Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2003 -00166
6 DEVELOPMENT SERVICES DATE ISSUED: 5/1/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12085 SW 135TH AVE 066 PARCEL: 2S104BA -00100
SUBDIVISION: GREENFIELD VILLAGE APT. ZONING: R -25
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: 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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 20' of sanitary sewer.
FEES
Owner:
Description Date Amount
GREENFIELD VILLAGE
PO BOX 5668 [TAX] 8% State Tax 5/1/03 $5.80
PORTLAND, OR 97228 -5668 [PLUMB] Permit Fee 5/1/03 $72.50
Total $78.30
Phone :
Contractor:
METRO ROOTER & PLUMBING
BARRICH INC
630 1ST ST
GLADSTONE, OR 97027 REQUIRED INSPECTIONS
Phone : 503 Sewer Inspection
Final Inspection
Reg #: 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: ! � Permittee Signature: r • �,!
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
04/30/2003 10: 05 5032416565 MRP PAGE 02
fixtures ,J ti1Te5 FOR C1kl'1CF L`Sl� ONLY
tit i Q P ermit ��ul eat on D �= : 5- - v 3 l a:, ' No.: 4-..2.4..A.• - / to 4,
�� V ® D an ri rog Approval Sewer
City of Tigard R Datell3 . i'ermitNv -:
Plan Review Other
Tigard, Oreg
13125 SW F cn Blued- R O 2 03 pate/13 . Permit No.:
on 97223 a t':e
Lend Um ,
Phone: 503- b394171 Fax: 503' -1960 4,,,:,6,,„, ...,T, � t
t \. Datede� 1 Case No.:
Internet: www.ei_tigard-or.us CITY OF TIGF+P . p lI luris. �+ See Paee
a Y+ �_
24 -hoar Inspect Request: d i- gkd4.1715 ►VIA;:;; _.« Name/Method: Su , lc-mental information.
•
x I' �-� c'3i7 i�'' ..I� • , ?rfi. �_.C�:y��G�.; ? �J�� �c +k 75'x-• • , �i�',��,�7;rJ :;i+!. ':F��� �. .._ .. .. �` - I (�} y . eeCe71 -) Total
"''ll Demolition Descri . den ;,r ��
[� New CQII5#tW3t1,ot1 • i -�: i,,,',i �•. ( i �, -.� ...,��.� .!:i� t � " ;`�� ' '�i:.i _ ;'::. i 1 . t.. • . 7• � ;: " %: t c •
mitt: •11 � i ,� I 1' ,:IP r .04 1� IT. I � ° c - , ,, " N , � 1+�•tl �,�', <b 4': 4
an/r lac etrlent Q O ', . ' " ' 1 ir + If'tiei .1 1 Er •.n oa`W �.�.lOt.:. , a,: m$
MI A,dditionlal�terati eP _�, ° ..
1 & 2 :' ORY- o � -'i'IL C N D i;':1;;:';s •k's. �r) N s,R (1) bath 7119,20
� - Famil dwelli - I. Con mer'cia3u1 clusttrl,al Sm. (2) bath 350.00 •
�� �� 399.00
Ili Access •t Buildi _ r ►tt Multi Fatn S FR (3) bath
Ill Mast= Builder • Other: lr aeb, additional bath/kitchen _ 45.00 MON
` :! . :ir, SIT I •it Ct' 4 110: ' il;LO 4,` U A.:i ^,', •t �',n' +d , "e' Fire s.alder -. y 1•Irl }j�( y� I y� " �1.1�� -'1':r�
Jab site address: I a -7h _ [ each basin/area drain 16.60 '
Sui>re #: � Bid!. .1' • . eWicach line/trench drain 16.60
' ' • act 1 alr!_e: �i: rlr I ' l , . , a_ j Poo : drain lto. liu�oat ft.
Cr OS street/Directions to job site: Manufactured home utilities _ 110.00 MOO
Manholes IIII 16.60
' Bain drain connector 16.60
. sanitary sewer (no. linear ft.) • ma P : 2�'�
Stoma sewer no. linear ft. NM p
Wastes service xl l
Subdivision: Lot # o ii near it MEMNIIIIIIIIIIIIII t]]a i /.: cel #: �!i;ti! $! lol� #i, a �frl ll'.r fr',t, e l _ �_ �r. ° : r ' .: ; r 3 t� :: ,: :
T ax rD ki , ; . i a•: . d.'j i 1.1 ,Ill�f r �,f!.,S;. ali,i ,
i .• : f�: ]a��;�'jk ISj l . I SF� 7e 1E ° ! '- • ;. ::Lit :, Also • lion valve 16:60 IIIIIIIIIIMI
Dunkin' fountain 16.60 a Y :BliinEirill=i E'cetors/- i.. MI 16 -60
Na:'tle: r A .A JAI. -it 1 _ ansion tank 16;60
z Vhcra +drawer cgp 16.60
Address: Floor drain/floor sinkihub 16.60
Ci /State/Zip: Garbage disposal - 16.60
Phone: Oy , 12_ 1 - a' Fax • Nom btu 16.60 Illa
��� 3k .s t : 71 �, 2g' �qrP 4- 4Mi _ Ice mak
� �>r�'i a '•iG' � , �,i;:l:ill;f I ,: ',: i .,, �, «, /:' ,� � � • 16.60
Ynt . • .• 1. , -anew 16.60
Namo: 1? �'l Jr ( i( X0./1 Medical gas - value: $ Page 2 MI
i dI85S: . s - Primer 16,60
6 11 r1 A. rl : Roof draintcornmerdal) 16.60 1111 Phony: Fax: Sinlc/basiidla , ..24. 16
FrkaYl;
Tub/shower /shower, . an 111111 16.60
Urinal 16.60
i i a,: a; 111 .i' i'.1 4n :r', U ?�!t0 F ' .. 0 .' .' ; `; , ,, r ;:i): i ,C;t7 : d
�'4: . �o .r "r: ' • �.,.i . „'. • Water closet 16.60
Business Name: I1g?1•rp'R(r e ( ., .. AA 6..A . a Water clos - _ 16:60
Address: Z. : 5 - --
.• Other yy :r.. �1.J rs :A „�_. �;,�, .:� G'�
one; j A •iin:i::-LEN" j�'D;'•h'q • 1'itiblilin 1 I , t ;:k •;. ,, IT415!:,�� ;74
C . ski\s1$1, 111 Plumb, Lie* 8-ZiirgB Subtotal
Minimum Permit Fee $72.50
Authorised 4 f / 0 3 Residential Backflow Minimum Fee $36.25
Signatures _ � Da T' Plan EtevieW 25°x6 ofTermit Fee
- . A a 0 1e' : Ala State Surchar: c :.% of Porroit Poo Eillriffell.111
tease print name) TOTAL PERMIT FEE $ '7 ' ,An
Notice; his permit application expires if* permit is not obtained within All new commercial buildings require 2 sets of plans withisometric or
180 days after it has Aeon accepted as complete, riser diagram for plan revIev.
*Fee methodology set by Trl- •County Building Industry Service Board -
j: lActs1PcrmitFornis\P1mPermitApp -doe 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION ,DI )/ISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested s AM PM _ BUP
Location I d ' - 0 $ S /3,c ` J4'v'� Suite i4 677 -6?. ` MEC
Contact Person Ph ( ) ca-q - & Lis"
PLM 3 00 r c(0,
Contractor Ph _( a_ SWR
BUILDING Owner ? 4 - .111. ( S
' .s - -_ ELC
Footing ELC
Foundation Access: '")
Ftg Drain } 3 a -/� ELR
Crawl Drain 1
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
Water Service / J
anitary ewe
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi
PART FAIL
1bC 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 0 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