Permit CI TY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2003 -00331
` �- I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/9/03
SITE ADDRESS: 10998 SW 68TH PKWY PARCEL: 1 S136AD 06505
SUBDIVISION: WAY LEE ZONING: C -G
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B 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: Installation of backflow prevention device for irrigation system.
FEES
Owner:
Description Date Amount
BANK SALEM
PO O BOX 847 [PLUMB] Permit Fee 7/9/03 $72.50
B
SALEM, OR 97308 [TAX] 8% State Tax 7/9/03 $5.80
Total $78.30
Phone : 503 - 585 - 5290
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone : 503 642 - 7323 RP /Backflow Preventer
Final Inspection
Reg #: LIC 24184
PLM 26 -162PB
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
Iss • d By: 1 r , � A !� i Permittee Signature: AIL . / -7 ��`"`'
Call (503) 6 -4175 by 7:00 P.M. for an inspection needed the next bu iness day
06/07/20 16:12 5036427755 ANCTIL PLUMBING PAGE 02
• B Fixtures
phunb Permit (m r i Ic l : 1:� ().1.,
g '' °n
C 4 11 Date received: Q O I MEIR i , 1033
<I A* i.. Clay Of Tlg Sewer permit no.: wilding permit no.:
CitY of Nord Address: 13125 SW Hall Blvo ? , Z
1
J11� .
phone: (503) 639-4171 Pro�ecUapP
Fax: (503) 598 -1960 GITY OF TIGARD Date issued: I' Receipt no.:
Land use approval: BUILDING DIVISION Case t'lle no.: Malt type:
711'1: OF PI :It1IIT
Cl 1 & 2 family dwelling or accessory 1 ".• 0 • ncmercial/industrial ❑ Multi- family '■ Tenant improvement
0 New construction '• ddition/alteration/replacemcnt I] Food service 0 Other:
JOB 11TE INI.O101:1T1ON FETE: SCIII:DUL1 ; (for % pccialittlormatiunu .e diet kli.l)
Job i . /
tion 1 .Fee ea. Total
address: t ew - and - dwe . o ,1
Bldg. no.: Suite no.: ' (Includes 100 ft. for each
Tax map/tax lot/account no.: SFR (1) bath
Lot: Block: Subdivision: SFR (2) bath
Project name: ' ' - 0 13 1 - " D SFR (3) bath
City/county: 1 ZIP: Each additional bath/kttchen ,
Description and location of work on p ees: Site utilities:
2L " 1 ✓ riketiT 0 /►1 e Catch basin/ara drain
Est, date of completion/inspection: Drywells/leach line/trench dram ,
Footin_ drain (no. lin. ft.)
PLIiA:BING CON7R:1Cf(tlt Manufactured home utilities
Business name: i S Manholes
Address: .,.
. , . P _.'' P Rain • in connector
EEEIMIFt•YZIMIMMIIIIICZMIIIkt,Lfifgr6F _ Sanitary sewer (no. lira. ft.
gin p ' -mail:
�� tl: Storm sewer no. lin. ft.)
Phone: , IL � k., r_'
CCB no.: Z O / vi Plumb. bus. reg. no: 26 I (e 18 Water service (no. tin. 19 City /metro lic. no.: - "It; "rill Fixture or Item: •
:
Contractor's representative signature: Beek flow .reventer �g�o
Print name: %_ a' a �� A,b � • lion valve � �
te: Backwater valve
(ONl 1C1' P4: It5ON Basins/lavato
Name: Clothes washer .
Dishwasher
Drinking fountain s)
Cit : , State; I ZIP: Electors /sump
Phone: Fax: E-mail: Expansion tank
OWN! it Fixture/sewer ca •
Name (print): - -` 1 ' M Floor drains/floor sinks/hub
AI
Garba , e di = • . sal
Mailing address: heew " Hose bibb
C State: ZIP: Ice maker
Phone: J 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
I: N(, 1 N I H Tubs/shower /shower pan
Urinal
Name: Water closet
Address: —
Water heater
City: I State: ]ZIP: Other:
Phone: Fax: E -mail: Total
`Not all •,ai.dionode a udit e.,d.. plum till lv:i.dimim far mare Iafa m.don•' Minimu �, fee a F �
a s Notice: This p ermi t a Plan revi • (at %) $
O Vim t] Magee atd pea if a tt is roc obtained V6
Coedit card numb= pua within 180 days after it has been State a • arse (8 %) .... S
TOTAL S e
Nam show e of oudholder a sho on credit crud accepted as complete
S . 3O
C.rdholda Amooat 440.4616 (6/O0K.OM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ZZ AM PM BUP
Location / 9 9 p Suite MEC
Contact Person YY\ Q J-&_. Ph ( / -SD3) c 1 a =13 P,�
Contractor Ph ( ) SCI - ' 46077
Lik
BUILDING Tenant/Owner G
Footing •. . l .e-x -)3 3
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: S D _c) p p Z� SIT
Post & Beam
Shear Anchors E t G- pZQO - I
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P�� :T FAIL
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
'r
PART FAIL
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 Tinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2 i Inspector E7ct
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL