Permit t lITY OF TIGARD PLUMBING PERMIT
°o IA DEVELOPMENT SERVICES PERMIT #: PLM2002 -00049
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/2/02
SITE ADDRESS: 17005 SW 92ND AVENUE PARCEL: 2S114A0 -01500
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: NONE FLOOR DRAINS; 3 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 100 ft
Remarks: Picnic Shelter - Phase II of Cook Park Master Plan expansion. The (3) floor drains are 2" and the other fixtures
are (2) hose bibs.
FEES
Owner:
Type By Date Amount Receipt
TIGARD, CITY OF
13125 SW HALL
TIGARD, OR 97223 Total
Phone 1:
Contractor:
COLUMBIA MECHANICAL INC
1702 DIKE RD
WOODLAND, WA 98674 REQUIRED INSPECTIONS
Phone 1: 360 - 225 -5761 Underfloor /Underslab
Rain Drain Insp
Reg #: LIC 151122
PLM 37 -451 PB 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: _ ! LI 1 I . mo► i Permittee Signature: f
- Call (503) .39-4175 by 7:00 P.M. for an inspection needed the next business day
Pt0.-0 1 C— .5 + �it,
P
406, ,i, lumbing Permit Applicat
D ate received: 7 09- Permi no g
: 2.: City of Tigard Sewer permit no.: Building permit no.:
" Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: E ire date:
Fax: (503) 598 -1960 Date issued: By Receipt no.:
Land use approval: CUP aGLD ` e e 1 Case file no.: Payment type:
'' - r .. - . ' TYPE OF PERMIT - > : :.
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
X New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
_•• - '' JOB SITE INFORMATION- -- r .: :; FEE 'SCHEDULE' (for specialinfort ation use checklist)
1 Job address: 1'-i 06 S 5 1,3 `i ,c Aye. Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: Block: Subdivision: SFR (2) bath
Project name: ', K. PA _ I, rd is.. d A SFR (3) bath
City /county: i . D ( ZIP: 9 . .V_ Each additional bath/kitchen
Description and locatio offwor on pre ise : Site utilities:
fl ( I t TE /� Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
/, -,r ti Footing drain (no. lin. ft.)
PLUMBING CONTRACTO ,. ,: .; Manufactured home utilities
Manholes
Columbia Mechanical Inc Rain drain connector 1 "!
1702 Dike Rd Sanitary sewer (no. lin. ft.)
/, ' V Storm sewer (no. lin. ft.) /
i 0 } i Woo WA 98674 t t)p
\`, -' Water service (no. lin. ft.)
1- 360 - 225 -5761
CCB #: 15122 PLM #:37 -451PB Fixture or item:
Absorption valve
Contractor's representat s Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON : = Basins/lavatory
Clothes washer
Name:
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
OF , y '�¢� Floor drains/floor sinks/hub o 2 r _
t
Name (print): > Garbage disposal
Mailing address: 1 3 (a4 560 f,q- /( /L Hose bibb as
City: -- q Aia I StateCW I ZIP: q 7 2 3 Ice maker
Phone: 6 3 4_(..4 ( I Fax: 1E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the pm i • , I ow
_, as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: ,� .. , _ — —' 2. Sum
Date: . Sump
ENGINEER ' Tubs/shower /shower pan -
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $
❑ Visa CI MasterCard expires if a permit is not obtained Plan rev (at _ %) $ -
Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $ -
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6,00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection `tine: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested l AM PM BUP
7 Location / I O c 5 ''w `/ 0- A Suite MEC
Contact Person Ph ( ) PLM .- a"
Contractor ! P ) SWR
um
BUILDING Tenant/Owner `` ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: A SIT
Post & Beam ��l
Ext SShea t h /SSh ear 1 7 ite.X41
Ext heah/h L'r/'
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm / 4
Susp'd Ceiling
Roof ; 7 l if
Other:
Final
PASS PART FAIL
Post & Beam �f
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
ina
PASS PART FAIL
MECHANICAL
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 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL