Permit (186) , r CITY OF TIGARD PLUMBING PERMIT
veI4 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00142
., II 13125 SW Hall Blvd., T igar d , OR 97223 (503) 639 -4171 DATE ISSUED: 5/1/03
'� . PARCEL: 2S115BA -00101
SITE ADDRESS: 16200 SW PACIFIC HWY Ya
SUBDIVISION: TIGARD TOWNE SQUARE " ` ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: 1 TRAPS: ,
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Building fixtures all new: (2) lays, (1) 3" floor drain, (1) primer, (2) sinks, (2) toilets and (1) water heater.
FEES
Owner:
Description Date Amount
BIT HOLDINGS LTD PARTNERSHIP
BY FORUM PROPERTIES INC [PLUMB] Permit Fee 4/16/03 $149.40
FIVE CENTERPOINTE DR STE 290 [TAX] 8% State Tax 4/16/03 $11.95
LAKE OSWEGO, OR 97035 Total $161.35
Phone :
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 - 7619 Underfloor /Underslab
Top -out Insp
Reg #: MET 00001047 Final Inspection
LIC 12889
PLM 34 -4PB
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
Issued B Y Permittee Signature: ex/ / f'j13 /C'�i /O VtJ
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
S }C - 2-4o
• ' Plumbing Permit Application
Date received: Sl -/b p, ag Permit no.: j )o3 - Ub /Y
'~ �� City of Tigard
., 4. - i — Sewer permit no.: Building permit no.:
of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
City f g Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
Fax: 503 598 - 1960 �- Date issued: B)(�jB I Receipt no.:
Fax: ( 503) ba,R06)2`" 5 p
Land use approval: Case file no.: Payment type:
111'1: OI 11:12\11
O 1 & 2 family dwelling or accessory N1 Commercial/industrial O Multi - family O Tenant improvement
1I New construction 0 Addition/alteration/replacement 0 Food service O Other:
JOB 'lII I \I \1 \110\ III :4(' III :I)l I r. pccialinlurm :iliumtt.cclic(I:li.I)
• Job address:I C740 Si-) c / Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
Tax map /tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath ,
Lot: (Block: I Subdivision: SFR (2) bath
`.k\- Project name: SFR (3) bath
`� City /county: I ZIP: C f )7Z, tf Each additional bath/kitchen
Description aa4 location of work on premises: Site utilities:
tr'C) 4IC1..) i 41-7STLAD tt.iS Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
I'Ll \IItI \(: l \IIt \( fOlt
Footing drain(no.tin.ft.)
Manufactured home utilities
Business name: [ r )/ r( L Manholes
Address: (�Gj S (,>) i `' Rain drain connector
City: c ) State: ZIP: �? �,' Sanitary sewer (no. lin. ft.)
Phone :. 0 �61 1Fax:4y 9,2OI E -mail: Storm sewer (no. lin. ft.)
CCB no.: CA 14+ I Plumb, bus. reg. no: Li- 4 Ks Water service (no. lin. ft.)
City/metro lie. no.: Fixture or item:
Contractor's re sresentative signature: �^ Absorption valve
' ^ Back flow preventer
Print name: Ca a t . `? Date: / 0 - Backwate . lye
('O\ f \(F I'FItaO\ Basin avato 2-
S
Name: Clothes was er
Address: Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture /sewer cap
• nor drain floor sinks/hub
Name (print):, D." I' 11,.‘" IL``
arba e disposal
Mailing address: Hose bibb
City: I State: I ZIP: Ice maker
Phone:2C/ cc'7 ei Fax: l E -mail: Interceptor /grease trap
Owner ation/r sidential maintenance only: The actual installation Primer(s) I t , I(
will be made by me or the maintenance and repair made by my regular drain (commercial)
employee on the property 1 own as per ORS Chapter 447. Sin s); basin(s), lays(s) 'L -5'329-
Owner's si_ nature Date: mp
1'N (:1 \ I :I it Tubs /shower /shower pan
Name: Urinal -
Address:
Water closet -2.-- 33 �' -
Water heater 1 1 6°
City: State: ZIP: Other: ' i YO
Phone: Fax: E -mail: Total
Not all jurisdictions Minimum fee $ I' ��l . '.10
a ccept credit cards, please call jurisdiction for more information. Notice: This perm application
la Visa O MasterCard expires if a permit is not obtained Plan review (at %) $
• Credit card Dumber. Expires wi 180 days after it h as be en State surcharge (8 %) $
r' TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440.4616 (6/00/COM)
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 -- �e a � � J Suite 1 - z---- MEC
Contact Person i y.4 Ph ( ) 6 ( 74/ PLM 3 - 66 qZ-
Contractor Oh ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg.Drain Access: 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
P P ART FAIL
LUMBIN
os m
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
• na
S PART FAIL
LAICAL
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date c / � Inspector Ins ector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL