Permit CITY TIGARD PLUMBING PERMIT
� ; * DEVELOPMENT SERVICES PERMIT #: PLM2003 -00332
'�` '� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/9/03
SITE ADDRESS: 09585 SW 69TH AVE PARCEL: 1S125DA -06800
SUBDIVISION: KINGS VIEW ZONING: R -4.5
BLOCK: LOT: 054 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Water Service
FEES
Owner:
Description Date Amount
BILL HAACK S
9585 SW 69TH [PLUMB] Permit Fee 7/9/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 7/9/03 $5.80
Total $78.30
Phone : 503 452 - 8536
Contractor:
D + F PLUMBING
4636 N ALBINA
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone : 503 282 - 0993 Water Line lnsp
Reg #: LIC 465
MET 00002033
PLM 26 -23pb
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 By: Permittee Signature: ,�� / :d (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the next busin
Jul -08 -03 12 : 1bP P . Ol
Liu aub s ......�
' i ` +• �� � � 1'O1(OF1 ICE USE ONLY lumbing Per ' c d i l l Received Plumbing
DateMly: Permit No 2DV3 - D7) 330--
1 1 1 08 Planning Approval Sewer
City of Tigard v 2003 Date/By: Permit No.:
13125 SW Hall Blvd. DUTY OF TIGAR 11,4 Plan Review Other •
Tigard, Oregon 97223 4 (V'S Date/F1Y Permit No.:
Phone: 503- 639 -4171 Fax: Io ��N P U Post Review Land Use
//...,. ,v.,,_1 I. :1,. Date/; Case No.:
Internet: www.ei.tigard - onus $� ' 1 Cont luris.; See Page 2 for
24 - how Inspection Request: 503 -639 -4175 Name/Method: • Supplemental Information.
• . - .•,41 "a:::. s'.`..., ,fI'.YPE'OPMURiC:: +. . . <: .;w�`:. ' `E'(ftir'lipectal • iQlr:'itia otl,at :e'ellecltlistj'.; • .
R New construction • Demolition Descri . lion Qty. Feelca.) Total
E dition/alterataon/re • lacctnent a Other: .� - ... a. �1• l yi.�.. � - • `..�;�':
., " • a • CATEG e•R .: �: i) , S'I'R, ..• :iONi;', , _.
. ::1.,...:4• ;;; 1 411eiudetf iaiiil {d cb u(i11t Connection) "•.. .
!� 1 & 2 -Famil dwellin _ • ■ Commercial/Industrial SFR�) bath 249.20
SFR (2) bath 350.00
• Accessory Buildin 1 10 Multi - Famil sFR (3) bath 399.00
r Master Builder • Other: Each additional bat /kitchcn 45.00
-• I ,:SIT •INPORm' •TYON,ariti.LOCATION Fire sprinkler - sq. Page 2
Job site address: gS �ls S . 7-i /91/4c _ T/L� :., . M 3 ` !r•�," • �•�.,e,!•
iixij��f � •'• "ai- r:��itc'Uftllitles� .�� :?t`fs. • •- Y:.:.,..
Suite #: 1 131dg- /Apt. #: Catch basin /area drain 16.60
I)ry
Project Name: /141-#9-GA- /141-#9-GA- well/leach linc/trcnch drain 16.60
Footing drain (no. linear ft -) Page 2
Cross street/Directions to job site: Manufactured home utilities 110,00
Z'oorh ofr .S'b 4LF+t () g' - Manholes 16.60 -
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 1 Lot #: Stonn sewer (no. linear fl__.) Page 2
Tax map/ parcel #: Water service no. linear ft- a w / Pate 2 47,S
.:a N., . FBI (4iitF;
r r.. 1-
' ; 4.: !fi. t, a w0l ,:f1'. . F: .. ::'.Y .)•: •,• i $�. . Wf,• a iX��a �� �R�Niel�'+ 17i'- !1CCE:. ": 4�:
ti.
... ` Absorption valve 16.60 _
'Ff'L.4z Y8 / 4"7 " . /- ✓/, - /X - r „Veit' l/ /GG Backflow prcventer _ Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
ri5,, i170j,r7., "'a a -1 }:�M Ejectors/sump 16.60
82fi Expansion tank 16.60
Address: Fixture/sewer cap 16.60
Cit /State/Zip: 7722. Floor drain/floor sink/hub 16.60 _
Garbage disposal _ 16 -60
Phone: - Hose bib 16.60
S fW T s' l' r. ' I' c m ".I I 9r1Va gE t ., tE Ice maker 16.60
_ Interccptor/grease trap _ 16.60
Address: i Medical gas - value: S Page 2
' Primer 16.60
Roof drain (commercial) 16.60
Phone: Sink/basin/lavatoa 16.60
Tub/shower /showcLpan 16.60
r- : ;; ;,.; Urinal 16.60
Business Name: JF * PL- lthe /& .Cl) water closet , 16.
Water heater 16.60
Address: 4fl• /l/• ,4-2, 1 0,40v- i etzF______ - other:
Cit /State � � T L ' ✓ ✓ Q , O n - q 717 Other; . F - • Phone:?8�• - DIV..; Fax: -0 6 05' "' ',ui '" ..= . isPiiutribitiiter�liilt;iiees't ; 141 r_. ,• .•:,;..: 'a:
CCB Lie. #: _ „ _ 1 ��'� '
r Plumb. Licit: ac..., 3 eg s$7 $
Minimum Permit Fee 572.50 2.50 S '/ Z...S
Authorized ��� Residential Backflow Minimum Fee $36.25 -
Signature: / 1 - -.- Date:_ Plan Review (25% of Pennit Fcc) $
ae/p t/ _ _ S Late Surcharge (8% of Permit Fcc) $ a
(Please print name) TOTAL PERMIT FEE ' $ , ;:9
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with Isometric or
180 days after It has been accepted as complete. riser diagram for plan review.
'Fee methodology set by Tel-County Building Industry Service Board.
::V)sts.Permit Forms\PlmPermitApp.doc 01/03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested _ d AM P BUP
Location q S C° 1Q— Suite MEC
Contact Person Ph ( ) P- Fa — o l 43 PLM 3 -Ov
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Acres � r
Ftg Drain f / /� / r 5 L ELR
Crawl Drain l v J
Slab Inspecti Notes• SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling /0#9., /'
Roof
Other:
Final
PASS PART FAIL
PLUMBING -
Post & Beam
Under Slab
Rough -In
Sani . ry Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin -1
40 PART FAIL
ANICAL
\ Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
1 Low Voltage
Fire Alarm •
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /� fix) ) 7 2 7, Ext
Inspector
ADA Date / 6 V
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL