Permit CITY TIGARD PLUMBING PERMIT
**ANC A DEVELOPMENT SERVICES PERMIT #: PLM2004 -00227
A� l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/20/2004
SITE ADDRESS: 12242 SW TIPPITT PL PARCEL: 2S1036C -08100
SUBDIVISION: MLP1999 -00005 MOSES PP2000 -077 ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
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: 1 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 water heater.
FEES
Owner:
Description Date Amount
HARRIS, JOHN
12242 SW TIPPIT PL. [PLUMB] Permit Fee 5/20/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 5/20/2004 $5.80
Total $78.30
Phone : 503 372 - 5615
Contractor:
HOODVIEW HEATING & AC
1090 NE 8TH ST.
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone : 503 665 - 0764 Final Inspection
Reg #: LIC 154513
PLM 3 -311 PB
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: — cc�c,1 .�.� d9 / Permittee Signature: 09/1 q ijh(I,4 7j
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
H iew Heating 5036652158 05/18/04 09:19P P.005
,
Plumbing PermilJApplication
City of Tigard Rcocrvat �a�ia� �p I Y1 j � D y ,
p 01e/gy D Permit No
13125 SW Halt Blvd., Tigard, OR 97223 Plan Rcvic
Phone: 503.639.4171 Fax 5 03.59/1,1960 w' 'r' i ?'` nnte/F3v. Other Pcraai No •
24- flour Inspection tine: 503.639.417. D,,le K an dy /py �ww. m Sec Page 2 for
Interact; www.ciiigard.or.uh �
Nub f ird/MNhod Supplemental Information
. .. i i;•. ,TYPE OF WORD FEE SCHEDULE
o New construction ❑ Demolition For specialinlorma/Io use checklist
Description _ _ Uty, Ea Total
❑ Addition/alteration/replacement ID Other; New 1- 2- family dwellings (includes 100 It fur each utility connection)
. - .' ,: . 'CATE4I ORY OF CONSTRUCTION ' ' - SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ CommerciaVindu tri al SFR (2) bath 350.00
-
❑ Accessory building ❑ Multi-family SIR (3) bath 399,00
mi
Q Master builder Each additional bath/kitchen 45.00
Hire sprinkler ( sq. R) Page 2
JOB SITE YFOR1rIATION AND. LOCATION Site utilities -
Job site address: 12242 SW Tippit P1 Catch basin or arca drain 16,60
City /State/ZIP; Tigard, OR 97223 l)rywcll, leach lone, or trench drain 16.60 —
Suite/bldg./apt. no,. if Project name; Harris, John & Brandie Footing drain (nu. linear It : ) Page 2
Crush street/directions to job site:
Manufactured home utilities 1 10,(X1
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear IL: ) Page 2
Storm sewer (no. linear ft.:, ) Page 2
Subdivision; - Lot no.: Water service (no. linear R: ) Page 2 ^ y
Fixture or item
'I ax map /parcel no.: ,
- . Absorption valve 16 60
D1 ,SCRIIPTION. OF WORK Iiackllow preventer Page 2
Replace Water beater. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY' OWNER ❑ TENANT' , Drinking fountain 16,6(1
Effectors /sump 16.60
Name: Harris, John & Brandie
Expansion tank 16 60
Address: 12242 SW Tippit PI Fixture/sewer cup _ 16.60
City/State/ZIP: Tigard, OR 972 t3 Floor drain /floor sink/hub 16.60
Phone: (503)372-5615 Fax: ( ) Garbage dikposal 16.60
. ❑ ;rtPIMICANT • . ' CONTACT, PERSON Hose bib 16,60
Ice maker 16.60
Business name: Iloodview Heating & Air Conditioning
►- Interceptor /grease trap 16.60
Contact name: krlly/Tom Medical gas (value: $ ) Page 2
Address: 1090 NE 8 St Primer 16.60
City/State/LIP: (; resham, OR 9 Roof drain (commercial) 16.60
Phone: (503) 665 -0764 Fax: : (503) 6652158 Sink/basin/lavatory 16.60
E- mail: iboudview(a)verison.net
Tub/shower/shower pan 16.60
Urinal 1 6,60
CONTRACTOR "' Water closet 16.60
13usin name: Hoodview heal ng & Air Conditioning Water heater / 16,60 /K., 6a
Address; 1090 NE 8' St Other:
-
City /State/ZIP: Gresham. OR 9'030 Subtotal /( ,
Minimum permit fee: 572.50
Phone, (503) 665-0764 9')`° Fax: (503) 665-2158 / Residential backflow Minimum permit fee: $36.25
CCR Lie.: 154513 Plumbing Lie. no.: 3-311 PB Plan review (25% of permit fee)
/� // �, > State surcharge (11% of permit fee)
Authorized signature: -% Q
,/ � TOTAL PIiRMI'1' I'lai 7, , 0
Print name: Kelly Bryant /— Date: 5 -18 -04 This permit application expires if a permit is not obtain wild thin
180 days after it has been accepted as complete_
Y r'.... ......I... .,...... .... L.. T_: r...._�. , ...:.a:.... rw A........ C....,:.... A. .._J
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re nested 7 aM' __ r PM BUP . .
Location ---r ��'
.� 9 Suite MEC . 4D -DOS
Contact Person ��E C.�� r Ph ( ) lD 0 7 (4 PLM ,oeof -ODa 7
Contractor Ph ( ) SWR
BUILDING Tenant/00• itJ'L r� — ELC
Footing v / a` — s� o / S ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Ins • ection Notes: _ _ SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear -:( !Z p 9 / so v S
Int Sheath/Shear�,_ y = =-f
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL %
PLUMBING i .1
Pr1110
POStT B@3m_
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Oth r:
*AS! PART FAIL
r: CHANICAL r1
Post &`Beam -'
Rough -In
Gas Line
Smo e Dampers
410
PART FAIL
CTRI
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 I _ Inspector Ext
Other:
Final D NOT REMOVE this inspection record from the job site.
PASS PART FAIL