Permit 1- .._
• CITY OF TIGARD PLUMBING PERMIT
A.gove DEVELOPMENT SERVICES PERMIT #: PLM2005 -00045
,4111- . .� �- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/4/2005
SITE ADDRESS: 12921 SW WALNUT ST PARCEL: 2S104AD -02601
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW 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: 70 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 70' line work
FEES
Owner:
Description Date Amount
PETTERSON, THOMAS W
PAULINE M [PLUMB] Permit Fee 2/4/2005 $72.50.
12921 SW WALNUT ST [TAX] 8% State Surchari 2/4/2005 $5.80
TIGARD, OR 97223 Total $78.30
Phone :
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD #344 REQUIRED INSPECTIONS
MILWAUKIE, OR 97267
Phone : 503 653 - 5301 Septic tank
Plumbing final
Reg #: LIC 138941 Sanitary sewer
PLM 3 -434PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: i Permittee Signature: /fyl c
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
02/04/2005 11:12 =M' ° ' C EIVED PAGE 01/02
Plumbing Permit AppliEER0214 2005 FOR OFFICE. (JSF ONLY
City of Tigard � Reeeiv
13125 SW Hall Blvd., Tigard, OR 97'429TY OF TIGA " ,il Dat e i� /v t .86 3
permit No �� M ?06,5_,..90,, Phone; 503.639.4171 Fax; 503 ;;• :, Piaevt w
G DIV • " ^ Plan Re Other Perm{t No..
24- Hour Inspection Line: 503 639.4175 I �
,r,,!,7 - _,,, Date Ready/By; mra� ®$ee Page 2 for
Internet: www ci tigard.or.us
No[Ified/Medlod; T Supplemental Information
"` y, Pii.,4: l r,1 9 164 7 a'icrl ' 7 " • .'t'lr1.7,.li a ,: 1¢1' tiP' p ' ' - ,
- TY C, � 11.1. : w I.I,; � '
61 , ,, � r , ' 1 7 ,
r ; 1 , { �H m !t k gIL I I' I c I.,.'it 'J1,i 'I 'h , f
i C14-4U1: 4r � .�r1+,�;�� �r,t���}?d� �,�t1� ��red:' tnM'a. ,�� � :�:' � -Ta.," ,• ' - . �. - • `'� , . � 1 � r ��` .$�1��i3�)
t n, i� r;•t7 ,: �h : ., �'L : a tl 5 y� ' l ' r , .. 1 1-4-V., ,� :oa .ri
❑ New construction O Demolition For credal information usi cheCkliSf
Description 1 Qty. [ Ea i Total
tdditton/alteratton/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft, for each utility connection)
I a �" �� tl'V JIAkkJ � 671E � y,
1f y �� 11 1 �l / ( A Iv j i J11'! � ^ ' 't {in l i , s ;'71 ° ,11 z
4 I 1 1�F..1�, 'I. � `+SSt ��,7 r .7 ul f� ll ' R 1'( r, F n � �.F - -
,,1 i 41 7'f" n.el ,,, ,,,..,. Ljr'era�u„ ^,mu-1'�� >Y,�. altd�t�,�Y n�{s!a�±l' � , u t !:11:x• i ".�+� SFIt (l) bath 249.20
and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Muiti- family SFR (3) bath 399.00
❑ Master builder
Each additional bath/kitchen 45.00
Other
1 , 4"� ivv{' f '"� �t l , t r t uruit f ?Tr r {7 — T Tvr Fire sprinkler (. sq. ft) Page 2
I ke. f.l'�i,'lAi1, �tz. a.5" r }.i1 i }I.• 1,1 S g,ib kr) wt� 10 .i�t,
+�i'�I � T /�;'� r�x- � t�+��k r':{.- �,t�il�•r�ucTt,�,r�� .t.wll�iatelR,..rst.�. ,,.- '�� L�' : Ilr.' � 91te utllltlea
Job site address: 120 2.1 5 W u,) IPtt,N t,`'t Catch basin or area drain 16.60
City/State/ZIP. I . fib d ii ci 223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: -20 (1- De Gr,ia,r 55rr4, Footing drain (no. linear ft: Page 2
7 �4 - Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
V6DT— , 2--4V7` 6, J u Rain drain connector 16,60
J Sanitary sewer (no. linear tt. • _) lo o- Page 2
Storm sewer (no. linear ft,: ____) Page 2
Subdivision: Lot no.: Water service (no. linear ft.; ) Page 2
Tax map /parcel no.: Fixture or item
,, y � rr , (( r , ,r a 1 ro` zltu;�^�'n^ L� , s r�s ✓r":� r
Absorption valve 16.60
>, t'j'" d, �11'; °t i `.' 1 "11Az` , l.i1, ,T l j t T •I " 5. ; ' Ir ^r} , I I ,'.1P -NSYfiir BaciCflO prevcntcr Page 2
R.E.PL
J, ' l w � :1 � 1. �I�1�t 3�rrb'�` . ,'- F r n nls w
r -1 -1_ 1 o 0 F S e-w�_ Backwater valve 16.60
LlN 1'v •-- F . Low,. 64 (,%.C. t uy1 d5edZi LL Clothes washer 16.60
nI ` Dishwasher 16.60
yy_ l oq f 1 1" �3 �g Drinking fountain 16,60
t�,. {�rt..6 I .711 t1'er:/ „�1a�9I� �. 0 , It 1'�\� I l IttG�; rllll`;�'I�I16i fi t +' -- ,j1.;,. ''i61 F gi„tors /sump 16.60
bn :k„�r sa i.,In. . az.,._tf�.NEhn.?t, l.t1ll t uYt ,.d _a Ixnf„n.,.
Name: m 'o fv Expansion tank 16.60
Address: PA 2 t e L)- 1A) N iT ( l Fixture/sewer cap 16.60
City/State/ZIP: TW,- (s -.2t) _61(2, q "7 'Z.3 Floor drain /floor sink/hub 16.60
Phone: (01) Gnt o - ( Fax: ( ) Garbage disposal 16,60
'ir'i .��¢� �F+ t >r :fi'f+'If7rsr r�Flf ^'?� Aw,. Hose bib 16.60
;i V, 11 4 1 n I l GI N'ul l i spy 1 f 1 M °61 5- i I IL
16.60
-...In i S ,... ! L, rrtL'il ,^v�1, g ITir; .fR;,:44 ,,.a, .., h.. : I IFS... 0c :..=:5 't tir ,Y .r�, . ll rd_: [ rl rf s . I , w. „
Ice mak
er
Business name: 1-4 1a- e.00'r` .iz.
I /greaac trap 16.60
Contact name: J e�f ■ 7 0.)e...—T
Medical gas (value: $ ) Page 2
Address: ( 3-3 '- p"`C L f! t../ I l ) - Primer 16.60
City/State /ZIP: /�( I W �i . o f . 97 p'7 Roof drain (commercial) 16.60
Phone: (5 a (a S 3-5' / I Fax: : (9)3) 655—'53/ 6) - ower/ hove 16.60
Tub /shower /shower pan 1660
E -mail: Urinal 16.60
iN a' ' ! , ! I :r� 7?p"I�T�rI.� ��, p
;a); y ;a .1 , r', ,,.'' , 1: ,' r4i{ qr� :'�� t
1 h ` �r �tlt!' Y IOra{�fAtti r ithiY ..4 t , '.Litt: 1”. A 4,:''-I` � 11'I,A ;40 Water closet
1 16.60
_,ta r�. �.,Jlta Y. , :.,�
Business name: • y Water heater 16.60
Address: / �r i Other: kei subtotal
City /State/ZIP:
Minimum permit fee: $72 50
Phone: ( ) Fax: ( ) ^ - ./� Residential backflow minimum perrnit fee- $36.25
':CB Lic : \ ` Plumbing Lic. no.: ` pja) Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Autborized signature: (041/4----” r TOTAL PERMIT FEE
+y
Print name: Lt5 Pt- 0 i2T Date: C r I This permit application expires if it permit it not obtained within
ISO days after It has been accepted as complete.
'Fee methodology set by Tri -County Building Industry Service Board,
i-'.Bwlding\Pcrmlta \PLAT- PennitApp.doc 12/03 44o - 46 t6T(10/02:OlVWER)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line :, (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 2 -g / ` � AM PM BUP
Location l 90 l ‘,2±
d� Suite MEC
Contact Person Ph ( ) S3-530( pLM A DOS- - d 0 0
Contractor Ph ( ) g 4 9 - 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 .
Ina Sheath/Shear F I 1 �.d. Prav(A Co L zi
Framing S2 �'I' c- tea" �� f '"'
Insulation p
Drywall Nailing e I f �'�/ ����s�� 1 w� gI R�v� C; "��
Firewall
Fire Sprinkler r� y r ro I%< 4 1-c.
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Se ice
ni ary Sew
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• Ier:
CO PART FAIL
M ANICAL
Post & Beam
Rough -In .
Gas Line
Smoke Dampers 0
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage .
Fire Alarm
Final D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW. Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Q Un to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7 - T 1 0‘ Inspector c7 Ext
Other: -
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL