Permit Aft‘ii CITY . O F T>I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 -00393
Aza " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/9/2002
SITE ADDRESS: 16230 SW 104TH AVE PARCEL: 2S114BB 09100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
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: 65 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 65' WATER SERVICE
FEES
Owner:
Description Date Amount
%BEEN, GREGORYA /KAREN S
6230 SW 104TH AVE [PLUMB] Permit Fee 10/9/2002 $72.50
IGARD, OR 97224 [PLUMB] Permit Fee 10/9/2002 $0.00
[TAX] 8% State Tax 10/9/2002 $6.00
[TAX] 8% State Tax 10/9/2002 $0.00
Phone 1:
Total $78.50
Contractor:
NTEGRITY PLUS PLUMBING
' 0780 SE HWY 212
LACKAMAS, OR 97015
REQUIRED INSPECTIONS
Phone 1: 503- 650 -9878 Water Line Insp
Reg #: PLM 40 -445PB
LIC 140943
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 direct questions to OUNC by calling (503) 246 -6699.
ssued By: c—k//)/47../.G Permittee Signature: _v r •
Call (503) 63'9-4175 by 7:00 P.M. for an inspection needed the next busi - s day
10/07/2002 13:51 5036509878 IPP PAGE 02
toeu(ii:uu6 14 :06 FAX 5035981960 CITY OF TIGARD ?6% ? 3 001
• BuildingFIXtnxe
Plumbin er�m rtA�
gl plication
on 1 :F_ I :SE 11 \1.1 i
Date • Permit . • . -OD � C of Tigard
hl � . � - Sewer ... 't no.: Building permit no.:
c ry oj l�aa�d Address: 13123 SW Hall Blvd T
Phone: (503) 639.4171 Projecdsppl, no-: Expire data:
Fax- (S03) 598 -1960 a r �Q�2 Date issued: By: Reoei t no.:
Land use approval" QC Case fite no.: Payment typo: -
II 1 & 2 family dwelling or accessory 0 f, 'ah1m4roial industrial D Multi-family ❑ Tenant improvement
D New construction D4 ddition/alteration/replaocttieet D Food service ❑ Other: .,
.Olt SITE INFOR 1AT ON ' FEE SC11LDUJ.li (lot si vial information tut. check i f)
JO address_1 X Z o 3, w, l o l l . _ Description t Tow •
-
Bldg. no.: Suite r n -: -` ew 1- and 2 - ail glY s only:
ptteladaq 100 R. for each utility ( u nnection)
Tax map/tax lot/account no.: SFR (1) bath
Lot: Block: I Subdivision: ' SFR bath _
Project name: ( � T , ,�„ J u .r' •. ) bath .
City /county: r I Zr?: 1' Each additional bath/kitchen.
Description and :lotion of work on promises: Siteudlltlatr
C a~J V t s-C__ , Catch basin/area drain
Bst. date of co n . letion/bi • action: I 11s/leach line/trettch do in _
PI,IJNIRING CONTR:1tf' OR Footingdram(no.lie . ft _
Manufactured home utilities
Business same; a 1 4 . - $ r e ` d - PL�ts I , _ I . ` . ' Manholes _
Address: , -,- 40 / _ Rain drain connector _
_
City: 1 ' State:, DP: 1 ?0ts- Sanitary sewer (no- lin ) •- -
Phone: era - 'T Z1 %mil:
F : storm sewer (no• lie ft-)
Water service etl0. lin. ft.) CS 4 6S •
CCP no.: I Lin ' Plumb. bus. rc g. no: -
Ci /metro lie. no.: Fixture or item:
Conn re • reSentative signature: (111, Absorption valve -
Back' flow pre /enter
Print nettle: Z1 1 N . I s ' ate: [1•I - 7 - O 0- Backwater valve
CO\ 1.- CI I'LRSO Basins/lavatory -�..._ - _
• ' Clothes washer
Name: Y' • _ Dishwasher -
Addresa :10 7 if a S by a l Drinld fountai:l s)
Ci State-, IEZIP: a fin
Phone: 6% Fax: li mail; Expansion tank •
OWNER Fixiure /sewer cap
Floor drains%floor sir ub
Name (print): _ _ e • . • _ e disposal
Mailing address: Hoge hi • b _ _ + I
City: ' - I State: - .a9; Ice maker �� _
MOWN . I Pax: I L mail; In or /grease tree -
Owner installation/resideotial rfnainteeancc only, The actual installation Frim s)
will be made by rile or the maintenance and reps Ir made by my regular • . • fdrain (oommerer:
employee on the property I own as per ORS Cie ipter 447. Sink(s) basin( lav s
Owner's si • ature: .. - - S ump
F\ G i \ 1:.(:i2 a Tubs/shower /shower Psi _-
Urinal
Name: — - Watercloset -
Addrees: Water heater
City: _ St ate: j7.IP: a . . . -
Phone: I Fax: I E email: Total •
- —' Minim rm fee -r.- S --
f Not tai Alpaca. wwst aod;t <ant& Pilsen 'a lmi$diedoe for a an in"'"" °11. 'idodoc: This Permit spPlieadoa Plan re view (at %) S
13 via O MagietClw0 capites if a permit is not oba
/ *baffled within BO bays slaw it has been • state a lrchat C (s9'6) •• -- $
axial ewd Number ' • - " B$TIitae TOTAL a -
accepted as oomplete.
tuim of w,ebolner n s on credit cant •
„II, M0.4816 (6NWt OM)
csrdbotdet Or me AaIOWK
■
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION - Bys 1' iness Line: (503) 639 - 417 MST
BUP
Received Date Requested l ` AM PM BUP
Location I t.2 3 d / d / — Suite MEC
Contact Person Ph ( ) PLM ' - 17. '3 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: U � , + � e ,r / lJ �y '—y� J1 ELR
Crawl Drain -
Slab Inspection Notes: 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 FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Sanitary Sewer
Rain Drains '
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
-) 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 reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date ' i ' i nspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL