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15134 SW 96'x{ AVENUE
CITY OF
TI GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00248
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/6/03
SITE ADDRESS: 15134 SW 961-1-1 IVF PARCEL: 2S111DB-13000
SUBDIVISION: PP1991-034 ZONING: R-4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 1
rUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WA1ER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install New Hot Water Dispenser
^T FEES
Owner:
--- Description Date Amount
ELLIOTT, LESLIE F
15134 SW 96TH AVE I I't.I1ti1131 Permit Ice 6/6/03 $72.50
TIGARD, OR 97224 [TAX] K State'rax 6/6/03 $5.80
Total $78.30
Phone
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND,OR 97206 REQUIRED INSPECTIONS
Phone : 501-771-9449 Rough-in Insp
Final Inspection
Reg#: LIC 42671
PI.M 14.701113
This permit ;s 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: O.-egon law requires you to follow rules adopted by the Oregon
Issued y: 4�� , G<kCl-liL�7� Permittee Signature:
\\ Call (503)639-4175 by 7:00 P.M. for an Inspection needed the next busirisss day
JUN-04-2003 08 51 AN GROWN. PLUMB i NG 503 771 9454 P. 01
Plumbing Permit Application
M O'd Qf r M Sow experimlttia: _ Building parrnitM.: _
Address: 13123 SVk4BIvd P ."97%x;
elrvofndad e: (303)69171
Ro)ec/eppl.no
Phan
Fax: (503)59&1960 ,;* Dae Issued: ' ny Itece1pt no.:
t",1y, ' }Ue�o.: paymenttype:
Land use approval: ' _--
10 1 ;(,nWy dwelling c,K ac±�yasocy Cl�ottutletC{tt1/tadtutria� .__._.. D Mal t�mily i O Tenant Improvement
❑New eoastruetion (�ddWcxt/altbmtioa/roplaUernent� D Hood servloe' O(hlher. - --_ —
fl•/ F I Uecri t-lon
. Fee ea Total
r7lob rddres .5eM IT,n
Bldg. o' "a f (Mudo1a64(Weach utility acou)
Tax awpltax lot/a000untno., I SFR 1)bath,
1"at 1810CL. ' ' Subr'vision: JWR(WFaifi --
Pto ect name: � .• ( •, •. � •`'W• "•°un t I'Ft a �
City/coup r s•s!� uJo-'-i�:- 9 7 X=o' _- ac additlnn7he�Ft Jk tc rr• -
Description and ucatlon 7i wnrit ort PttitttiAes: -- — 6lteetWtlec
dniea... /�a,• c..�• / • nom: �"•.';�� : -- Catch batin/amdrain
Bit.date O1 owtt(iletion/tnspection: - I iF..
y wo c h teen earn
'i3ciutj�n dr�nia no. n.
Manufactured home utilities
Rusiow nane: r_±!eW r--- TIL41 �Lt1 -• o G '
Address t��°�— irv`rx n n connocinr _
;�, t d Stun: 2 ZIPSAMWY sower uo.1 n. _ --
1'twne: l lra7t: - Iftneil: .torah!ewer no. Irl.rt_)
t'_Y'H nv.: t Plumb.bus.reg.no., stet se ea no. n.ft.) -
lEt►xturo or kaw
C'i /nxAv lie.no.:
_ --- A�bt�o don valve
Cwtrsct&s ntative ai naurr.; _ auk(]ow venter "
Print nano: ( ' °5" ac ater VMjVo ——
asiu avato
f- Clothes wu r --
Nano: j�,yr�L - esu
Address: _ n n ountt�un s —�
Cyt'. __ -_ Stec: ZIP at2
Those: Fut: i l�mall: part on uuik
FixturalwWw CW_
Nurse nt):
Moilial address:�—/�3 y w' " -- i - - -
City: T--
Phone: at+- F/n t'ax: 13-malt torte ewe tarp _
owner Irtsirtilatlnrhreldential mxintcnrnoe only: 'ihe actual Installation me s _
will be made by me or the nmintoutulae end repair Made by my Mgular Roof drain contra
enipkgw on tiro pmjxAty I own u poi ORS Chapter 447. s, a ave s --
Ownara signature: _. -Dater - - Sump --
TuWahowatFiowerpan
Name: V. arta-T
_. — ---- ator n cbtet
Address• star heater
_
State; I ZIP Ober. w 77 v
Plow: — �f■a_r F mail: TOW _
WOW cl"rape,piece wt)wWdkwo n.�.terms,.' Minimum (........ ) S
!�� Nutioe�!eels permit application Ran review(at � '!6) _ .�
expires iia Immit is opt nadained
State surJuarse(B%)....S
within I l0 day.after It bee risen i-
n re.
a�cxpted u ootnplete TOTAL .......................SU
--
Jhr tntture — AnUMM 4MN616(6AlrrJ�M)
IIYfr 9•v 1r� ^ r"e�Y fes. U5
CITY OF TIGf,R D 24-Flour
BUILDING Inspection Line: (503)639-4175 ML r
INSPECTION DIVISION Business Line: (503)639-4171 BUP
Received ___Date Requested-__��s��- AM -PM-- BUP
Location %y5 -- -� Suite _ MEC ---vv---
Ph ---) - PLM -00 c 6
Contact Person —_-- (
Ph(—)--
) 7 7�- 9 SWR --
BUILDING Tenant/Owner ELC
Footing ELC -
Foundation Access: / ELR --_ -
Ftg Drain /
Crawl Drain �� SIT —
Slab Inspection s:
Post&Bearr, - - - -
S' Sar Anchors
Ext Shdath/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 Pan -
Other: J..- --- --
d _PART FAIL ------------- - -- ---
CHANICAL �_----- - -
Post&Beam _
Rough-In -- _-__— - -- -
Gas Line _ --
Smoke Dampers - - -
Final -
PASS PART FAIL - -- -J--- —
ELECTRICAL
-
C -_ - ----- --� --
Service
Rough-In -
UG/Slab
Low Voltage -
Fire Alarm
Final Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Ball Blvd.
PASS PART_FAIL
_
SITE _ - [ Please call for reinspection RE: [� Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sideoualk Dat! }-
Other:
Final DO N REMOVE this Inspection record from the Job site.
PASS PART FAIL