Permit v
CITY O �yC
I TIGARD PLUMBING PERMIT
I�
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00077
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/20/04
SITE ADDRESS: 12828 SW WALNUT ST PARCEL: 2S104AD -03401
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 80 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 80' of water service.
FEES
Owner:
Description Date Amount
LEWIS, BRIAN C + CHRISTINE C
12828 SW WALNUT ST [PLUMB] Permit Fee 2/20/04 $101.40
TIGARD, OR 97223 [TAX] 8% State Surchari 2/20/04 $8.12
Total $109.52
•
Phone :
Contractor:
NORTH'S PLUMBING
17120 SW SHAW
BEAVERTON, OR 97007 REQUIRED INSPECTIONS
Phone : 649 5544 Water Service Insp
Final Inspection
Reg #: LIC 340
PLM 34 -18PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Is ued By: - . ;;1`�,/(� l Permittee Signature: 4411_
all (51 . 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
Plumbing Permit Application : ,, ,
Datereceived: • j - Penult it y ._ 0 �
0,1j_. -, City of TigaI ECEIVED
Address: 13125 SW Hall Blvd. Tigard, Sewer ppt7Nt no Building permit no.;
g OR 97223
City of Tigard
Phone: (503) 639.4171 FEB 18 2004. "
° ' � ° pp' "° ire date:
Fax: (503) 598-1960
Da te issued: ' (B : Receipt no.:
Land use approval: CITY OF TIGARD Case file no,: Payment type:
• ► DIVISION -
I'hI'F. 0I' PERMIT ;
1 & 2 family dwelling or accessory ommercial/industrial 0 Multi - family , O'Tenai,t improvement
CI New construction 12r Addition/alteratlon/replacement 0 Food service 0 Other:
' .1011 SITE INFOItMA'I7(1N .. Y . 4 ., • Job address: f cz$e 057 ft ), / - Damrl don 0 . Tot„ I I
Bldg. no.: Suite no.: `ew 1• and 2-family dwe ' gs only: •
Tax map /tax lot/account no.: (includes 100 ft. foreach utilityconnection)
SFR (1 bath
. Lot: Block: Subdivision: SFR 2 bath
• Project name: FR 3 bath `
• Ci /coun ' ZIP: f- - -h, ;• • A t,..: 54, en -
Description and location of work on premises: Site utilities:
• . Catch basin/area drain "
Est. date of completion/inspection: Drywells/leach line/trench drain -.. _
PLUMBING CONIItA('T01i: Footin: drain (no JET)
Manufactured home utilities
Business name: Wr ;a •anholes � ~ 7
Addr s: .., . R1i�� �i e . ,
• nnector j
t ,s=MEDI AN Sanit • - ( .. I . R.)
Phone: " 3 n A �• E-mail: Storm sewer no. lin. it) , O/• %p
CCB no.: , Plumb. bus. re ?. no: 5 fy' '11 Ater service no. lin ft_) MM." ; ' -
City/metro lic. no.: O - 'L 2 j illIlliis.- Fixture or hem. • . -! • Contractor's re •resentative signature: I/ / Ji;/ Absor valve
�U : ark t ow revcnter
t!- - �Mi4 Date:O / - ' p _ i
�' t? �' a" Backwater valve
CONTACT PERSON Basins/lavatory
Name: lothes washer - -""�
Address: - Dishwasher - -"
Ci State: ZIP: Drinking fountain(s) —"
Electors /sump
• Phone: Fax: E -mail: Expansion tank
OWN1 1 • ixtur sewer cap — '
Name Orbit): - Floor • rains/floor sinks/hub _ " -- _ ;
Mailing address: , � Garbage da • •sal
Gity: h ey iP State' ZIP: 7� . ose b:bb
Ice maker '—"'" _______
_
Phone: 34,' - -'9b I Fax: I E-mail: terceptor /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) - H
employee on the property I own as per ORS Chapter 447, Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump . - _
I,NGINEER Tubs /s tower /shower pan j
Name: Urinal
Address: Ater closet
Water eater
City: � State: 1 ZIP: Other:
Phone: -- : • I Fax: E•mall: Total , `"-' 11111
---I - ,
Not sit iuri,Nnlo t accept mirth cards. rykaw eau iurndictioa for more toforntiwon N This permit application Minimum fee �+' $ — /� �
O Visa ' ae •• - - ., _ Plan review (at _ `.o) $
expires if a permit is not obtained
A 4 ` ~ L aurae N/fl J r re, i w 180 days after it has been State surcharge (bob ) .... $ _ /'
' � x01 - - accepted as complete. TOTAL .. 5 _ f C7�� '
`' and alder 1 n mourn ua.1616, (c ";oCC .'.f
/0
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
� 2 3 /0. 2 3 a Z
Received Date Requested � 4 AM PM BUP
Location / a d 22 ail/ Suite MEC
Contact Person ZJ Ph (_5_0_5) 6 9 ' S 412, 9 27
Contractor 7iQ17 & O&M • Ph ( ) SWR
BUILDING Tenan �f // u," 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 oi
Firewall .� —
Fire Sprinkler /
Fire Alarm
Susp'd Ceiling 1 3 p
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
,Under Slab
Rough -In
ater ervice
a er
Rain Drains L!/"
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: •
Final
6/1M PART 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: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date t j (1, Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL