Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2001 -00046
'' •� �� . DATE ISSUED: 05/25/2001
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11560 SW 67TH AVE PARCEL: 1 S136DD -00
ZOO SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: 2 WATER HEATERS: CATCH BASINS: 5
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 150 ft
WATER CLOSETS: WATER LINE: 140 ft
DISHWASHERS: RAIN DRAIN: 520 ft
Remarks: Site utility permit.
FEES
Owner:
Type By Date Amount Receipt
GREEN, JOSEPH W PRMT CTR 05/25/2001 $619.20 27200100000
PO BOX 759 PLCK CTR 05/25/2001 $154.80 27200100000
PORTLAND, OR 97207 5PCT CTR 05/25/2001 $49.54 27200100000
Phone 1: Total $823.54
Contractor:
TROUT PLUMBING
2095 NW 160TH
BEAVERTON, OR 97006 REQUIRED INSPECTIONS
Phone 1: 503 - 645 -4993 Sewer Inspection
#: L IC 101758 Water Line Insp
Reg Water Service Insp
PLM 34-291PB Storm Drain Insp
Rain Drain Insp
RP /Backflow Preventer
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 b = • regon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through P R y. -0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling 03) • 1987.
Issued By: �� (L_ _I� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne business day
.
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1,.
Plumbing Permit Application
r . Datereceived: 01 /V D/ Permit no.: PL/e/App/ .-eCi? 4
5 ' . ' 1 + I City o f Tiga sewer tno.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Pew g�
t ' s City o)gard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
` • -
Fax (503) 598 -1960 Date issued: By I Receipt no.: '
i'" =,:.: - Land use approval: 6� SOD ' ®6®/ Case file no.: Payment type: IT
0 1 & 2 family dwelling or accessory ffCommercialrndu l trial 0 Multi-family 0 Tenant improvement
Gr New construction ❑ Addition/alteration/replacement 0 Food service ❑Other.
J011 SI "fE INEOR 19A770N FEE SC11EUt (for special information use checklist)
Job address: �l15�j . ,/,',0 , (' �yf _ 3 Description Qty. Fee(ea.) Total
Bldg. no.: �� no i New 1 and 2 family dwellings only:
Tax map/tax lot/account no.: 1 5 1 3 6 pp - fl t ( inc ludes bat h
R. for each utility connecttoa)
SFR (1) bat .
Lot: o O 0 Block I Subdivision: SFR (2) bath
Project name: (7 /L F J (2V �(G E' PI,Pt..� SFR (3) bath
City/county: b /�jZ�)► ZIP: Each additional bath/kitchen
Descripgipn and location of work on premises: 011-0 t■• D ite utilities:
• 0 F 0 PAC i3 ti' 6 * / Catch basin/area drain S (i.tc Silo
Est. date of completion/inspection: 0 (i , ZOO Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
1'1,1ii1111NG CONTRACTOR Manufactured home utilities
“. Business name:, i
•Ti2.�, (-tiM 6 t J) C i/j --2y 0 4 005 Manholes
Address: „ ,, /4.<) (v0 41 ' Rain drain connector _
City: t /r / V State: d ZIP: ?Teo r Sanitary sewer (no. lin. ft) /
Phone: (, r 45 -4'?9 j Fax: E -mail Storm sewer (no. lin. ft.) 4 II
CCB no.: /0 75$ Plumb. bus. reg. no: 3e 029/ '6 Water service (no. lin. ft.)
City/metro lic. no.: ' ' 3 -o'. Fixture or item:
Contractor's representative ac flow sentative signature: k valve
Back flow preventer <{-- -41r440
Print name: Date:- Backwater valve
Basins/lavatory
Name:
O tr /- (� fti Clothes washer
Address: I t . v b � o • rT 0aNS I�7'. Dishwasher _
City: r0/07.4 tor , A 1 State:0r(•j.ZIP:4 '7Z Drictong ump
ptains)
Ejectors/sum
Phone: F ' 0 Fax: 4. ; •-, , ■, mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): ) IC) E 6 p J • Floor drains/floor sinks/hub
Mailing address: I f 0 4 t .v U/ /rr Garbage disposal
'
City: [�Q State: 0K ZIP• 7 i01 Hose bibb Ice maker •
Phone: 91,0-1,12,7 '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
EN G I N EI : R Tubs/shower /shower pan
Name: 'd L C Li & t W C 2( ti Urina ,
W ater closet
Address: • 4' CIP Water heater
City: State: ZIP: Other. 5_ &
Phone: I Fax: I E -mail: Total
Minimum fee $ t of ?,
Not all *bastion accept credit cards, please call jurisdiction for more information. Notice: This permit application
O Visa 0 MasterCard Plan review (at _ R $
rcard / / expires if a perm within 180 days after it has been it is not obtained State surcharge 8%) .... $ i `� l 8 4
Credit
Name of cardholder as shown on credit card
Expires accepted as complete. TOTAL $ 4 (;i
$ 6
Cardholder signature Amount 440 -4616 (6/00✓COM)
CITY OF'� -IGARD i Inspection Line: (503) 639 -4175
BUILDING MST
INSPECTION DIVISION Business Linei.- (503) 639 -4171
BUP
Received Date Requested ci AM PM BUP
Location 1 ) cs6O 67 Suite MEC
o2
MEC
�
Contact Person Ph ( ) �U (a 3° 9 PLM -0 / * �Oc '-(
Contractor Ph ( )
SWR
BUILDING Tenant/Owner ,. ,----7,e,-,_ -6,cy ELC
Footing
Foundation - — ELC
A ccess: -
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 J
Susp'd Ceiling - J f
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:
Mna
PART FAIL
iiii - ANICAL
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
Approach/Sidewalk Date 7 (V6 1 Inspector �/��� Est
•
L Other:
DO NOT REMOVE this inspection record from the job site.
S PART FAIL
CITY. OF TIGARD 24- Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION* DIVISION Business Line •_(503) 639 -4171 MST
BUP
Received
-
Received / V (- Requested / 2 AM PM BUP
Location 1 l S O 7 i1/24-11-- Suite COO (:)Z
Contact Person. 76 4/c-41-6 LS Ph (s01_..) 4/ 1 75 -7---2 7/3 PLM / — Q 2 - / 5;
Contractor Cik rt-2€- 1 Ph ( ) SWR
BUILDING Tenant/Owner Cs-ree.h. eV/ W ( 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 'ANA, i
Fire
Fire Alarm
Susp'd Ceiling
Roof AO,
Other:
Final
PASS PART FAIL
PLUMBING •
Post & Beam
Under Slab / -
Rough -In /r
Water Service
Sanitary Sewer
Rain Drains
Catch Basin /Manhole
Storm Drain
Shower Pan
Other: l t f o vvw
Final W • :
PASS 4 0; FAIL
MEC A ' AL
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 )6 Inspector ' Ext
Approach/Sidewalk ``r
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 : Business Line: 639 -4171
BUP
Date Requested /O — 3 — AM PM BLD
1 Location ) 1 S (o O ( Suite MEC
Contact Person Ph f --- 7(> q - 7 PLM r - RDe,l Old 4 V (
r r
Cont acto Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain. SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear •
Int Sheath /Shear
Framing
Insulation
Drywall Nailing.
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling / ary` l'A' /it
Roof
Misc:
Final //
PASS PART FAIL � -2 /?r llr --�' O o � ° � '1 , S � / ' C, s � �{ S 1,+ (—I'll tc-/
PLUMBING S'fr IAj S e 7?-e y G :/ l rse
Post & Beam .
Under Slab
Top Out `
Water Sery a �1
Sanitary Sewer
Rain Drains
Final
PASS PART F AIL
MECHANICAL
- • Post &Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage •
Fire Alarm .
Final
. - PASS PART . FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain _ [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA•
Approach /Sidewalk Date 1 ` a Inspector 7L '1/ [ -/ ✓'t . Ext
Other
Final
PASS PART. _ FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:(503) 639 -4175 MST
INSPECTION DIVISION Busines :ine:' ;(503) 639 -4171 -..,
7f� BUP
Received Date Requested '7 7 AM PM BUP
Location I /3Ce 6 cU 7 ��� Suite MEC
Contact Person 9% Ph ( ) - 3o d q ' �T
Contractor % Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: p ^ > i _ '
SIT
Post & Beam L X- v
Shear Anchors . ���' `�--
_-S,E V�'1 a -li'y ti 1 •
Ext Sheath/Shear ��
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall I V 0 S i 1 ■tt,.S
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling n �,—
Roof `J.) u` (5 � P1,,1A1 1 _
Other:
Final
PASS PART FAIL - `' � •
PLUMBING x .. S O_
Post & Beam ?(NA .2 0 ; 1- O3 14
Under Slab �1 Y , V�.J •
Rough -In
Water Service
Sanitary Sewer i _.-
Rain Drains '
Catch Basin / Manhole
Storm Drain a I <Lr / - of/ - e411..../I0 I �� l 1
Shower :hi n lie
Other: i ' "
Final ,a.../:,"'" �i.�/ �� , 4/14....ii 1 - L %�
PASS PART FAIL '
MECHA � ,
Post & Beam
Rough-In • /fir / __40••-
Gas Line
Smoke Dampers
F
/
inal
PASS PART FAIL -
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please II for reinspection RE: 111 Unable to inspect - no access
Fire Supply Line iV _
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection re rd from the job site.
PASS PART FAIL