Permit C ITY OF TIGARD PLUMBING PERMIT
T G, I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00200
l 13125 SW Hal I d. i rd, OR 97223 (503) 639 -4171 DATE ISSUED: 7/17/03 _ ^�
�j ( ) PARCEL: 2S102CB -00100
SITE ADDRESS: 1.2-85 GRANT ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R - 12
BLOCK: LOT: 041 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: Site utilities for new building.
FEES
Owner:
Description Date Amount
TIGARD - TUALATIN SCHOOL DISTRICT #23
6960 SW SANDBURG RD [PLUMB] Permit Fee 7/17/03 $1,510.40
TIGARD, OR 97223 [TAX] 8% State Tax 7/17/03 $120.84
[PLMPLN] Plan Review 7/17/03 $377.60
Phone : Total $2,008.84
Contractor:
COFFMAN EXCAV (CCB 146689) t' , � )' (7
563'656
REQUIRED INSPECTIONS
Phone : Sewer Inspection
Sewer Inspection
Reg #: LIC 146689 Sewer Inspection
PLM 3 - 407PB Water Service Insp
Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Rain Drain Insp
RP /Backflow Preventer
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
Issu d By: V , Permittee Signature: & �.,� i
Call (503 .39 -4175 by 7:00 P.M. for an inspection needed the n-xt business day
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y , .,:_E,
--�- { �• . - . FOR�OFFICE USE ONI , ; . - ,' '
,,o Plumbing Permit �tSOn Received Plumbing
Date/By / 5 - 03 (3 p Permit No. a/Y'J'903 - 00 a -cO (�
Planning Approval Sewer ` �
City of Tigard Date/By' Permit No
13125 SW Hall Blvd. MAY 1 5 2003 Plan Review' 4/ RR.2 Other
Tigard, Oregon 97223 Date /By �( "( U Permit No.: �1
Phone: 503 639 - 4171 Fax: bT1� OETEPARD � Post - Review Land Use au 3 _� DO �' \
w � '�I Date /By Case No . Q.
Internet: www.ci.tigard.or.u JILDING DIVISI ,_� .rc ( Contact Juns.. ® See Page 2 for
N 24 -hour Inspection Request: 503- 639 -4175 stir -- Name /Method.
TlG7 Supplemental Information. , V
4' cif-4,1 1.o F 116 p aeli aairi-a re MT>e: i_
€,`''� m�„ p " ", ' ;�: 'Vie'. %;`;; �, .iF ' - °e^ ... i -. °. - c ,» : .. . ,,, +i :�a,
y :l'A F:, :``FEE .SC1.1.0AE "for,�s, ectal informal on tgkett eklist)_ „
�x;:• ,• ,.. ..... •, � �.:TYI'EOF�WORIC ��'�`c. ='�. ,.z,•� «. � .� >,�',�s ...:. _t.'� .. _._..� _. _ . _ . _ . �, ,,... �. � P � ,.
M. New construction ❑ Demolition , I Qty. I Fee(ea.) I Total
I � : ,,, Description
.'Newt &21fam►l d,�vel'tin s..; �k, ; `,, : '',.:._. "'.;�:E,;,;;.0 :`
Addition/alteration/re lacement ❑ Other: ;, a ;; �'' ` '' , l - .i �:= aiii g "° "`
p = w 'y ` kA includes 100 ft,';for °e a n "ect�on) ..',;
r , . .., ., ._ , � -. -.. 'r.,� -� - - . ea =;utility 'p a
ia'; 'k;x
• < ° ,; :; f ;> CATEGORYQFxrONS,TRIJC,TION ,;° ,,
SFR (])bath 249.20
❑ 1 & 2- Family dwelling Commercial/Industrial SFR (2) bath 350.00
DAccessory Building ❑ Multi- Family SFR (3) bath 399.00 .
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
",'' ` :2,t4QB „SI-`I;E)NF'O .___TON and Lo ATI"ON =' ; !_`E - y'' Fire sprinkler - sq. ft,: Page 2
`.:a 'tt" .. - - , s r.� ; "�a ; . :� °:. ����.'T•�F�,;'�` i:.- ;;?R, . >a:: -` 1 •a °.;�, :�c^ � .;�fi;..�":;`':��;e;;��,;c,+ �;
Job site address: 5D Cle / (rya e4 t Ave . - at ;� •. .� E _. , x :i Site Ut lit CC ,•.... _ ..' � �a.<.,.. ..�ri
Suite #: /293-5-- Bldg. /Apt. #: Catch basin/area drain q 16.60 /q
T >tlewteh fir y Sa vo/ Footin l /leach line/trench drain 16.60
Project Name: C F
/ �et Ceaf6n�" Footing drain (no. linear ft.) 0 Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
SW SD It oa 1 Sf. E&o Sf ri('&2 Manholes A 16.60 ( 4t4 .1/o
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) 4 Page 2 j6
S torm sewer (no. linear ft.) g Page 2 4-g. ?p
Subdwision: Lot #: li f �
Tax map /parcel #: Water service (no. linear ft.) no Page 2 3
,511.m.:,r •. ,': 59 ESCIflPTZO,I ii' w_ s ,.. = .; ,° s >' .1 r
,
O R K ' °`�` "� "� `� Absorption valve 16 60
`. tot l i,rfie! ✓ r ed, lesce0, f Backflow preventer CA . ° , ... Page 2 q-) S
e /e Nt e0 h i i 'G6OU /- (/ Backwater valve 16.60
/ Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
p ,, ER `TE AN, T,u..q',4' °`,;�;�'.��. Ejectors /sump , 16.60
Name: S71e /2L c'41 PoQ' & Expansion tank 16.60
Address: 0 S k✓ sei h d6N r 4f. Fixture/sewer cap 16.60
City /State /Zip: I," a ,-I o i > 1 72 7 3 Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: $i 3 - g3� - �f o 0 3 Fax: 5b 3 - t{ 3/ - Ito ,-/- 7 Hose bib 16.60
.[ AP.KICANT':V'; ` A i,M :nr- # .°` C ONTTACT`PERg(Kt Ice maker 16.60 _
Name: TA a Abe / Interceptor /grease trap 16.60 _
Address: 3 /o , SW A4ac i, At 4 Ave . Lift Medical gas - value: $ Page 2
City/State/Zip: di 0, q 72 39 l Primer 16.60
y p po✓ #lu'K
Phone: 5 - 705 if 6'f o I Fax: 93 - 295 - /14 6 Sink/basin/lavatory 16.60
E -mail: 10 L ,, a e 4 evilee$ /o.u2rq 4 1 /' . CoM Tub /shower /shower pan 16.60
z ' s;n .< I`;,`. ^.'..<lf:A CON1PRA'C:TQR `-.:' ' ',''..:.; Urinal 16,60 ,
Business Name: crN -l� ex-0,1d4/7/1/4.!4 Water closet 16.60
�_ - l e: A ^ - ,v. i . i- . ti /ix Water heater 16.60
Address: " " Other.
City /State /Zip: . Other:
, ,' ;�. .� i�, � °a� �a �;,�: q ._ v .mat ' � '��',p�." r���;��
Phone ax: -t ° ` '
>;��;� >'� ;.��,n���'�...��, :'��.� °lumtiingF1'e.>r•tntt.Fecs ,� �� �:t�..�'.,��;�..��,;,�r . _,��Y�.�
CCB Lie. #: /4(p frS. r/ P , nib. Lic. # -Z- L /p7P/ W )
( Minimum Permit Fee $72.50 $
Authorized l Residential Backflow Minimum Fee $36.25
Signature: i Date. S1 /. / Plan Review�25% of Permit Fee) $ - - 7 7 ( f ,)
rob,/ i#6. // I State Surcharge (8% of Permit Fee) $ /,gyp (.el
(Please print name) TOTAL PERMIT FEE $ G s f • `
- 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.
000 *Fee methodology set by Tri- County Building Industry Service Board.
i \Dsts\Permit Forms\P1mPermitApp.doc 01/03 �� 0
s1 •
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ' AM PM BUP
Location a. O p� .etA/t., Suite //2 MEC
Contact Person Ph ( ) 7/ - O 9413 PLM d0O3 — 6O �4
Contractor Ph ( ) SWR
BUILDING Tenant/Owner �' / 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 IMO Firewall Fire Sprinkler ����
Fire Alarm
Susp'd Ceiling
Roof ,_3�
Other: _40
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
ir
Sanitary Sewer
Rain Drains
/ Manhole
Shower Pan
- r:
j . 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 ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date / - Inspector Ext
Other:
Final D • NOT REMOVE this inspection record from the job site.
PASS PART FAIL