Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 - 00065
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/12/04
SITE ADDRESS: 15680 SW UPPER BOONES FERRY RD PARCEL: 2S112DD
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 3
OCCUPANCY GRP: B 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: (3) backflow preventers.
FEES
Owner:
Description Date Amount
FERRYMAN, H E
9110 NE HWY 99 [PLUMB] Permit Fee 2/12/04 $139.20
VANCOUVER, WA 98665 [TAX] 8% State 2/12/04 $11.14
Total $150.34
Phone :
Contractor:
MP (MILWAUKIE) PLUMBING CO
P.O. BOX 393
CLACKAMAS, OR 97015
REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 503 655 9161
Final Inspection
Reg #: LIC 5002
PLM 3 -17PB
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: ca.4 Permittee Signature: C/r a12-pt-
Call
(503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
FEB -10 -04 07:59AM FROM -MP PLUMBING 5036551726 T -719 P 02/02 F -508
" Pitima<rin Permit • ation FOR ()F LitiE ONLY
Reaeivcd D Plumbing
Da "/0 2 / Pe m No i7 C'0 -DOv65
City of Tigard R Planning Approval Sewer
Darti8y Perms r No:
13125 SW IWI 13lvd- F EB 10 2004 Plan Review Other •-
Tigard, Oregon 97223 Daadl : Permit No.:
Phone: 503 - 639.4171 1bg1b0E5 §1A.6 Pose- lievied Uce
CIV .It•r,, +.r. • i ns •f i DateBw Land
Case No.:
Internet: www.ei -cigar 1 DIVI .r �
� � . : ` Contact s : ®Sco Pagc 2 for
24 - hour Inspection Request: 03 - 639 - 4175 " Name/lvlethod: " '�� Supptcmcntal information.
'.'.. ..4 r: FIF,: 4, 4i• nVoitl a. ?!: Vic". _C' ii. ‹'.1 41.1 E ' E Sc.HE foif,ri egi i 1p e l 'y q p :i
p i New construction Ii Demolition Descrl . tion - Qty. Feetea.) Total
Addition/alterari s 1 - , laeernt nt Other: , -+ ,,, . , . r ' : ; i $ f ! ' ' �; < ^ , ;za : s : .,
: *•rte,AVE() 1.01 a R UCTION• :.:'_"•tgl .:�c ' o m e ip.r:, b _ °'.riF_;;
;� :;.`...':21 SFR (1) bath 249.20
II 1 & 2 -Fa�i dwellin 1 Ilk Commercial/Industrial - y - (2) bath 350.00 -
�■ ze� • • Bu>Ydin; e� SFR ( 3) bath 399.00
IN Master Builder ■ Other: Each additional hath/kitchen •r. ' 45.00 '
r`:r' ` :1e. t ? T£51 tORMATIteir 'i✓di• ' o CATION,:'r..`' ', ; . • ?' Fire s - cr - • ' . ft.: P: • e 2
Job site address: 11 peoa, nT ,r r. 4 :rte e. .. •0,1M1, . '.r e;It$iilidc@,a ^x.:0f.::l.1 y.,j .•l',t'
Suite #: / 5- g ° . Bld: JApt. #: Catch basin/area drain 16:60
Pro act Name: u. _ .. 5 -e}s
Dwell/leach line/trench drain .36.60
Cross street/Dizeati to job sitr: Footing drain (no. linear ft) Page 2
1 Marmfseturcd home utilities 110.00
7,
/ ' 0 Manholes 16.60 •
/ Rain drain connector 16.60
• Sanitary sewer Sao. linear ft.) Page 2 .
Subdivision: LLot #• Swum sower (no. linear ft) Page 2
Tex ma y f el #: Waxer service no. linear ft Pa. e 2 �
Y'^'A•e
'. 41 ;'l i::! vrici • 'x d. r , nl: � , ..�
' - �1 '. ikl.`.r F 1:k.L. 1t.v � I'i " "� .b ' • •h:1 •. • ` -_�m 4" 4.r...",; .
- Absorption valve • 16.60 '
o - _ si Backflow pm-venter -5 - 1?ane 2 1lei . Zo
IIIIIIIIIIIIIM Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
gt ; ".'„I l " ;,..:� Drintcingfauxrtain 16.60
�; lv' � '�~ .hD;_.r �+'1.�;:�.;., E ee[ols/s . 16.60
_si• T a �. - . sion tank 16.60
Atoms: Z 414ia��r s nq v Fixture/sewer cap 16.60
as /State/Zifp :'j' �, (.../ C "� S Floor drain/floor si:ak /hub 16.60
Garbage disposal _ _ 16.60
Phone: .B Fax: Hose bib . 16.60
Et:crfi�it MLLE/ IMF7 glt-• c •. f _
Ise maker 16,60
Name: .... , - . Qt� Inxcrcc todgrease uap 16.60
Address: y Medical has - value: $ Page 2 , _ _ -
Ci /StarwZi •
Primer _ 16.
\ �_ w. �, bl �' Roof drain_Lorninercia9 16.60
Phone: . 1. - t Sink/basin/lavatory 16.60
E-mail: mb/uhower /shower,pan 16.60
:^: ' e ' - ::*/::1 . 1 :1.- ;•• :Np1CCi 1 t) ' I; ... .� , �; };',11pc,.� ='.; Urinal 16.60
J Water closet 16.60
Business Name: v- k 9 OU_t_vv\1n (,,-,s el, Water hearer -- 16.60
Address: 3e.,.??,,,, 4 other: _
Ci /State/Zi . : _ (-1, c') ib1 °then. '
Phone: c S Ova` Fax: Co. $ _ n ' 11 f N ' y : 4•' ___ __ Lr _,__ -
'`t � • ; ' .
CCB Lie, #: ' . .z Plumb. Lic. #: yZ �, Subtotal $
Minimum Permit Fee $7250 $ q 2 " C " ) A tidtn[zzod I Residential Bacicflow Minitrnun Fee $36.75 ‘
Signatt e: a x-04 PIan Review 25% of Permit Fee $
. - State Surcharge S% of Permit Fee) S t
(Please print name) TOTAL PERIVDT FEE $ O .
Notices This permit application mires If a permit is cot obtained within All new cnmmorcial buildings require 2 sets of plef with isometric or
180 des attar It ban been aeevpted as complete. riser diagram for plan review.
*Soo Incebodology eat by TrI $oltd(ng Industry Service Board.
i:\Dsts\Petmit 1?omt7 P1mPerrnitApp.doo 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
off/ 3 4 / �► BUP
Received / � 3 7 D ate Requested I AM PM BUP
Location • w �Il! �,� ae1 I -: i , : MEC
Contact Person /56 Ph (% 3) , 55 /b/ -0OD � �S
Contractor /r') P 1 Ph ( ) SWR
BUILDING Tenant/Owner giv -dem P eel 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 A
Fire Alarm
A r or /,/,- �?
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer _
Rain Drains
Catch Basin / Manhole ,
Storm Drain
Shower P n.
dlie PART FAIL
HANICAL
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 E Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date - D Inspector " - 1 27 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL