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CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT: PLM2003-00594
13125 SW Hall Blvd.,Tigard,OF% :23 (503)639-4171 DATE ISSUED: 11/17/03
SITE ADDRESS: 11170 SW NOVARE PI_
PARCEL: 2S 103DB-04200
SUBDIVISION: GENESIS NO. 2 ZONING: R-4.5
BLOCK: LOT: 049 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPA,;ES:
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Water heater replacemeot.
FEES
Owner: --
Description Date Amount
WIERSEMA, ALc3ERT + ELIZABETH —
1 1170 SW NOVARE PL [PLUMB] Permit Fee 11/17/03 $72.50
TIGARD, OR 97223 [TAX] 8%State 11/17/03 $5.80
Total _$78.30
Phone
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : Final Inspection
Reg#:
IL
oc
i ' b' h regulations contained in the Tigard Municipal
�j Thls permit s Issued subject to gula to d e g dCode, State of OR.
W 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 obtaiii copies of these rules or direct questions to OUNC by calling (503) 246-6699.
Issued Byrui'--_ �� Permittee Slgnaturek/J��!"" �---1/_
Call(503) 6394175 by 7.00 P.M.for an Inspection needed the next business day
10%28/2003 10:39 FAX 5035981960 CITY OF TIGARD Ia;J001
Building,Fixturos
Plumbing Pernit Application Received Plumbing
Date/B -�� Permitplo. ! 0 Q
City of Tigard Planning A va Sewer
Da»Z�_- PamutNo.:
13125 SW Hall Bled. Plan Review Other
Tigard,Oregon 97223 DatdBy: Permit No..
Phone' 503-6394171 FLc: 503-599-1960 Post-Revlew Land Use
Internet: www,ci.tigard.or.us Date/By: Cast No.:
2
contact Julut Set Page 2 far
4 hour Inspection Request: 503-639AI75 Name/Method: ! sapplemtngl Intornutb■.
TYPE:OF WORK — ^F8B•_SCHSDCJLL for' Jl Jqhrjj&j uft ab a ?r
Ll New construction Demolition Desch tio■ I Qtr-
4 r . Uta:
� .GAdtion/alteratio lacement Other: WG*L -&2 � .Z
CATEGORY.OF 011 ��ialattae7MR t3 astds tr a _ .(, r.,y
_
1 &2-Family dwellingSFR(1)bath 249.20 Commercial/Industrial SFR(2)bath 3$0.00
cce Building Multi-Family _ SFR.(3)bath 399.00
Master Builder U Other: Each additional bad kitchen 45.00
OB SIETET1110N Iii LOCAITON _ Fire n .ft.: P e 2
Job site address: ,r./ Flo�'A2 C P�A c c ;. `i
�: ..
Suite#: Ell d ./A t.#: Catch basWarea drain 16-60
elWench line/trench dra
Project Name: —_ in— 16.60 —
Footing drain(no,linear ft.) Pae 2
COOS$3trCCt/1)IreCtiOtls to job site: Manufactured horse utilities i 110.00 —
1I S G F N f S r S ( p o Manholes_ �__ 16.60
in
Rain draconnector 16.60
Sanitary aewerinnlinear ft.
Subdivision: &Irrt'E6 sS AJC, _Lot#; G+ Storm sewer no.linear ft. Pa 2
Tax map/parcel#: S 1 3 d C 4 2C<� Water service(no.linea tt.) P 2
DESCRIP QI NOF WORK
Absorption valve 16,60
c P A G C Backflow preventer P e t
Backwater valve 16.60
Clothes washer _ _ _ 16.60
—�-- — Dishwasher _ 16,60
-- — !a---� ��, : Drinkingfountain 16.60
W.Name: A!6-��T- i.✓i t=2 S£1M/>♦ E passion tri _ 16.60
_ Expansion tank _ 16.60
Address:_ 111-10 St _4*/)o'✓4120 f14 C E Nxture/sewer eV 16.60
City/S'tate/Z.i : 'T I UAB D 04— 9-7223 Floor drairrr.loor sir k/hub� 16,60
Phone: ; s r' Garbt a doposal 16.60
�,1 c 1 ¢i FAX: Hose bib
APPI:ICANT' c-:r; �,ON'1CAC 1< N•. — 16.60
.: Ice maker 16.61)
Name t./3 Intenr/ ase trip 16.60
_Address: 111-7 o s A./ ^1tJ✓A2E FL 4 c f MedicA Ras-value: S _ Page 2
Ci /State/Zi _T/G }2 T 0 2c? z 2 3 Frimer _ 1560
L
Roof ir,(co=ncrcial) 16.60
Phone: ax: _ sink/barinnavetnry — --- 16.60
E-mail: Tub/sh-,wer/shower,pan 16.60
_ ":. ' -- "MR Urinal 16.60
_Business Nam �4!'1S ig T L-A f'f 5>r -14 water closet ..--- 16.60
S _Address: I 1 1 -7 0 5�.�' NGS✓4,'Z t /1'L Other;
heater _ 16.60 —
other
Cit /State/Zi i/t, 4-IL D o✓L el-7-z 1 3 a:
� Phone: CS-c: 3 lc 70-9/Oil Fax: - � .�.r _ Ptitti�i!•Reeiit �• r•.,.
CCD Lic._#: Plumb. Lie* Subtotal S
Authorized Minimum Permit Fee$72 50 5
signature � t,,;� )w,Gtt- s » •--Date: 1/ ;7 13 Residential Bacldlow Minimum Fee 536.25
� Plan Review(25%of Permit Fee) S
%�L L>EiyT L✓t E.Z SE�t�4 State Surcharge($%of PertnitFee) S
(Please print name) --�- TO i AL FERMI FEE S Q
Notice: This permit sppllcatlon expires If a permit Is not obtained within All new Commercial buil-TOTAL
ings require 2!K!of plans with isepwrie or
180 days after It has bevot accepted as complete• riser diagram for plan review.
'Fee methodekW set by Tri-County Bulldl-.R tadustry 12ervite Beard.
i.\DstslPermit Forms\PlmPermitApp.doe 01/03
ITY OF TIG/ARD24-Hour
BUILDING Inspection Line: (603)639.4176
INSPECTION DIVISION Business Line: (603)6394171 MST _—_—
IUP
Received ----Date Requested /A" I —AM---PM--- SUP
Location 1/l 7Q /�oV e-!l•-- _ Suite
Contact Person tr hfle - -- - - Ph(---) 4�,ZD -- . e.% t7 6914
—
Contractor __ ----___--- Ph(-.— —) _ SWR .
BUILDING Tenant/Owner ELC
Footing ELC -
Foundation OCA58; -
Ftg Drain ELR
Crawl Drain ...�.
Slab Inspection Notes:�TAs eG *— Ner S e_ Cotte Al StT --------
Post 8 Beam -�__._____.
Shear Anchors �, / L.A —
Ext Sheath/Shear I o v 7S D' �f• —
Int Sheath/Shear (/
Framing
Insulation
Drywall Nailing — —-
Firewall
Fire Sprinkler - -- -- ---Fire Alarm
Susp'd Ceiling --- ---
Roof
Other: —
F1nal —
PART _FAIL - -
LUMBIN
Post&Beam
i
Under Slaks - -
Rough-In
Water Service ---- - - - --
Sanitary Sewer
Rain Drains - ---- --— — ---
Gatch Basin/Mennole
Storm Drair - - - —
Shower Par
Other-
F' PART_FAIL -�
MECHANICAL
s Post&Beam
Rough-In ---- -
fL Gas Line
Smoke Dampers ---
�.. Final
y PASS PART FAIL -
_ELECTRICAL
Service
Rough-in
C9 UG/Slab
jLow Voltage -- ---_-- -__ - -
Fire Alarm
Final F] Reinspection fee of$ ___ _required before next inspectlon. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL_ _
SITE -_ F1 Please call for reinspection RE': _ Lj Unable to Inspect-no access
Fire Supply Line Y7
ADA
3
Approach/Sidewalk Dab / -, __ -- - 1kt--
Other:
Final DO NOT REMOVE this Inspeatka mmmW fnm Un"dbL
PASS PART \'•AIL