Permit CITY OF TIGARD PLUMBING PERMIT
A 4 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00289
'I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/1/2005
PARCEL: 2S101 AD -02800
SITE ADDRESS: 12665 SW 69TH AVE 100 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 031 JURISDICTION: TIG
Project Description: 1 new fixture.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CEDAR ENTERPRISES Description Date Amount
12665 SW 69 AVENUE
TIGARD, OR 97223 [PLUMB] Permit Fee 6/30/2005 $72.50
[TAX] 8% State Surcharl 6/30/2005 $5.80
Phone : 503 636 - 6657 Total $78.30
Contractor:
PREMIER PLUMBING
20 SW 131ST AVE REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97005
Phone : 503- 469 -8631
Reg #: LIC 124547
PLM 34 -318PB
•
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 Utility Notification Center. Those rules are set forth in OAR
952 -0001 -0010 through OAR 952 -0001 -0100. You may obtain copies of these rules or dire questions to OU C by
calling 503 - 246 -6 • • 9 or - 800 - 332 -2344.
Issued By: ��� _ / . Permittee Signature:
Call 503 -639 -4175 by 7:00 a.m for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
06/29/2005 15:39 FAX Q001
lsu 'Laing r ixtures
PlUmbine Perm6iitation
b
In , ., 0 Planning al Sewer
. City of Tigard ,. - Datclity: Permit No.:5/f) ka0(:)5 - 0224 )
13125 SW Hall Blvd. G Plan Review - Other
O
' 'CI ' S\OA
Tigard, Oregon 97223 - \ ■\ ‘ Date/By: Permit No.:
Phone: 503-639-4171 Fax: 1.4.:,.-WM60 Post Land Use
ate/By: age No..
Internet: www.ci.tigard.or.us t) 14.: •A i I
D
..,-. ___. Contact ris.t ta See Page 2 for
24-hour Inspection Request: 503-639-4175 - Name/Method: V Supplemental Information.
i 01 Ai6 .
-f:" l' ' ';'ir:t' F i'.P = /. INIEMEMop
• New construction • Demolition Desert . don Qty. 'ke(tle.) Total N,
05 Addition/alteration/r . lacement • Other: ,..".1 , ..V.:) , f",": , '..'ff f if
h
i1OT'''Fi7,!Pftt11911= '• ',•' ..:.:' 2.1' _'_i.li == - (
SFR (1) bat 249.20
I . 1 & 2-Family dwelling ilk7.4 Commercial/Industrial (2) bath 350.00 ■
I• Access° Buildin: 111 Multi-Famil SFR (3) bath 399.00
Ki Master Builder 1• Other: Each additional bath/kitchen 45.00
11522*.a.L'A M-1.M:Effi-gailEM/ Fire s , rinkler - -.. ft.: Pa:e 2
•
Job site address: / 241 5W' (p q limaturmemirrg=mfm_P!K.M
Suite #: 1 Clo Bldg./Apt.#: Catch basin/area drain
Drywell/leach line/trench drain 16.60
16.6
.e 0
Pro' ect Name: 4 • .. • &
. Footing drain (no. linear ft.) Pa e 2
Cross street/Directi . , s to job tew Manufactured home utilities 110.00
S CM. @A
8 0
\ Manholes 16A0 yea-
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Pa e 2
Subdivision: 1 Lot #: Storm sewer (no. linear ft.) Pa e 2
ft. P : e 2
Tax ma •/.arcel # Water service no. linear :
INNEVVE%triE/2 ..C.771F-711.0_7=A:17.21MENIMMIN Ilif.4..z.a...-
......-...-2,,, -1" ..;;1 ' • -:...' k : - i .' , 1 -.TeNca..-' , ') . , -',t2.r ,4 araffil
_IIIIMarrIMPAPBRIMMINIMII Absorption valve
Backflow preventer 16A0
MIM
Page 2
B r A r'-z vJ Backwater valve 16.60
Clothes washer 16.60
CA • f • .. a. 0 ' • . Dishwasher 16.60
. Drinlcing fountain 16.60 t
iii;2 IL:12:1. Ejectors/sump 16.60 I
Name:C-11 a w -r • in , 1....1...C-. Expansion tank 16.60
Address: a g, , „.. • a d Fixture/sewer cap 16.60
Cit /State/Zi • : _ , 411,L., __I 0, • fILIEM Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: lb , . is , - 7 EM Hose bib 16.60
Lig V.VT,IC;Ii_. ‘, ilisiDY;''`' r -rFaMflvit,.EIT/7E6.■±W: f ia.: s afil1111 Ice maker 1660
Name: c,_ v - c el W ;q to Interceptor/grease trap 16.60
Address: ,/ J 4. im Medical gas - value: $ Page 2
Primer 16.60
City/Stat ip: Rz-A i Or,,, q 70 ts Roof drain (corrunercial) 16.60
Phone: 9y3 3,1D 3ig3 Fax: 57, i i- ?7/5 Sink/basinAavatory I 16.60 (, , /La
E-mail: Tub/shower/shower pan 16.60
blilit6fgalkilickiik.gailMaiNifignieMai Urinal 16.60
Water closet 16.60
Business Name: IIIIMM Water heater 16.60
Address: a 0 5 k , t ) 1 -A t. i Other:
Cit /State/Zi • : r yff i P ' 7 I Other:
Phone: 5D3 . q c d„ 9) 31 Fax: Lit,q BEEENCEMEL Itil:4 : li -1 '
Subtotal $
CCB Lic. #: 4 54-7 PI b. Lic.#: -3(Lici , p Minimum Fern* Fee S72.50 $
Authorized, 1 1
/ , Residential Backflow Minimum Fee 536.25
Signature: , _ , / - • , q - . -dA- _ Date:49 c9 Plan Review (25% of Permit Fee) $
_ C Jr k i 1 ' • lAti))1f114/1 State Surcharge (8% of Permit Fee) $ 5. f0
(Please print name) TOTAL PERMIT FEE 5 7 v . 3o
Notice: This p -44it application expires if a permit Is not obtained within Ail new commercial buildings require 2 sets of plans with Isometric or
180 days after It bas been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri Building Industry Service Board.
tADsts \Permit Forms\l'ImPermitApp.doc 01/03
0_,46tAlba-ef ' -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00289
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/1/2005
Phone: (503) 639 -4171 iiM!,,rag1111t
Inspection Requests (24 Hrs.): (503) 639 -4175 _ -'
INSPECTION WORKSHEET FOR DATE: 7/22/2005 TIME: 7:09AM PAGE: 58
SITE ADDRESS: 12665 SW 69TH AVE 100 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 031 TYPE OF USE:
PROJECT NAME: CARLSON GROUP
DESCRIPTION: 1 new fixture.
OWNER: CEDAR ENTERPRISES, PHONE #: 503 - 636.6657
CONTRACTOR: PREMIER PLUMBING PHONE #: 503 - 469.8631
Inspection Request Scheduled For: Date: 7/22/2A05 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011930.01 503 - 320 -9483 N
Corrections /Comments/ Instructions:
g -I?ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
' Inspector: / Date: ? 7- Phone #: (503) 718-