Permit 4�' ; T `' CITY OF TIGARD PLUMBING PERMIT
" '411 DEVELOPMENT SERVICES PERMIT #: PLM2002 -00051
VII 13125 S 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: 1
OCCUPANCY GRP: M FLOOR DRAINS: 15 TRAPS:
STORIES: 1 WATER HEATERS: 2 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: 10 OTHER FIXTURES: 6
TUB /SHOWERS: SEWER LINE: 25 ft
WATER CLOSETS: 10 WATER LINE: 25 ft
DISHWASHERS: RAIN DRAIN: 75 ft
Remarks: Restroom with concession - Phase II of Cook Park Master Plan expansion. The (13) floor drains are 2 ". The
other fixtures are (2) drinking fountains, (3) hose bibs and (1) ice maker.
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 Rough -in Insp
Underfloor /Underslab
Reg #: LIC 151122
PLM 37 -451 PB Top -out Insp
Rain Drain Insp
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.
c 1
Issued y: , _,i.4 `: � i► X11 i1 Permittee Signature: d9110( O , IF !G ---
Call (503)'63' -4175 by 7:00 P.M. for an inspection needed the next business day
L j - d� U I.) e ion-) 5u02 g
R P1 � bing Permit Application,
•
Date received: 7 p2. Permit no.: Ff _art)57
'''rqv lii" City of Tigard
-1+�- , r Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: C j/ r ' g 0 oet, I Case file no.: Payment type:
TYPE OF PERMIT'' .
0 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
X New construction 0 Addition/alteration /replacement ❑ Food service ❑ Other:
. • t '";' ' , :r -'' JOB SITE INFORMATION , n • • FEE SCHEDULE (for special information use checklist)
Job address: ) ' 6 5 (A) `i off 4E . Description Qty. Fee(ea.) Total
Bldg. no.: I 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: _, z : ,w g, riggy � 1 ,/ SFR (3) bath
City /county: ADD 4 „ ZIP: c ? . . _ Each additional bath/kitchen
Description a ^r1 Iwratinn niwnrlr nn .,rPn-; ,- ••• Site utilities:
�✓i o-0O11/4-1 w/ L9Aq-ei &) Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line/trench drain
Footing drain (no. lin. ft.)
. .,,. .:, ;'',PLUMBING CONTRACTOR Manufactured home utilities
Columbia Mechanical Inc Manholes
1702 Dike Rd Rain drain connector
Woodland WA 98674 Sanitary sewer (no. lin. ft.)
�/• Storm sewer (no. lin. ft.)
VI/ 1- 360 - 225 -5761 Water service (no. lin. ft.) •
CCB #: 15122 PLM #:37 -451PB Fixture or item:
..,ttyrtttcttu tr... uv..
Absorption valve
Contractor's representative signature: Back flow preventer / •
Print name: Date: Backwater valve
'` -.� : ' < 'CONTACT PERSON Basins/lavatory /0
Name: Clothes washer
Dishwasher
Address: '
Drinking fountain(s) A
City: I State: I ZIP: Ejectors/sump '
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): t 0(' 'R Floor ains/floor sinks/huba" /3) aS 5
�� � Garbage dr disposal
Mailing address: j 3 ( , q - ( /i/ Hose bibb 3
1)_.... City: -77 q i} 6 I State ZIP: q 7 „z,..3
Ice maker /
Phone: 6 ,3 -�[T ( I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primers)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) •
employee on the pro I ow as per ORS Chapter 447. Sink(s), basin(s), lays(s) '�
Owner's signature: Date: - " - G . ? . . . Sump
Tubs/shower /shower pan -
Urinal ' '
Name: Water closet /O.
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 $
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Name of cardholder as shown on credit card Expires accepted as complete. TOTAL $
$
Cardholder signature Amount 440 - 4616 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /c AM PM BUP
Location /' b 0 5 '%7470( Suite MEC
Contact Person 1.1 Ph ( ) ��2 `t 7_jPL a -•O 0
Contractor Ph ( ) -w o1 -0 e) 5
BUILDING Tenant/Owner L t� -i g-- D o eS1
Footing
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: j i L - SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof f
Other:
Final
Ca PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
rxpff PART FAIL
‘ 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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA l '
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL