Permit CrrY OF TIGARD
PLUMBING PERMIT
iIn DEVELOPMENT SERVICES PERMIT #: PLM2002 -00404
!� °' ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/21/02
SITE ADDRESS: 09645 SW WASHINGTON SQUARE RD FC -8 PARCEL: 1S126C0 -01107
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS t GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocating 4 fixtures: 1 lay, 2 floor drains /sinks, Install 1 backflow preventer.
FEES
Owner:
Description Date Amount
PPR WASHINGTON SQUARE LLC
P.O. BOX 21545 [PLUMB] Permit Fee 10/21/02 $96.20
SEATTLE, WA 98111 [PLUMB] Permit Fee 10/21/02 $0.00
[TAX] 8% State Tax 10/21/02 $7.70
[TAX] 8% State Tax 10/21/02 $0.00
Phone 1:
Total $103.90
Contractor:
HIGHLAND PLUMBING
PO BOX 1866
OREGON CITY, OR 97045
REQUIRED INSPECTIONS
Phone 1: 503 - 723 - 4445 Rough -in Insp
Top -out Insp
Reg #: LIC 145756 Final Inspection
PLM 3 -479PB
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: P / %� / � � 1 . i Permittee Signature: %)j 0 ,0 #
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Oct 18 02 09:17a Doug 503 - 722 -2274 p.3
10/18/2002 14:38,, FAX S035981980 CITY OF TIGARD (ih001
• `' - Building Fixtures -
°~ . g ..'. Plumb�n PermitA lication OFFICE 1_'1F O \ONLY �,,, A
(7 �� l Dale received: 0--at -
c 2 Permit no 1-kQ - / ,1
� ' �ity of Tied li/ ' ; r Sewer permit- no.: Building permit no.:
Address: 13125 SW Hall 81 d, Tigard. O 47 2 2 3
City of Tigard Phone: (503) 639.4171 1' 1 7 Projectfappl. no.:
Fax: (503) 598- 19960Cq Ir � �� Datc im,cd �� Receipt no.: 8
Land use approval ' �' 7 1 '.:1.7 '' ' Case the no._ Payment Type:
TYPE OF FERMI
0 1 & 2 family dwelling or accessory `: Commercial/industrial 0 Multi- family 0 Tenant improvement
O New construction ■ Addition/alteration/replacement Cl Food service 0 Other:
' JOB SITE 1NFOR\MAT1O\ l EE SCII[DI ;LE (for %peci;tl inf.rinaiigtruse ehcclaist)
Job address: 4 ' ` - 7 , , ./N, , . � ( Description Qty. Fee(ea.) Total
Bldg. no.: 1 Suite no.: New 1 - and 2- family dwellings only: .
Tax map/tax lov:tcoouni no :
(includes IN ft- for each uWity connection)
SFR (1) bath
Lot: / Block: Subdivision: SFR 2 bath
Project name: 5 SFR (3) bath
City /county: ZIP: Each additional bath/kitchen ,
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of co. letion/inspection: 1 Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. fL)
v
Business name enufectured home utilities .
�_ di , • Manholes
Address " i - : y _ -'- , Rain drain connector
City(5V ..„-I t z Stat e[ ZIP:' V)(,L(� Sanitary sewer (no. lin. ft.)
Phone 7J ...Lf LIt. -ILII E -mail. Storm sewer (ao.3in. ft.)
CCB no.: i y �1� umb. bus. reg. no: �j - `-1'1"1
Waterservue no. lin. ft.)
City /metro lie, no.:13c ".) Fitctur or item:
Contractor's representative stgnatu>c!'. ,a Absorption valve ,
�, .�� Back flow preventer 'zp c t , c t _ y6 +
Print J .-� -.. C _ - - a : Backwater valve
CON I . ACI' PERSON Basins/lavatory I ' /l0.40,
Name: Clothes washer ,
Address: Dishwasher
Drinking fountain(s)
Cott : I State: I ZIP: , Ejectors/eump
Phone: Fax: E -mail: Expansion tank
i
O wti'CR Fixture/sewer cap
Name (print): Floor drains/floor sinka/hub 33 . aD .
Mailing address: Garbage disposal
Hose bibb
City: ) State: j ZIP: ice maker
Phone: !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 signature: Date: Sump
FNCINEEH Tubs/shower/shower pan .
Urinal
Name:
Address. Water closet
Water heater _ ,
City: Statc: ZIP: Other
Phone: - I Fax: E - mail: Total ,
Nat "Mill"' z p. awn °mill. Pic' eon jaiadiaiOf f« more iafanuaai Notice: This permit application Man fee S 7 c[� • Q
O visa D MasterCard etphea If a permit is net obtained
State revv iew (at a v.) S
Stare surcharge (8%) S -AS , 7v
Credit card awnba. _ b*D res within ISO days otter tt has been TOTAL S /Oc� • 9 V
Nuns or audterdar as shone en credit care accepted as complete
S
Cardholder aigas,p, Mecum i 440-L6$6 (doO OM)
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / - AM PM BUP
Location 9 �/) S w 4S#k . 5y. / Suite MEC
Contact Person Ph ( ) 72_3r V ` � PLM aribZ —4 b c/O y
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain f� !` � L �, e / ?2t /� /,7 ELR
Crawl Drain l!
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear FO° °eL.i
Int Sheath/Shear
Framing POI?
Insulation
Drywall Nailing •
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
ost & Beam
Under Slab
Rough -In
Water Service / ® �
Sanitary Sewer / MMrAgirg.
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Te
PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service _
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 Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA ,{
Date ia
Approach/Sidewalk v Inspector /7 / 2 / Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL