Permit A CITY OF TIGARD PLUMBING PERMIT
''" 't DEVELOPMENT SERVICES PERMIT #: PLM2004 -00147
'�' 6 ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/7/04
SITE ADDRESS: 11365 SW TIGARD ST PARCEL: 1S134DC -00700
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: A2.1 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: Installation of backflow prevention device for irrigation system.
FEES
Owner:
Description Date Amount
BAPS TEMPLE
PO BOX 41160 [PLUMB] Permit Fee 4/7/04 $72.50
SAN JOSE, CA 95160 [TAX] 8% State Surcharl 4/7/04 $5.80
Total $78.30
Phone : 408 - 453 - 6464
Contractor:
NEW GROWTH LANDSCAPE
PO BOX 1571
BEAVERTON, OR 97075 REQUIRED INSPECTIONS
Phone : 503 - 439 - 3341 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7425
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
� Is s d By: - P ermittee Signat !� -�j
— 'Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Apr)n'6 -'04 15:18 Mike Kolodziejczak 5034398877 P_02
CE ED
Plumbing Permit Application 1.01( ()l l.l( I: I .F O\I,), •
I �,
of Tigard ? R Ob 200� y
tl of O - ..r//97
I
11125 SW hall Illvd, Tigard, OR 97223
f4rn, N, .
Phone 501 619 4171 lax 30.3.5911.1960 GVV �� �1 PI, �nite�leR
'Itni
�:•. �1 Da te/B y . Perna! No
• 24- Ilour Inspection I and S03.639.4I75 p111L D 11VG �lj - now
11111Tuel www 11 ttgard or US
vv - I -+ this Reody/RY ® yes rage 2 for
...A. NoutlediMe111nt 1 tiuppleroenW Information
T\ PP.. OF WORT{ FEE° St WIWII .I
.-
01 construction ❑ Demolition _ For vivid information use cJecAliu.
__- I Racriptlial i r F:1 Total
❑ Addltuoll /allcnrtlur ✓replutamenl ❑ Other. - New I- 2- family dwellings (include. 100 0. fur each utility connection)
— - C'ATEGORI OF CONSTRUCTION SFR (I) bath 249 20
❑ I - and 2- family dwelling IA Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 -
❑ Master builder Each additional bath/lutehen -- 45 00
❑ Other:
-- -- Fire sprinkler ( sq. tl.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities -
)4;(1 rile address II 3 VS .lA) T 151IC6 St . Catch basin or area drain 16 60
City Statd1.- ./aliIP ! t q 1_ . � � 912.23 � Z lrywell, leash line, trench drain 16 60
Su1ic/hld t no Looting drain (no. Linear it. ) Page 2
T Project flame. � P F 1q � IC - west- 1 Manufactured home utilities 110.00
(•r ass street /dtfccitons to job site - . — - -
Manholes 16 60
--- - Rain drain connector 16.60
-- _ - Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear fl.: ) Page 2
'nl$Jlvlalun - I Lot no •
Water service (no linear A. ) Page 2
lax neap /parcel no Flrturr or Item - - __
Absorption valve _ 16.60
DESCRIPTION OF WORK Beano** pteventer ` Page 2
irlsiallaton Di flew tw..11_ ditev lO,G . - lb( I iio(. 13ackwatervalve 1660
Clotho-s washer 16.60
•_ - -- Dishwasher 16
I ❑ TENANT Drinking fountain 16.60
❑ PROPERTY OWNER ._
Nam c Ejectors/sump 1660
- Expansion tank 16 60
Address Fixture/sewer cap y 16.60
() iv:Statc/71 P Floor drain/floor aink/huh 16.60
Phone ( ) Fax: ( ) Garbage disposal 16 60
❑ .•►PPI.I( ANT ❑ C ONTAC•T PERSON Hose bib 16.60
- - Ice maker 16.60
Business name
- Interceptor /grease trap 16.60
Con tact name Medical gas (value: $ ) Page 2 -
Address: Primer 16.60 - -
CIIV /SIAI& 11'' Root dram (commercial) 16.60
Phone ( I _ - - - 11•ax.. ( ) _ Sink/basin/lavatory -- 16.60 -
• Tub/shower /shower pact 16.60
I •mail _
- • -. _ Urinal 16 60
CONTRACTOR Water closet 16 60
Business name New 6-(otrJih I..A/tJ etpG Water heater - - 16.60 —
Address ? CI a D}( I S i i _ Other:
r: .. --
Clly State/ /IP grovleftin tx p 12 ( Subtotal
(5 ) 431. 33 �/(� (7`� ).113/- Minimum permit ter $72 50 So
Fax: �{� 'I Residentia b_acktlow minimum permit fee $36.25
_ 1 L
L.L'Ft I 'c Plan Plumbing l.1e. no,. review (25%01 fec) �- -
Authnn,ed signature.
}5 f 7 p a Q 7� State surcharge (R4b of permit fee) g d
Tam'. PERMIT FF,F. ,
Pont name � fare: ylbiG q l This permit application expires 1f„ permit is not obtained within
180 days after 8 has been accepted as complete_
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received /2t? Date Requested / AM PM BUP
Location //3J' C) /ter) / �p�� d 7 Suite MEC
Contact Person / /te/ .!, Ph ( ) PLM 4/ /4
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
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 .arg.)el
Susp'd Ceiling
Roof
Other:
Final
PASS P T FAIL
UMBIN
eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan ,
AWN'
PA 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: en Unable to inspect — no access
Fire
ADASupply Line G A0` /
Approach/Sidewalk Date Inspector Ext
Other:
Final DO OT RE OVE this inspection record from the Job site.
PASS PART FAIL