Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00018
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
DATE ISSUED: 1/13/2005
SITE ADDRESS: 13125 SW 115TH AVE PARCEL: 2S103CA 00104
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 20 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Line work to septic tank. Approx. 20ft.
FEES
Owner:
Description Date Amount
HOOGENDAM, MAARTEN + JACOBA
1 31 25 SW 1 15TH [PLUMB] Permit Fee 1/13/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 1/13/2005 $5.80
Total $78.30
Phone:
Contractor:
METRO ROOTER + PLUMBING
BARRICH INC
5008 SE WOODWARD ST #3 REQUIRED INSPECTIONS
PORTLAND, OR 97206
Sewer Inspection
Phone : 652-2626
Final Inspection
Reg #: MET 2150
LIC 106824
PLM 3 -265PB
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.
Issued By: 6 :'4A (yeet_ Permittee Signature: k _.1.(11/1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi e s y
`Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received
13125 S W Hall Blvd., Tigard, OR 97223 Date/By: f - ?j -05 .815 Permit No. yy �
'hone: 503.639.4171 Fax: 503.598.1960 / /yam- NN F; ° \ Date/ByaeW
mr.9 1v5 _0a / ii 1- Hour Inspection Line: 503.639.4175 ( Other Permit No.:
Internet: www.ci.tigard.or.us
Notified/Method: ' I - . Date ReaReady/By: luris
H See Page for
eo 7I Su
� � �� � � Supplemental Information
❑ New construction ❑ Demolition For special information use checklist
ddttton/alteratton/replacement ❑ Other: Description Qty. Ea, Total
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
'4 , v well) r0 ` i ' IY ,-?' E � `,° `r 3 I I 249.20
a - F H.,.,. SFR (1) bath
K1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) I I Page 2
.
c F 3 .�, • ' l � .: `�i a.•it � Site utilities
Job site address: / ? 1 a J 5 IS S j4( Catch basin or area drain
..t
City /State /ZIP: t Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: �L. ayev C/ /� Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: / 'J' I Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
w Absorption valve
- . k 4 r , e , _; , t , , , -. : g 16.60
Backflow preventer Page 2
6.4411."1.=.74: .��ri.�`I` -- % ter .
_ �-- /���� Backwater valve 16.60
.
.. .d; 14/ M7 / j 2424 ` Clothes washer 16.60
{ e, e, / .1 t'..vt. ji) �. �J,1 ' /� / Dishwasher 16.60
' ' ' E, W Q , y, is Drinking fountain 16.60
Name: J� "� Ejectors /sump 16.60
r `� �' r aC Expansion tank 16.60
Address: / 31 a� l✓^ /'/ Fixture /sewer cap 16.60
City/State/ZIP: 0 ' Floor drain/floor sink/hub 16.60
Phone: ( 3) 6 ♦ 3.7,0 Fax: ( ) Garbage disposal 16.60
'�. '., . : g Hose bib 16.60
n
�� " Ice maker 16.60
Business name: / r � n 16 a 0 / } , . -
�( •( -( A
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
P. �
Address: , �K S'----- b ( g -
D Primer 16.60
City /State /ZIP: P6 C:�-E r C 7d- % Roof drain (commercial) 16.60
Fax: Sink/basin/lavatory 16.60
Phone: ( )
�Sa - a�a ( ) all 1
Tub /shower /shower pan 16.60
E -mail:
, A s ` ' Urinal 16.60
' °. ` � ' . Water closet 16.60
Business name: A i 1.+ frill. L � `i= Water heater 16.60
,
Address: r o t Q e ,X 3 5 5 Other:
,(,Q n � + , C1 A „� 9 7� 9 a Subtotal
City /State/ZIP: pm
v+ �-e�1 9 7 Minimum permit fee: $72.50 'l
"hone: ( ) (0 Sa _ G I (_ (p Fax: ( ) a Lit-. Co 1 ( Residential backflow minimum permit fee: $36.25 7 2 - 5 j )
.B Lic.: (6 ( g' a i ` `�' Plumbing Lic. no.: 3 _96,,s PA Plan review (25% of permit fee)
Authorized signature: J State surcharge (8% of permit fee) 5 %0
TOTAL PERMIT FEE /7 IV, :V)
I Print name: 5 ict 6e, IA) - a NsO A.J l Date: / - /3-0s- This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line-(503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ! J AM PM BUP
Location ( � /VS ( / 41 -- Suite MEC
Contact Person Ph ( ) Z�� - 3g1 PLM 0 1
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 1
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Drywall on
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling F-
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi
00 PART FAIL
NICAL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date 1 ✓ 1 U Inspector l " l 1;0 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL