Permit (30) ...
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ap "CITY OF TIGARD PLUMBING PERMIT
A-cove I4 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00529
t � l II 13125 SW Hall Blvd., Tigard, O R • • 3 (503) 639 -4171 DATE ISSUED: 10/2/03
SITE ADDRESS: 16200 SW PACIFIC HY A PARCEL: 2S115AB -01900
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SUBDIVISION: TIGARD TOWNE SQUA ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: A3 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: 90 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 90' of water service.
FEES
Owner:
Description Date Amount
BIT HOLDINGS LTD PARTNERSHIP
BY FORUM PROPERTIES INC [PLUMB] Permit Fee 10/2/03 $72.50
FIVE CENTERPOINTE DR STE 290 [TAX] 8% State Tax 10/2/03 $5.80
LAKE OSWEGO, OR 97035 Total $78.30
Phone :
Contractor:
DETEMPLE CO INC
1951 NW OVERTON ST
PORTLAND, OR 97209 REQUIRED INSPECTIONS
Phone : 503 - 227 - 2641 Water Service Insp
Final Inspection
Reg #: MET 1986
LIC 2510
PLM 26 -25PB
I
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
/ � � I s ed B y : � ��'�% Permittee Signature: � / (0.—c-,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
10/01/03 WED 07:13 FAX X1001
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des -
J 0 Plmbi 7' : ` ` ni plication OFFICE USE ONLY
r - �� "' City of Tig er CO Date received: /o /i D� Permit no.: 0003 - 0a5: 2 - ;'
I
Address: 13125 SW Hall BI OR 97223 Sewer permit no.: Building permit no.:
Clit o f Ti g ard Phone: (503) 639 -4 TY CR- Projecd �� appl. no.: Expire date:
Fax: (503) 598- I9(01. l` " I
k �"� � Date issued: / Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory i % Commercial /industrial ❑ Multi- family ❑ Tenant improvement
O New construction Ttion/alteration/replacement ❑ Food service 0 Other:
JOB SUE 1NFOR1;1A17ON FEE SCHEDULE. (tor special information usechecidist)
Job address:
- Description Qty. Fee (ea.) Total
Bldg. no.: / 6 9 1 Sul e no.: # II New 1- and 2 -faroily dwellings only:
Tax map /tax lot/account no.: (includes (00 ft. for each utility connection)
SFR (1) bath
..i Lot: Block: I Subdivisia : ' SFR (2) bath
Project name. - i� / __ KE.6 j u/ j,07 ` SFR (3) bath
City/county: i Z ''. J Each additional bath/kitchen
scrip on and to to on k on premises: She utilities:
C4 4 To Catch basin /area drain
Est. to of completion/inspection: Drywalls /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: • eht l C�1 ' h ., , / a
co _ Manholes
0 Address: A � ' Rain drain connector
\ City: r i I State I'" ZIP: 0/ Sanitary sewer (no. lin. ft.)
Phone: ` Fax:Z :� : E -mail: Mpg Storm sewer (no. lin. ft.)
CCB no.: 9i 5f) j Plumb. bus, reg. no: �j-, Water service (no. lin. ft.) iTi/,t��j L
\1
City/metro lie. no.: fq / - ` - ` Fixture or item:
Contractor's representative signature' .,, , / "' m Absorption valve
Print name: Date; � � Back flow preventer
,
Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer •
Address: rDishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank -
OWNER Fixture /sewer cup
Name (print): /T �G ni c r
Floor drains /floor sinks /hub •
Mailing address: Garbage disposal
Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: 'Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: _ , Date: Sump
ENGINEER Tubs/shower /shower pan
Name: Urinal " —
Address: Water closet
Water heater
City; I State; I ZIP: Other:
Phone: I Fax: I E -mail: Total D
Not all Jurisdictions accept credit CAW; please toll jurisdiction for more infomudi Minimum fee $ _ ��Y"° / � ' s
❑ visa ❑ Mastercard Notice: This permit application Plan review (at _ ° /a) $ 5 2�
expires if a permit is not obtained
Credit rxrd number: ti r - within 180 days after it has been TOTAL harge (8%) .... $ $ 30
P
Name of cardholder as shown on credit card accepted as complete.
S
Cardholder signature Amount
4404616 ( 6100 /tom)
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date ' - quested /D AM PM /1 BUP
Location i a-cA �- - Suite -s p- 4 - MEC
Contact Person 7- Ph (_5V23) ?—J' l / 5S 403-0 S (5
Contractor a ��' Ph ( ) SWR
BUILDING Tenant/Owner 7'7
T lit I ELC
Footing ELC
Foundation 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 ,'J
pr
PLUMBING '�
Post & Beam /
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Man ole
Storm r. rain IN
Showe Pan c
Other: pl.�
F .. - �"
; PART FAIL
M ' 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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA f
Approach/Sidewalk Date `04_, Inspector Est
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL