Permit ^ CITY OF TIGARD PLUMBING PERMIT
r DEVELOPMENT SERVICES PERMIT #: PLM2002 -00203
— ` VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/7/02
SITE ADDRESS: 15151 SW 83RD AVE PARCEL: 2S112CB -17200
SUBDIVISION: HAMPTON COURT .ZONING: R -7
BLOCK: LOT: 021 JURISDICTION: TIG
CLASS OF WORK: ALT - GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF' WASHING MACH: BACKFL OW PREVNTRS: 1
OCCUPANCY GRP: R3 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: Residential Balckflow Device
FEES-
Owner: '
Type - By Date . Amount Receipt
PERPETUA PHILLIPS PRMT CTR 6/7/02 • $36.25 27200200000
15151 SW 83RD, 5PCT CTR 6/7/02 $2.90 27200200000
TIGARD, OR 97224
Total $39.15
Phone 1:
Contractor:
TREE CARE UNLIMITED
P.O. BOX 1566
LAKE OSWEGO, OR 97035 REQUIRED INSPECTIONS
Phone.1: 635 -3165- RP /Backflow Preventer
Reg #: LIC 5659 .. 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 by the Oregon Utility
Notification Center. Those rules are set forth in OAR .952- 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: " ` 1 P ermittee Signature: L 9 614 Gr h et
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next i6 siness day •
06/04/2002 10:46 FAX 5035981960 CITY OF TIGARD lj 001
1: '
• Pl umbingPermitApp li cation - ... . ..
..... .... d 4, : J � , . Sewer p Building permit no.:
Address: 13125 SW Hall Blvd, .'l gard, 8,97223 tno.:
CiryofTigard .phone: (503) 639.4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 ' JUN - 7 Nut Date issued: ( -1_47- ByL L. I Receiptno.: .
Land use approval: i . f I Y OF l t ., i , P.
Case file no.: Paymenttype: C 1 eG K
TYPE OF PERMIT
• I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement 0 Food service 0 Other.
.1013 S1TE _ 'lNFORMATION ; , ; ,, • . FED S4l1EDIjLE (fur special information use checklist)
Job address: / Q3r Description Qty. Fee (ea.) Total
.S 5� �{ v • New 1- and 2- family dwellings only:
Suite no.: I Suite no.:
Tax map/tax lot/account no.: Cmcludes 100 ft. for each utility connection)
SFR (1) bath
Lot: 1B lock: I Subdivision: SFR (2) bath
Project name: 1:01 t i t t S _ SFR (3) bath
City /county : -- [ i ar d, 22)-/ 1 ZIP. 3 7- Z Each additional bath/kitchen
scn do and lo of work on premises: X tfr ri // SiteotHlties:
yet ca low ? dt- ves% r Fr u A -y4 r d Catch basin/area drain
Est date of completion/inspection: 2. 6, u A L d Z DrywCIlslleach line/trench ench drain
Footi drain (no. lin. ft.)
Manufactured home utilities
Business name: re. 4- n shape.l UK (4-el. • Manholes
Address: PO Sox 14(efi /510 00 Su! ao 0e eel ,. Rain drain connector
City: _ • kt • Sw e o State: d (Z ZIP: 703 5 Sanitary sewer (no. lin. ft-)
Phon • 4,5 ' Fax /5 E-mail: Storm sewer (no. fin. ft.)
CCB c '. 42, (� 3 i. . ' mb. bus. reg. no: Lea 54,5 Water service (no. ha. R)
City /mono fie:-no.: _ afire a O 3d Of tt>r or it
Contractor's representative signature. _ Absorpt valve
Bata flow prevents -
Print name: L t et ' l( • }X.ITIM Date: t 02-- - Backwater valve
CUNT AC) PERSON Basins/lavatory
Name: Clothes washer ,
Dishwasher •
Address: Drinking fountain(s)
City: I State: I ZIP: ' Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER • , sewer cap •
FIQor drains/floor sinks/hub
Name (print): G,(' Q • - 1 , Olt t f 5 - Garbage disposal . •
Mailing address: /5/ 5 / JtA./ 83 e e ii v • Hose bibb
city: 3 q .rd. J Stare:OL I ZIP: e i •.ZZ`( :lanai= •
Phone: Fax: • I E-mail: • , 7 1uteicepwr/giease trap
Owner installation/residential maintenance only: The actual installation : 'Priuieds)
will be made by the or the maintenance and repair made by my regular Rdof drain (commercial)
employee on the property I own as per ORS C2rapter 447. Sink(s), basin(s), lays(s)
Owner's signature: • Date: ' Sum .
.Tubs/shower/shower pan — ,
Urinal
Name: Water closet •
Address: . ' Water heater
City J State: I ZIP: Other.
Phone: [Fax: 1E Total
Minimum fee- $ ' sap • LS
Not as Accept aria arils. pieta* all J [tie blot sselm permit a pp '
0Visa. o MestnCard o�itrs _ If apeimit is not Fla n a lOvi ow (at 9b) $ .
CMS era gamete . / / . Within 16J d llya after It has been Smote �W) ••_ S o on on A c
• 9 0
apes JUN -04 -2002 11 :18 5035981960 97% P.01
CITY OF TIGARD . 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received • Date Requested O AM PM BUP
Location IS lc( d 3- /8-0 Suite MEC
P l° 3 PLM �cd 3
Contact Person ( )
Contractor Ph ( ) SWR
BUILDING. Tenant/Owner ELC
Footing
Foundation ELC
Drain Access:
Ftg 9 ELR
_ Crawl Drain
Slab Inspecti•P '•tes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FA IL
PLUMBING
Post & Beam •
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan 0
Othe •
S PART FAIL
CHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm •
Final - L Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA D Inspector Ext
Approach /Sidewalk \�
Other:
Final - DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL