Permit CITY TIGARD PLUMBING PERMIT
� DATE ISSUED: DEVELOPMENT SERVICES PO 30/03 00560
'`
° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
SITE ADDRESS: 10220 SW GREENBURG RD 540 PARCEL: 1S135AB 01004
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of (1) sink & (1) water heater for TI.
FEES
Owner:
Description Date Amount
EOP LINCOLN, LLC
10260 SW GREENBURG RD [PLUMB] Permit Fee 10/30/03 $72.50
SUITE 100 [TAX] 8% State Surcharl 10/30/03 $5.80
PORTLAND, OR 97223 Total $78.30
Phone :
Contractor:
MCKINSTRY CO
5400 NE COLUMBIA BLVD
PORTLAND, OR 97218
REQUIRED INSPECTIONS
Phone : 331 -0234 Rough - lnsp
Final Inspection
Reg #: LIC 40981
PLM 37 -22PB
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
� , U ` -f Permittee Si nature: r p_,&ip--
y:
Issued � L � �_�� g � -
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
s4 .
Plumbing Permit Application OFFICE USE ONLY -
Date received: /e) 8? e)..3 Perm no.: #4 . 5 0
t I City of Tigard S ewer permit no.:
�) p , e, • —4038 Building permit no.:
Address: 13125 SW Flail Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project /appl. no.: PABEI
Fax: (503) 598 - 1960 Date issued: I By • -/'/ Receipt no.:
Land use approval: . Case file no.: Payment type:
TYPE OF PERMIT` . -
❑ 1 & 2 family dwelling or accessory Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration/replacement ❑ Food service ❑ Other:
' JOB SITE INFORMATION . ' FEE SCHEDULE (for special inforiration,use checklist) .
Job address: /ozzo s &2EE/V8E2v gp. Description Qty. Fee(ea.) Total
Bldg. no.: Two L /# 6L I Suite no.: 57fp New 1 -and 2-family dwellings only:
(includes 100 ft. fo each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: Pf} - X TO /V - M / (-tele. SFR (3) bath
City /county: PO2Te NO I ZIP: cj7 ZZ3 Each additional bath/kitchen
Description and location of work on premises: Tm5 /( ((Ls/ i Site utilities:
CO 14) gE57G Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
' . PLUMBING CONTRACTOR . Footing drain (no. lit. ft.)
Manufactured home utilities
Business name: /Vick /N5'T/Zy 60. Manholes
Address: 5 /v es COLUM /. // - R LVP Rain drain connector
City: P0277 —A-NO I State: Q'2 ZIP: 97218 Sanitary sewer (no. lin. ft.)
Phone: 6 Fax: :3 E -mail: Storm sewer (no. lin. ft.)
CCB no.: , 7 1099/ Plumb. bus. reg. no: X37. zz pg Water service (no. lin. ft.)
Fixture or item:
City/metro lie. no.: / /7�l Absorption valve
Contractor's representative signature:
� /f RA /0-2.1-7-03 Back flow p alve
Print name: Da te: Backwater valve
CONTACT PERSON Basins /lavatory
Name: C_L, /F t4//1.-Za71J Clothes washer
Address: 5 tits COLUhei /Pl- BLVD Drinking king fountain(s) / - ��7L/1lVO I State:(a/LIZIP: c172_,8 Ej Ejectors/sump
Ejectors /sump
Phone:3b3.331.02Z' Fax: 33/. E -mail: _ Expansion tank
OWNER ' ., Fixture /sewer cap
Name (print): Floor drains /floor sinks /hub
Mailing address: Garbage disposal
I-Iose bibb
City: I State: I Z1P: Ice maker
Phone: I Fax: I E -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 property 1 own as per ORS Chapter 447. Sink(s), basin(s), lays(s) (I) /4 ;. "
Owner's signature: Date: Sump
' ENGINEER Tubs /shower /shower pan
Name: Urinal
Address: Water closet
Water heater L) //o, Ge
City: State: ZIP: Other:
Phone: I Fax: E-mail: Total (2.)
Minimum fee $ '72,. d
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application o
❑ Visa ❑ MasterCard expires if a pemiit is not obtained Plan review (at /o) $ '
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ . X0 Expires TOTAL $ 7 p , 30
Name of cardholder as shown on credit card accepted as complete.
Cardholder signature Amount 440 -4616 (6/O0.1COM)
CITY OF TIGARD 24 -Hour.
•
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
/ BUP
Received 1 1/ a ' • 1 0 Date Requested f 17(7 AM PM BUP
Location ! () 2 2 -0 C'— ' i 10c1 -1/-9 Suite S MEC •
Contact Person ►�i( Ph (c%-O) 255 "— 60`2-3 PLM 3 — 0 l) 5(o
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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL 0/72.„11/1"1-(
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
PART FAIL
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 Hail Blvd.
PASS PART FAIL
SITE ❑ Please call for reinpection RE: Unable to inspect — no access
Fire Supply Line
ADA d
Approach /Sidewalk Date Inspector /�/ Est
Other:
Final DO NOT REMOVE this inspection record from the job site. .
PASS PART FAIL