.60
Address: a 5 33 "Z'S k....,3 U a t'A,♦✓L S pa Oth :
City/State/ZIP: i ,), ' T ( O subtotal ( k (,, ( -(.O
Mi Minimum perm f ee: $72.50
( 3 I( a , /_ F (v& .6 a. - 3 + f cr Residential bat/kJow minimum permit fee: 536.25 `7 2 ` Sv
Phone:
CC(3 Lie.: 6 13 ( Lic. no.: Plan review (25%ol permit fee)
$
Authorised si nature: Stale surcharge (8% of permit fee) 5, s Q
ate( ` _ „ r
Mr', � /// '1'O'1'Al.. YH RMI'f N8E - * � r_' � ' V_
Print name:4 \ ; \ Date: 6 / / /� (i This permit application lupins if perndt la not obtained within
Or !! 1110 dam after It has been accepted as complete.
-Fee methodology set by Tri- County Building Industry Service Board.
r\R • .. 12/03 440•46IOT(10/02/COM/WPB)
/ ( . ‘ q-, 0 j (1 N9 .,30
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 6.7/ AM PM BUP
Location // 3 3 S L—oQ Suite MEC
Contact Person � /I.c e� Ph ( ) �v�� �,C PLM ,a – Ce0 2h /7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
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
T FAIL
CR3 /
r / Unde r Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
'a
PAS 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 D 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 /j�
Approach/Sidewalk Date (/ 6 Inspector ✓ �' Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL