Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00486
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/17/03
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SITE ADDRESS: 15725 SW ALDERBROOK CIR PARCEL: 2S1 11 DC 02600
SUBDIVISION: SUMMERFIELD NO.8 ZONING: R -7
BLOCK: LOT: 473 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: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of a clothes washer.
FEES
Owner:
Description Date Amount
LIEBERMAN, VON E + DOROTHY B
15725 SW ALDERBROOK CIR [PLUMB] Permit Fee 9/17/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Tax 9/17/03 $5.80
Total $78.30
Phone :
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206
REQUIRED INSPECTIONS
Phone : 503 771 9449 Final Inspection
Final Inspection
Reg #: LIC 42671
PLM 34 -70PB
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:, ,7;_,Q,65. Permittee Signature: ,} ,A,/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
SEP -15 -2003 09:47 AM CROWN. PLUMBING 503 771 9454 P. 01
Building Fixtures !
?luni in Permit A lication
f R C' ei Plumb , / /
�� way / /7 3 PermitNo.: Lh' o3-UO Y .1
City of Tigard �J Planning Approval sewer
Date/By _ Permit No.:
13125 SW Hail Blvd. SEp 1 5 2003 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No,:
Phone: 503 - 639 -4171 Fax: 503-598-190R Post- Review Land Use
CITY OF i(RD �`'r "'`, ;a:l1ily:�ti' �� Date/By: Case No.;
Internet: www.ei.tigard.or.us ISIO',! '��_ Wage
24 -hour Inspection Request: MA 4 . Contact r Name/Method: / / C Supplemental Information. 1
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K 1 & 2- Familidwellin t is Commercial/Itidustrial SFR (2) bath 111 350.00 IIII
I.Accesso Buildin? , _ Ili Multi -Famil SFR (3) bath 399.00
'� Master Builder NIi Other: Each additional bath /kitchen 45.00
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Job site address: __ 5 � � 1 , _ i ; ! „, .,1„ i 'dl l ,,,,, ,R,, g'
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Suite #: : ldg. /Ap1. #; Catch basin/area drain 16.60
Pro'ect Name: Q - DDD!+well/Icacb line/trench drain 16.60
_ - Footing drain (no. linear ft.) Page 2
Cross s i e • + • • t@: Manufactured home utilities 110.00
, Manholes 16.60
Rain drain connector 16.60
- Sanitartawet (no. linear ft) Paye 2
Subdivision: -1 Lot #; Storm sewer no. linear ft. Pale 2
� Water service no. linear ft_ Pa: ( ( 2
Tax ma• /•areal T iIp y p, 1' p..,� '1N ' '1!u' I flit t t 1 „ '-+' �IIIIIPiI: IIGl1 !hl!1�11}IISIf <...l,+t,,,, , ;,,,.;•sl`i't'
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'� '' Absorption valve 16.60
Backflow preventer P • : e 2
Backwater valve _ 16.60
Clothes washer ( 16.60 Lie , D
Dishwasher 16.60
16.60
ss �j+h� I, �p����� �, (` ��, 11 Drinkin• founts'
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• . Expansion tank 16.60
Address: a Fixture/sewer cap 16.60
�. �` Floor drain/floor sink/hub 16,60
Ci /State/Zi • : Garb t : a dis i osal 16.60
Phone: , .` A — • 1 - , c Fax: , bib 16.60
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,..,,, �..,,11i.,Ri �� �I.,1�J1 . ,,' : �;II,�!II11GEiIf.��,.,! ' Ice maker 16.6
Name: C .S a v r '... CZc, 13 e.14 s Interceptor /grease trap 16.60
Address: Medical ELs - value: S Page 2
1 Primer 16.60
Cit /State/Zip: Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E-mail: Tub/shower /shower pan 16.60
�} p y� ` t J �I II1�� I , ! 1 , i qq� I j a„ ,I � I S I..{y s� II II Urinal 16.60
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Water closet 16.60
Business Name: (' rnto 1 ,.i_ 1• v,-. • ' - Water heater 16.60
Address: J 4r .t 1,, a t Other:
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Phone: 51 . C t_.) t I Fax : 511.5-'' c/ „! „!,11 "�.�,�I I? �� �eul� ?. la „II,,., r,,1.i , �aJ.I,�' �iE „}. ,1,1,1,141 ?r ,I,1; ,�� :t l l A l au li °',, R �f,1u,1'>iflo,m, II�,CII?
Subtotal S
CCB Lie. #: 142.1 l Plumb. Lic. #: - . , : Minimum Permit Fee $72.50 S
Authorized \ t,p Q Residential Rackflow Minimum Fee 536.25 11
Signature: V, 0 \t .t - - '`A \ )13 , _.A. Date: 1 -1 s - 63 Plan Review (25% of Permit Fee) S ---
1
V , C (e e {,, ) n. r _ State Surchar: 8% of Permit Fee $ C At
J (Please print name) TOTAL PERMIT FEE E o
Notice: This permit application expire If a permit is not obtained within All new commercial buildings require 2 sots or plans with Isometric or
150 days after it bas been accepted as otlnptctc_ Fee me set n by'Fri- County Building Industry Service Board.
i:\Dsts\Pcmiit Forms 01 /03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested Q-2 2- AM PM BUP
Location ) 55 ?z 5 a 67/1<_ Suite MEC
Contact Person Ph ( ) C) O / F0
Contractor 0 . 9 1 , P i 1 Ph (,5L—_,)Z) 7 ? / i / 7 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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
P ASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
0 •
iligr PART FAIL
‘1 CHANICAL
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: ID Unable to inspect — no access
Fire Supply Line
ADA
A
) 7,
pproach /Sidewalk Date Inspector Ext
Other:
Final DO NO REMOVE this inspection record from the Job site.
PASS PART FAIL