Permit � w -
//l CITY OF TIGARD PLUMBING PERMIT
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, DEVELOPMENT SERVICES PERMIT #: PLM2004 -00132
ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/1/04
SITE ADDRESS: 13134 SW WINTERLAKE CT PARCEL: 1S133DB -04700
SUBDIVISION: BRITTANY SQUARE NO. 4 ZONING: R -12
BLOCK: LOT: 075 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Backflow prevention device
FEES
Owner:
Description Date Amount
DANIEL BOCKELMAN
13134 SW WINTERLAKE CT [PLUMB] Permit Fee 4/1/04 $36.25
TIGARD, OR 97224 [TAX] 8% State Surchara 4/1/04 $2.90
Total $39.15
Phone :
Contractor:
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
NORTH PLAINS, OR 97113 REQUIRED INSPECTIONS
Phone : 647 - 5567 RP /Backflow Preventer
Final Inspection
Reg #: LIC 5742
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
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Is ued By:��'/ �I /�;, Permittee Signature: //
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Call. 503 . - ' -4175 by 7:00 P.M. for an inspection needed the next . usiness day
Mar 3 1 04 04: 36p L P - 1
03/31/2004 FAX 5035981960 CITY OF TIGARD ej 00 1
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Plumbing Permit Application f. orricE us' (0.1.1'
City of Tigard
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DatelEtv: Eb intil=1!f!!!'-,, a
13125 SW Hall Blvd., ligard. OR 97223
Plan Review
Phono: 503.639.4171 Faa: S03.598.1960 Dar/By: Ocher Pgrrritt No.:
24- Hour Inspection Tinc S03.639.4175 14 • i 1 Dam RudyiBy: 63 Set Page 2 for
Internet www.ci.tigard.or.us NoclOosliMethad: -*" t SePplemermi intbrwaas•
eFT.1.::,':oi.tr.!:, AI illpritk ,,-.' ,.“. *iiiiritoli c,..,,";,",' :;:: :1...;.,•,••• •.3.1:-,,r .;•'.1 1„ , -..s.. ia.Ti ;;-.. -•;:t- • ''',1 ithefar!' , ' ... .• •
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[3 New construction 0 Demolition For special issfarroorien we checklist
Description I Qty. I Ea. J Total
0 Addition/alterstionimplacement 00ther: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
rii.ti.,:li ;Ii' 11!: gEiTiMr.g. ' ' k '.sc.;.' -. , ; , tiziOe . . 9 i:: 1 1*;:lickl:Pfi..4;; SFR (1) bath 249.20
RI l - and 2-family dwelling 0 Commercialfiodustrial SFR (2)both . 350.00
0 Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bads/kitchen 45.00
0 Master builder 0 Other:
Fire sprinkler (___ in. ft.) Page 2 r
tiQ : 0 1' ,1 L I: i , git
Job site address: / 3 3 . L A,i ; -, f-e,..... C_,-i- Catch basin or area drain 16.60
City/StaterLEP: ,Q r) j,... 42 _ 9 2 2 , 2_ (,4. Drywall. leach line, or trench drain 16.60
-.....
Suildbldgiapt Do.: <-.) Project mime: Footing drain (no. linear ft.: _....) Page 2
, Mantactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
/ 30 1 4- 6..; ;- .-i_lf A?4te ./.. 4
:, ,, C-) Rain drain connector 16.60
Sanitary scorer (no. linear ft: ) Page 2
storm sewer (no. linear ft.: ...,_,) Page 2
S i r J'. A -
e
Water service (no. linear ft.: ) _ Page 2 _
ubdiv: t.......-z".. I Lot no.:
Fixture or item
Tax ineprpareel no.:
Absorption waive 16.60
-" . cp.... :.. r ......., -:.% c .1 ' - . • by. • •". '.' c• ? 0,FAVLII,(11,1, ' I•JV 1 :' : I' .': • „:
FP *MX A ' : I ' i 'c e : • f 4 r :011iii,E.- BatIdlow memo=
Pat* 2
A. ....e, k . , 'i I. Backwater valve i 6.60
; -
-• -
k ..t..4-, < , N Clothes washer 16.60
-
Dighwasher 16.60
fniuncin 16.60
r...e.i.'E :: , . 11., .• • ..., k - t:% 1, . . '11 ;?r,.;;I:.e - 1 '..4 'II RIID:1 . .: - , ... ■ • ■ 4 A re 41:1, 1. Ejmorsistimp 16.60
Name: .) .
-. • ... . ... ' ...1 Expimsion umk 16.60
IIMESIMEnt Fixture/sewer cap 16.60
City/Starr/ZIP: '73 r . - _._ $' 5 ? Z-
i-- Z y. Fl dminmoor sinkinob 16.60
Plcone: ( ) C.) Fax: ( ) Cradsage disposal 16.60
1 ;710-t•It R1 7 • ' k • 1 .. .`'. : 7," ' N194.14..iP;:f ••• Ifitl a :'",''',',.. ,'", ';,,,'
. ' Hese bib 16.60
p . 51,4 it;,?.
' • Ice maker 16.60
Business nain= 1 c . ." # "I . 1.-- 4 : • I V/Le-5 LC Les racc--CP €. bumeeptorigrease trap 16.60
Contact Milne: pi r..... 1.,, T ( lok <,t,Kje e , .. - Medical gas (value: $ ) Page 2
•-i
Addrms: p. ci , .er, p4 - -› c) 7 , ?Timer 16.60
City/StatteM: it..4 11 Pi c ... ,<- n e. 42 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Plionm3) A y e 7 6 -,... - . - I Fax: : „Kos) 4 9 7 si .
Tubisnovealshow, pari 16.60
E-mail: -
Urinal
.,,'•'•°'.: • - [1•47- 16.60 177:..■4 - ;- 1 1 .1 41m. it.l...
4 .th not i.:. ..1 i . , i _...ry , • ..., ., . .; '. , • •I' 1.,1 • •RI.,1•:e.. ; 1 I .; , ;• , .• • Water closet 1660
Business name: Al . }- 1 %,„ ..._5 ,.,.,ke....-s.- 4,... ,......, 41f .j neater 16.60
Address: i rr'c, le w et 7 Odstr:
City/State/MP: A. . . 4 .
- .._ Subtotal
. minimum permit fee: $72.30 i . 0 2. 16
Phone: L.Ci=3 ) C Sf 7 .c _57 7 Fax:ir,..: 9 .6 l 7 T Residential buicflow minimum permit fee: S3615 ,
CCB Lie.: , - L. Plumbing Lie. Do.: / 6 c, - Plan review (23°A of permit fee)
e
Sure surcharge UM of permit fee) u p Iwo
,
Authorized signature; ..-• Sure 7I #J
TOTAL PERMIT FEE
Print name: .. • • ` -' JINN 111 "e: 1 - 31 - This permit application empires if a permit Is not • ... eel ith:n
.it ' 4 t ca •
128 days after it has been accepted as complete
6 Foe methodology set by Tri-County Building Industry Service Board.
.11 iann 64 9 4 5 1etteruiCOmivillz)
A
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
� � BUP
Received �� � � � 2
2 Date Requested AM PM BUP
Location _ _ e MEC
Contact Person Ph (5 - 4 2g 3 4Z PLM - Cr� 1 3 Z
Contractor Ph ( ) SWR
BUILDING Tena • - /1(.t vJJ 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
Fire Alarm
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
Ot r:
Fin
S 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 El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL