Permit CITY TIGARD PLUMBING PERMIT
Alk � DE VELOPMENT SERVICES PERMIT #: PLM2003 - 00274
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/24/03
SITE ADDRESS: 10820 SW 130TH AVE PARCEL: 1S133AD 02200
SUBDIVISION: ZONING: R -
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: B 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: Installation of clothes washer.
FEES
Owner:
Description Date Amount
WESTGATE BAPTIST CHURCH
12930 SW SCHOLLS FERRY RD [PLUMB] Permit Fee 6/24/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 6/24/03 $5.80
Total $78.30
Phone :
Contractor:
KEVIN SHARPE PLUMBING
3851 SW CULLEN BLVD
PORTLAND, OR 97221 REQUIRED INSPECTIONS
Phone : Rough -in Insp
Top -out Insp
Reg #: LIC 112898 - Final Inspection
MET 00004632
PLM 26 -593PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: A�� � / Permittee Signature'. , ///
I' Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
FROM :" "iATE BAPTIST CHURCH FAX NO. :503- 524 -4560 Jun. 17 2003 10:45AM P2
• Hu g r ixtur' s • ‘15) FOR OFF ICE, USE ()NIX Plumbing Permit Applicati . Received Plumbing h
Date/B t 03
Permit No -: 4 i• - cea7f` •
%.- Q� Planning Approval Sewer ���`
City of Tigard Q Date/B : PermitI o10.: +' D0 -6611
13125 SW Hall Blvd. 0 \`r \ L �� t\1 Plan ]review
other rib
' • C \�
Date/B : Permit No.: `\
Tigard, Oregon 97223 • ,``l C 'C \ < Post- Review Land Vse -.$ Phone: 503 - 639 -4171 Fax 503 - 598- 1960A , r1
v'° ,s• ! I l ig : ( ;
Date/B • Case No.: '`
lInternet: w�ww.ci.tigard.or.us \\ l./ JI
contact 24 -hour Inspection Request: 503 - 639 - 4175." "° " Juris.: _� See Page 2 for
Name/Method: Su, , lemental Information. .
•
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,e New construction Q Demolition Description - • Qty. Pee(ea.) Total
W F : y '.u�' � VF � ipa A , � � r 4 - . 'i • , li W
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ddition /alteration/replacement El t y ,�ti8 1 :, ., C � * �} 'r :'� ' w ,i� ; , ,; ; 'a
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g a » 1 ,� r,%( ra.%�`e;�d o��it:`"tJ. , 'i r7�r ✓ ufii,I,aAbh E3' OIU a "}$'ai,::_:2;%'
;i';Cu >Ftwl l .,Cs:s� n 'odkS m , - ,, d ' R %'LEON =,i, ,uw re':.:: SFR (1) bath 249.20
0 1 & 2- Family dwelling M Commercial/Industrial SFR (2) bath 350.00
• Accesso Buildin l • Multi -Famil SFR (3) bath • .
❑ Master Builder . 17] Other: Each additional /idtchen
„y
ath 45.00
.ff:� :. ,. trial `° i '0: 1' . l ;, I" e)a�l °�' 4 .,41AIg. lefg,6� m.�l :. .., �:P
: Fire s•rinkler - .. ft.: Pa • e 2
Job site address: 10'82o I - ' .. K ,al t .. ;k f ' `?x M; .p +Wattiii;t ' ;i 1;
Suite #: 1 Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: L C - ST DrywelUleach line/trench drain 16.60
/E'f 4??Tt� ► C h�U2 i-E Footing drain (no- linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector • 16.60
- • Sanitary sewer (no. linear ft.) • Page 2
^ Subdivision: ' L #: Storm sewer (no. linear f) Page 2 •
' Water ce n- linear
Tax map/parcel #. i S133Pst> -4ZZ0 Ea ter" i o
„ „ MM y , �.
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Absorption valve 16.60 I
St lS KLL (.3 fc$rtfr2. S � .rer Cte Backflow preventer • • Page 2
(1 Backwater valve 16.60
Clothes washer f 16 -60 .
'�' I' Dishwasher 16.60
• Drinking fountain
A
' v 9r L o t,ei "„ : 1 ' 7:4 lid 1 fl ll 14.7 � � ' 'I. ; se u' ;, ! 'i :.. Z.'' :i fountain 16.60
4 1'I 6��S . =9' s ! Ejectors/sum
p 16.60
Name: Jo 1! ST t'r.E'C V) frP'r■ 'C _C rEv rt G ti- _ Expansion tank 16.60
Address: 12q 30 5th 5e.Ha EiAle a.y OA Fixturc/sewercap 16.60
City / State/Zip: T t C h�D 0 K. c c c� 7 ZZ3 Floor drain /floor sittk/hub 16.60
Garbage disposal 16.60
Phone: 03 szq oo Fax: 03 S z Li 4. '56 6 Hose bib 16.60
1V!,tEjf:C S`r I "eac �FlA:ni4 ° Uhl,:,µ: , ;';ice .M'f'r ^sr Ice maker 16.60
Name: i3itt " (AI 0 - • z, 1,z . Interc- . or/... case has 16.60
Address: l,tZ> S Ct.� 4, arts 0 CA �o's� . g L.,./ % Medical gas - value= $ Page 2 -- •
City /State /Zip:: ' . ' O ¢ g 7 35 Roof _Primer 16.60
.
1 Roof drain (commercial) 16.60
Phone: So Sri z N73; z 1 Fax: Sink/basin/lavatory 16.60 _
E -mail: Tub /shower /shower. pan 16.60
• tra y l' i i! g @@IIgi77��Y1:'tfe •e!:a "' ?:i } . ii.l ; ,, .: }: = �4 Urinal 16 -60
. f', §i:��iiiir.E�!�IYd�Rlnlai::, :�o ��: �'��IT'i�Y�i: . .m..,... s.. ._. ... _
Water closer 16.60
Business Name:
j .. V t. ..__A fi 4 Lo m i LIC- Water heater, 16.60 •
Address: 3Cg5t Sr..._ co t-t,t?-j l,vb Other: -
City /State/Zip: {>¢K.; t,.tt n)h 1 enrt.l (so • Other:
Phone: so3 ZQ 313/4/ Fax: ' , ; �..l w „ '. m lti : s , a_. l
4 1iv" ,i�hiE�il,�- :..,�„( "�>K�.,t��xt � .nib' pee i, p� ".�� e„ R' �r.�µ'*�:l?Mrriahe
CCB Lic. #: (tz%i t Plumb. Lic. #: 26 -5 3p4i, - - - Subtotal $
Minimum Permit. Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25
Signature: • / �/ „ Date: 4-17-c)_.3 • Plan Review (25% of Permit Fee) $
• .� } lq i AO P} / 0 1 AD State Surcharge (% of Permit Fce) $
(Please print name) TOTAL PERMIT FEE $
Notice; This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. • riser diagram for plan review.
*Fee methodology set by Tri County Building Industry Service Board.
is \Dsts\Permit Forms\PtmPenmitApp -doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested °- AM PM BUP
Location / o d 7,36 ' 911- /9' Suite MEC
Contact Person Ph ( ) S - 7� - 7 3 cj PLM 3 od a 7
Contractor Ph ( SWR
BUILDING • Tenant/Owner , _ : i /i :� .A!/ ELC
Footing
Foundation ELC
Access:
Ftg Drain • 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
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
er:
la p 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: El Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL