Permit CITY TIGARD PLUMBING PERMIT
�r l� DEVELOPMENT SERVICES PERMIT #: PLM2003 -00348
!c II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/16/03
SITE ADDRESS: 07125 SW VENTURA DR PARCEL: 1S125DC-01600
SUBDIVISION: WASHINGTON SQUARE ESTATES ZONING: R -4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft - -.
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install shower valve and drain
FEES
Owner:
Description Date Amount
125 S W VENTURA DR
7 [PLUMB] Permit Fee 7/16/03 $72.50
7125 SW
PORTLAND, OR 97223 [TAX] 8% State Tax 7/16/03 $5.80
Total $78.30
Phone :
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
•
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 24184
PLM 26 -162PB
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
Issued By: / -
Permittee Signature: A / ✓ o / _ _
Call (5 3) 639 -4175 by 7:00 P.M. for an inspection needed the next busi ess day
06/14/2003 E.13:•.05 :; 5036427755 ANCTIL PLUMBING PAGE 02
Building Fixtures
4 !'h . Plumbing Permit Application C
- i Date received:
Tnt►.:P/I9��3 a3 y of Ti �s and E Sewer permit no.: ilding permit no.:
Address: 13125 SW Hall Blvd,
City of Tigar Phone: (503) 639 -4171 Prajectlappl• no Expire date:
Fax: (503) 598 -1960 JUL 16 1003 Date issued: By: I Receipt no.:
Case file no.: Payment type:
Land use approval: - CITY OF TIGARD
& 2 family dwelling or accessory O Comnaercial/industrial ❑ Multi- family CI Tenant improvement
Now construction ddition/altcration/replacement 0 Food service ❑ Other:
.loll SITE INFORMATION FEE SCII4:DI. LE (for %pecial inlorumtio u•c checldiO
Job address: l Z S 5 ) ( 'IuY F v i r / _ Desert .lion M Fee(ea.) Total ,
Bldg. no.: I Suite no.: or - and l- rrn y , we Igo l y:
(includes 100 R. for each utility c , .. • on)
Tax map /tax lot/account no.: SFR (1) bath
_ Lot: Block: J Subdivision: _ SFR (2) bath
Project name: F 1 r NI' _ SFR (3) bath
City/county: I ZIP: / Each additional bath/kitchen
- Description and location of work on premises: Site utilities:
....W1/415,111$1.- StitytM6' i/4 (VV mvV P'2 IIJ Catch basin/area drain
Est. date of completion/inspection: Drywells/leacia line/trench
PLU[ I1lI :�t"1'nit Footin: drain (no. lin. ft.
_ L Q Manufactured home utilities
Business name: /� p f tlmt>g iw)4 xikic. Manholes
Address: / (q Ob S W J.)-7-4-0 J go Rain drain connector
City: (5lV. State:U( I ZIP: q 9 c _ Sanitary sewer (no. Lin. ft.)
Phone: (pit.(' 1-3Z3 Fax: Z„ SSI E -mail: _ Storm sewer (no, lin. ft.)
2,4( CCB no.: "t / $L! ,Plumb. bus. reg. • • : 7„,6,--1 (2. P13 Water service (no. lin. ft.)
City/metro lic. no.: AO 4 J Fixture or item:
Contractor's representative signature: /I • — ,,. Ar Absorption valve
Back flow preventer
Print name: g 1 L(. /�n�fi L F Date: -�-� 15 a3 Backwater valve _
i
Basins /lavatory
Name: Clothes washer
Address: Dishwasher
Drinking fountain (s) _
City: [State: I ZIP: Ejectors /sump
Phone: Fax: E-mail: Expansion tank
Fixture /sewer cap _
Name (print): E-B (/ Floor drains/floor sinks/hub
Garbage disposal
Mailing address: ,S^yn 6 Hose bibb
City: I State: 1 ZIP: _ Ice maker
Phone: I Fax: 1E-mail: Interceptor /grease trap
Owner installation/residential maintenance only The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. . Sink(s), basin(s), lays(s)
Owner's si ature: Date: Sum
Tubs/shower shower pan / `—
N Urinal
Name:
Water closet
Address: _ -
Water heater
City: 1 State: 1 ZIP: Other: , -
Phone: Fax: E -mail: Total Z. - I
-� Minimum fee S ' j.• 51) Not AI jurisdictions accept credit card.. please call jutedktloa fir more ieforamrlad. Notice: This p ermit application a
C1 Visa 0 MasterCard expires if a permit is not obtained Plan review (at u /a) $ .
Credit card amber: / / State sure large (8 /6) .... $
Expires within l80 days after it has been TOTAL . S WS. O
Name of cardholder u shown oa credit Card accepted as complete.
$
k Cardholder algeuure Araouat i 440-6616 (6/001COad)
CITY OF TIGARD - 24 -Hour .
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION . Business Line: (503) 639 -4171 . MST
• BUP
Received Date Requ sted /0 °' 7 AM PM BUP
Location 5 j V- 1' it OJ^ Suite MEC 3 — 006.369
Conta Ph (,LL) 0 a/ &9 PLM 3- - Oo3i / g
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain AC C ss: ELR
Crawl Drain 1 /7/e% 3 e
Slab I spection Notes: '7- `�
- / 7 / SIT
Post & Beam l
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
-
Framing
Insulation Z.lag
" " •■
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling /�
Roof / \ /
Other: • \
Final
PASS PART FAIL Mirtalairill..;a1111
Post & Beam /
Under Slab
Rough In \
Water Service
Sanitary Sewer `�
Rain Drains
Catch Basin / Manhole -
Storm Drain
Shower Pa
ar7 Ot z * \(.___.
ANIC • e .-----"'
Post & Beam
Rough-In
Gas Line (� /
_ / �� �}-,/
Smoke ' Da . : -
d MP
PART FAIL /
ECTRICAL
Service a (.7-"
Rough -In
UG/Slab
Low Voltage
Fire Alarm •
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Dat Inspector �•���Y Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL