Permit 'CITY OF TIGARD PLUMBING PERMIT
• DEVELOPMENT SERVICES PERMIT #: PLM2004 -00491
'�J II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -41 DATE ISSUED: 10/28/2004
SITE ADDRESS: 11768 SW SWENDON LP PARCEL: 1S133CD -01700
SUBDIVISION: COTSWALD MEADOWS ZONING: R -25
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: 1 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: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Kitchen remodel.
FEES
Owner:
Description Date Amount
RIDER, MARILYN Y AND [PLUMB] Permit Fee 10/28/2004 $72.50
JAMES M
11768 SW SWENDON LOOP [TAX] 8% State Surcharl 10/28/2004 $5.80
TIGARD, OR 97223 Total $78.30
Phone : 503 - 524 - 9163
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 503 - 639 - 5296 Rough -in Insp
Final Inspection
Reg #: 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: CLt,c� Permittee Signature: ;� .�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
WESTERN PLUMBING 6036849015 10/28/04 02:46pm P. 003
Pl um b in R Perm' ication FOR OFFICE USE ONLY
Received P Permit 1 .. 7�'y z y9/
E® DaWBy/��p�y Per
City of Tigard Planning Approval L /�% ' Sewer
OCT 2 Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 2U U4 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax � E '80 6p/ Post Review Land Use
Internet: www.ci.tigard.or.us I1' /WING G� G' ■ � �'� = ` � C ontact Case No.:
��`/' ;;. ►_� . �. r.� Contact !u 's :/� ® See Page 2 for
24 - hour Inspection Request: 503 639 - 417 3 Name/Method: _ ?/ U Supplemental Information.
- t.._r, _ :I`ri;ov : :if <! ; .!'t.{ #. a5'l; �,; n � $
Frg1 .0i_ . {t • 1y� r E h� (� r l,.
r l + �. .e ...�•�S�l'C7 - �. _' �.Oi1 A - fi1ICCSCI St .:
New construction Demolition Descri • Hon Qty. Fee(ea.) Total
.. 4., Addition/alteration/replacement Other: +^�` �;:i�,:' � .'': �?`„ rde i e ; 1 : - �' a I 't .. r s , : , x ,- . •
� I�. 1i'.� r• J [J ' a ' C � P' �Lt, � . � lr �,, � j�: . ;l. ;�'N ..
•:ri. .:::.t iAPEG.ORYiOF',GANSTPRUGTIOI!I �:;. s�;°l.;- i :i, ti (I'nsl. ttO' ' "` Qr.ea� ei ti. r►uectiQ4) t at =it"'i
1 & 2-Family dwelling SFR (1) bath 249.20
y g Commercial/Industrial SFR (2) bath 350.00
Accessory Building ] Multi - Family SFR (3) bath 399.00
Master Builder Other: Each additional bath kitchen 45.00
`.:: ;'Jb$ SITEkIN)" OI21Vl, iiiiiI OCA 01∎115H(' *: Fire s • rinkler - s• . ft.: Pa • e 2
Job site address: / / - 169$ 5,11/ Sv,ftrld ar L p rr ; i fmatmE yi y} s y ti!.iosm '. .
Suite #: I Bldg. /A t. #: Catch basin/area drain 16.60
U 1� G Drywell/leach line/trench drain 16.60
Project ject Name: fl I Q � /� Footing drainSno, linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 1 Lot #: Storm sewer (no. linear ft.) Page 2
Tax ma /parcel #: Water service no. linear ft. _ ' Pa:e 2
f �.Jy u 1+ i �r-ll 71 1 �i, i e'�i�f �I�;+I,i;l-• l ar .} +�, $ 'r r ':
I n l :SH _ 1 rt'r F :i�I \ {VF+c��o0',1V l�.r•'2i VaIt;K't:-:fii�Ih �1i��,��r \, ���y`171:Y��._, -.i t�.t��:v$`.}'3 . rr �� . .
Absorption valve 16.60
/4 /44 1 / v/fi/A R /�� -1 r,iiic Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher / 16.60 4,, 43
Drinking fountain 16.60
:' ,SiltOM 1ttI! ¢O .I•ER•is;4'•_• .'• 'i'll],TEIV`ANTc :'i -f?:; :4? M',: ', • Ejectors/sump 16.60
Name: TA w f3 y- MA r, ly yt p t 4..2. v Expansion tank 16.60
Address: i 11(p'g 5 514/e-a4 Dyl bo p -P Fixture/sewer cap 16.60
City/State/Zip: j i ct,.rat Q/2. q �aa/3 Floor drain/floor sink/hub 16.60
Garbage disposal _ / 16.60 4.,, Gz
Phone:5)3 -Saw 1 la 3 Fax: Hose bib 16.60
4210..PrL-.7103IT,;1 . ".'a' ":: *:3:a,:::' DLit 0,NTA'gkitits.01 .: 'y. Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory , / 16.60 /(. c
E -mail: Tub /shower /shower pan 16.60
- •.:13; 0]<e ""'r "'Mr t N. , r •,r r . , .!4 , . .. Urinal 16.60
W �Q 7 /AC Water closet 16.60
Business Name: Water heater 16.60
Address: 994,0 sb,/T //,,41,,9 ,4- /p/ Other:
City /State /Zip: - 7 7 6 4€# ' 22,27 Other:
Phone: ��- 39 - 2,G G am'-? ,lf .>�,. ,,� , l
es - �• „,�
.� Fax: D aid' �u, �` r����� "ki��i:x,�l`IF��'�k;Iuiicl' Ins; kEeri< nulli�es��?;�:�':?��.<<.a,'r.
Subtotal $ ,
CCB Lic. #: , Plumb. Lic. #:35e } Minimum Permit Fee $72.50 $
Authorized (C /y' Date: "!�� , . Residential Backflow Minimum Fee $36.25 2 . 5-0 Signature /o % Plan Review (25% of Permit Fee) $
.T4 /'Z._.. State Surcharge (8% of Permit Fee) $ S; I:12-
(Please print name) TOTAL PERMIT FEE S "If; 2
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
•Fee methodology set by TrI -County Building Industry Service Board.
i. \Dsts\Permit Forms\PlmPermitApp.doc 0 1/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 003) 639 -4175
INSPECTION DIVISIOAI Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / D- — ` PM BUP
-
Location /1 ' p Suite MEC
Contact Person 7f aikI Ph ( ) A Y — eq/‘0 3 PLM ?O 6 4 - 06 tilt
Contractor ' (51W-) ` d kt E . +L ^0 Ph ( ) � N ',)4 got SWR
BUILDING Tenarf t/Owner I) A v C q 0 ) ` C 4q ELC C i - On � O�
Footing IN \ l) P \ 3) ∎ `W \ - ELC
Foundation Access: ` /\
Ftg Drain C 0 � 66
Yl ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ��.
Drywall Nailing r ' �� 1111WLIIIIM° ��a / ��' �'�� C
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final f&A t 1. c .1 1) "19
P T FAIL
PL
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains v
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
\/
PART FAIL
ECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRIC
Service-
Rough-In
UG/Slab .
Low Voltage
Fie Alarm
ina ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'F S >ART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA �/
Approach/Sidewalk Date // 7 Inspector e-- • / 7 Ext
Other:
Final DO NOT REMOVE this inspection reco . from the ' b site.
PASS PART FAIL