Permit - 1 CITY OF TIGARD PLUMBING PERMIT
,; Y r, DEVELOPMENT SERVICES PERMIT #: PLM2001 -00299
,�,.� �i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/16/01
SITE ADDRESS: 13241 SW WOODSHIRE LN PARCEL: 2S104DC -08500
SUBDIVISION: MORNINGSTAR ZONING: R-4.5
BLOCK: LOT: 022 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: Installation of residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
WHEELER, JOHN R + TRACI PRMT CTR 7/16/01 $36.25 27200100000
13241 SW WOODSHIRE DR 5PCT CTR 7/16/01 $2.90 27200100000
TIGARD, OR 97223
Total $39.15
Phone 1:
Contractor:
SUPERIOR LANDSCAPE INC
27127 MOUNTAIN RD
WEST LINN, OR 97068 REQUIRED INSPECTIONS
Phone 1: 503 - 655 -7377 RP /Backflow Preventer
Reg #: LIC 6315 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued y: �� d/ , Permittee Signature: i/i. �' d i, i //f
Call (503) . 9-4175 by 7:00 P.M. for an inspection needed the next busi ess day
07/09:01 MON 12:49 FAX 503 59S 1960 CITY OF TIGARD Q002
.. a • Y�t�rf,n S � s J c r ,
Plumbing Permit lication
H811� �,{T,� '' tt „� Y �7 r s .� ti � ,2 �, a � Ft. ..�.
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li t City of Tigard RECEIVED Date received: '� 4x of Permit no.: in ' ai s l e / -Gad p
, Sewer permit no.: Building
Address: 13125 SW Hall Blvd. Tiger •$ OR 97223 gpermit no.:
Crn•nfTiga,d Phone: (503) 639 -4171 ji 3 1 1 ci Z001 ProJect/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued:
Receipt no.:
Land use. apprc't .l: i I � C1I MMUNITY DEdE LOPMEN Case file en.: P pe:
lg ,
r id Ott . ' ,: . 'lI nf - , _. , - - a •4. '1. ,1� ...R +'�h ,. tJ►711, 7. =k �' �' >s ' k� ` *- --) "= o v- - - ' ` Tom ... ,, 1C
.VYrx [ � •ti -�T3 s .r . � I �, -5 t d, -•t.
• 1 & 2 family dwelling or accessory U Cornm:fcial/industrial ❑ Multi - family U Tenant improvement
to ew construction O Additit )11/alteration/replacement U Food service ❑ Other:
' ^ ,1= 1 4'� 108 Si XL 11\l II0.\ t w s , `. . 4 , 1'Fl ,S( 111111i1 1 ( h ir:sinii d:minrltudiOn se._hei kh it)
Job address: 1 Description Qtv. Fee(ea. Total
.:- u ... - - . . ..
o
J b no e
Bldg. S uite no.: ew l- and 2- l'anllJy dwellings only:
Tax map /tax 1ot/acconnt no.: (Includes 100 B. for each utility convection)
l !Block: rSubdivision:
SFR SFR bath
(2) bath
Project name: SFR (3) bath =
i11
City/county: • - ��r , 3.. � Eac additional r.. ".'tchen
npt• and atiot f wQ�k Qn mi 1 Shenillitles:
A M A Q J P rtD l t+T' Catch basin /area drain III
Est. date of completion/inspection Dryweils/leach line trench drain
III
i” r,1
.'` 1 1,1111i \ t.i (4UNc 1 ii', 1 Ul2 '--;74',"''''-'''-"--",' „ - Footing drain (Xto• lin. (L)
• _ • ' - Manufactured home utilities
Business name: S . • anholes .1111 Address: 1151M. iii - =- -•` .`_ Q Rain drain connector a
�.__ _ - . State. 21,4•.• pl I Sa UM” se WV! tis0. lin. R.)
Phone: 5Itz . ' ; ed i Fax: - • , Q. Storm sewer (ten lin. ft.)
CCB no.: (:1 L5 I Plumb. bus. reg. no: ' •_ ^" ' ater service (no. lin. L MN
City /metro lie. no.: 1( 2 - -., Future or hems
C
II
ontractor' - •resentative signature: 1 ':• ♦ Absorption valve
Print name: r . ! M � I Z ft D 1111121011111 Back t ier valve vetner r
4, -,'' �� rt N s / (1 \ 1 ' 11'k I c w„ Y;, O y } � ; Backwater va MN
. z Basins/lavato _
Name: tA,AS,5 I lathes wasr -
Address, _ V , I . - Dishwasher
r ♦ 2 rP - p $ r : fountam(s) • 1111.1
one: ( t�`�)� +Y'' Fjectorslst tank
—
m � Ex .: • ion tank
d� 10 �i:t` Sr4 i -, `
,,'' '` ?;
... •��- �.. E- _ ._. <4 ..,. ��, : ... i '_� ,, f� . a•izturelsewercaE,
Name (print): •• a .. , Ji _ loaf drains /floor sinks /hub -
Mailing address: - e : • . • e dis. sa[ _
ose Wb
States3 0 ZIP: q`ra ^(16', Ice maker
Phone: 5 — - - l ax: E- : 1: Interceptor/grease trap _
Gwner installationiresidentiat maintenance ority: The actual installation Primer(s)
tlaLi be made by me or the mavntenar,ce and repair mad, by my regular Rootat*ain (commercial)
employee on the property I own as per ORS Chapter 417. Sink.(), basin(s\,, lays(s
Owner's signature: Date Sump
x,Y �f . ��Jj1 ,y re } N - � x i
r y � . +' `1L'`(r i + 'tr- ' tr 8 rr: ` u r'x , Tubs/shower/shower pan
- M Y r �,. " .... x _ 7 .. -t-4,- ' i ■ :. • r` . 1. ., : s t,r,, t ,£ 'g p
Name: Urinal
Address: Water closet
Water eater
City: State: Z P. Outer:
Phone: Fax: E- mail: 1 Total
Not all jurisdtctiutm ancept credit cards, please call Jurissd.rDoo for mere War nod Minimum fee $ 3 �.p� S
I
D visa D MasterCard Notice: This permit t application Plan review (at _. 90) $
Credit cord number 1 / expires if a permit is not obtained
gnu, j rn wit 180 days after it has been State surcharge (8%) .... $
Name of cardholder as shown or. credit cord accepted a5 complete, TOTAL $ ,
It
Cardholder Ida-nature Arnow It
440-4616 (6200014)
CITY TIGARD PLUMBING PERMIT
P ERMIT #: PLM2001 -00299
�•; DEVE H Blvd., MENg sO R9 2 639 -4171 DATE ISSUED: 7/16/01
SITE ADDRESS: 13241 SW WOODSHIRE LN PARCEL: 2S104DC -08500
SUBDIVISION: MORNINGSTAR ZONING: R -4.5
BLOCK: LOT: 022 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: Installation of residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
WHEELER, JOHN R + TRACI PRMT CTR 7/16/01 $36.25 27200100000
13241 SW WOODSHIRE DR 5PCT CTR 7/16/01 $2.90 27200100000
TIGARD, OR 97223
Total $39.15
Phone 1:
Contractor:
SUPERIOR LANDSCAPE INC
27127 MOUNTAIN RD
WEST LINN, OR 97068 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 503 - 655 -7377 Final Inspection
Reg #: LIC 6315
y f p( r rtcYi
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 0
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. o
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued =y: L OA ( / 4 i • Permittee Signature: iji �' ■ i /:.
Call (503) • 9-4175 by 7:00 P.M. for an inspection needed the next busi • ess day
"t)
BUP - Building Permit ELC - Electrical Permit
4 Inspection Description Date Passed By ,J Inspection Description Date Passed By —
Footing /Setback Underground cover _
Foundation walls _ Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab _ Electrical service _
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors _ _ ELR - Restricted Energy Permit _
Roof nailing I Inspection Description Date Passed By
Firewall _ Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
4 Inspection Description Date Passed By
Drywall nailing
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils
Welding Lab Final _ Mechanical rough -in
Fire damper
Concrete Lab Final _ Duct work
Bolting Lab Final
Smoke detector
Structural observation Mechanical final
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
Q Inspection Description Date Passed By
BUP — Fire Protection System Permit Plumbin: underslab
Inspection Description Date Passed By ■Crawl drain
Sprinkler underfloor /slab II Post/beam s lumbin:
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain • NEM
Water service ,];1,_11
SIT - Site Permit 11 Sanitar sewer ' U
H Inspection Description I Date Passed I By Culvert/catch basin /rA2S�
Footings • Pum s /fill se s tic tank
Foundation walls • Plumbin: final _ ��
Sprinkler supply lines
Sprinkler underfloor /slab
_ Catch basin /Manhole _ SWR - Sewer Permit
Engineered soils 'I Inspection Description Date Passed By
J Engineering acceptance _ Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \dsts \ forms \ InspRecordBUP.doc 04 /17/01