Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 -00413
t�J�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/02
SITE ADDRESS: 14680 SW 76TH AVE 087 PARCEL: 2S112BD -00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: OTR GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Replace plumbing fixtures.
FEES
Owner:
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 10/28/02 $99.60
#200 -L, MS63 [PLUMB] Permit Fee 10/28/02 $0.00
HILLSBORO, OR 97124 -3082 [TAX] 8% State Tax 10/28/02 $7.97
[TAX] 8% State Tax 10/28/02 $0.00
Phone 1: 503- 846 -4794 [PLUMB] Investigation 1 10/28/02 $99.60
Contractor: [PLUMB] Investigation I 10/28/02 $0.00
ALBERTA PLUMBING Total $207.17
LEWIS TRANER
PO BOX 55031 REQUIRED INSPECTIONS
PORTLAND, OR 97238
Phone 1: 503 Rough -in Insp
Final Inspection
Reg #: LIC 96782
PLM 26 -707PB
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
Issue By: _� /� Permittee Signature _ _ -
Call (503) 639 -4175 by 7:00 P.M. for an inspection nee - • the next business day
Building Fixtures
s OFFICE USE ONLY
Plumbing Permit App ®n
l s. ''—' D ate received: 0 DP - Permit no.: L J-/ j , „, _007/3
-'1'i+ City of Tigard l! � L .
__.. Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 OCT 23 20(2 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: - R_ , . - ., . Case file no.: Payment type:
TYPE OF PERMIT -
-
❑ 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement 0 Food service 0 Other:
' • ' ` . JOB SITE INFORMATION _ FEE SCHEDULE (for special information use checklist)`:',
Job address: /11 thb G1,6 '7 L' g
{- ” Description Qty. Fee(ea.) Total
Bldg. no.: J I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (I) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: 1 ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
Footing drain (no. lin. ft.)
a
,PLUMBING ` CONTRACTOR.. , .- .. . ' _
., Manufactured home util
Business name: 4 Manholes IIIII •
Address: _ f , Rain drain connector N
tff Ma .: ',gall Sanitary sewer (no. lin. ft.)
Phone:* .,3( i� . 'ax: S(/ y -mail: Storm sewer (no. lin. ft .) —
CCB no.: i • A . Plumb. bus. reg. no: 24_70 / • Water service no. lin. ft. ME
City /metro lic. no.: Fixture or item: 111
Contractor's representative signature: i; Absorption valve
Back flow preventer —
Print name: ate: _ - O L Backwat�i w
r CONTACT °P ERSON Basin •'r*
Clothes washer
Efflingr• M� — Dishwasher
Address. Drinking fountain(s) II
City: !_ , ,, .I State('v ZIP:' 1-1-1 Ejectors /sump _
Phone: / / '' Fax: E-mail: Expansion tank _-_
. - •£` I: OWNER' • Fixture /sewer cap M
Name (print): Floor drains /floor sinks/hub
Garbage disposal
Mailing address:
Hose bibb
City: I State: I ZIP: Ice maker
Phone: 1 Fax: 1E-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. • (s basin(s), lays(s)
Owner's signature: Date: Sump
- ENGINEER • - Tubs /shower /shower pan nil
Urinal
III
Name: • Water closet
Address: Water heater
City: 'State: ZIP: Other:
Phone: 'Fax: 1E-mail: Total -
Minimum fee $ 4l.fg/'J
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ visa ❑ MasterCard %) $
_ /o
expires if a permit is not obtained Plan review (at State surcharge (8 %) .. $ �' �g
Expires Credit card number: / / within 180 days after it has been c
Ex
Name of cardholder as shown on credit card p accepted as complete. TOTAL $
$ Cardholder signature Amount �0-464,9161081C017T'
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested l ( �� AM PM BUP
Location l LCD D?) 760. Suite ?7 MEC
!L
Contact Person Ph ( ) '7 7 0 q/S 7 PLM — 6 (ff 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation
Ftg Drain ELC
Access: ," /
� " S
1 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors 6'0 —
Ext Sheath/Shear (/ v V
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall � Fire A Fire Alalarm
Susp'd Ceiling ' l G )
Roof
Other:
Final , Are-
PASS PART FAIL -
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain ,r
Shower Pan
Other:
PART FAIL
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: 111 Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date/ /(1 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL