Permit CITY TIGARD PLUMBING PERMIT
f i b DEVELOPMENT SERVICES PERMIT #: PLM2003 -00536
Ai- = I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/9/03
SITE ADDRESS: 09685 SW JOHNSON ST 003 PARCEL: 2S102BA 01400
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R -12
BLOCK: LOT: 054 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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: WATER LINE: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Reroute 40 ft. water line.
FEES
Owner:
Description Date Amount
WOODARD PARK APARTMENTS, LLC
2083 NW JOHNSON ST #1 [PLUMB] Permit Fee 10/9/03 $72.50
ATTN: ROBERT D BALL - [TAX] 8% State Tax 10/9/03 $5.80
PORTLAND, OR 97209 Total $78.30
Phone :
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206
REQUIRED INSPECTIONS
Phone : 503-771-9449 Water Line Insp
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: ��2 ^%G�/���i� Permittee Signature: ddir
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
PlumbingPermitApplication .
� +: Date ; _, :, -, i ;,. :
, o aka +., s ," 4 ,,, *,, ' t - - Datdtecelveds 4 4 . i l Permit no.: • :t�1g7 ... ' • le '
F_! . -; : I ' 4 '' S�' a V - of ;T i nr s 4z ., -1; r! ; - _ ° Li' i. , -,.,,, - .•.tY.• j -
11 J� - t 13.••• - ",g- yam : , s: : - . {;�, -+,.° 1 `. ,t ''Sew« - - Penult . _ Buildin tno ::
-r •ti J. '7 .. ' .• '; 4 9� F=. "o-. ' .. r {J Y """' gP� :. ,
A .Tiga .. 9 7223
City ofTigard - Phone: "(503)'639"4171 -'' � � ` `L x � ...._.__.;.. :. Projecdappl.no.: __.... Expire date:
,; :e Fax: (503),598&1960. _ -. _ : :<. 1 - .
,�, e issued : �• By
�" - � ? � Receipt no.: -
,, `j
f _. . _ _.
...__.Land use approval. ,.. . _- _.., .._.. . _ . type: . -
Case file bo .: � Payment
- TYPE OF,PERAIIT
' 01 - &'2 family dwelling or accessory �'• `i' CommeictaUndustria .�.4 :,1.21_, 0 Mule - family; 0 Tenant improvement'' "'
p e - '.'1• .
O New construction Additron/alteratrodre lacement 0 Food service! 0 Other. " JOB SITE INFORMATION • <,. FEE SCIIEDULE (for special information use checklist) .
Job address: 9' 6 9 - 3 — 5 w Z6 I..w501'v 5 !•-. . __�_.;,". :I. ;"'' : : ": Description Qty. Fee(ea.) , Total
-, , ;:,j : .t =. ' s y,•�. �,• l x f... _.. . :1 ; -, -and 2- family dwellings only:
Bldg. no.: , I `Suite no.: , ,, - -..a.
• � (includes 100 it. for each utility connection)
Tax map/tax lot/account no.: (.Qin,,' r ) 70 , '7. - SFR (1) bath ' '
Lot: ' ,'_ .. , ., : '- I Block:' ',1::,1.:: F, " I Subdivision: . - SFR (2) bath: E. . .
Project name: .. , ' • .. , L' 11'''. ; ; a . :!r ;! i. ? SFR (3) bath i • •• . • .
City /county: -`,; *1 )1 l t iisi,; - ' ZIP:`' - _ ` -72.:x=3 "-^. i ,' Each additional bath/kitchen •
Descri and location of work on premises: s.
- ,Y -- -- -• lit: • • Siteut litres :.• - - , ... ..
-2 Y 1 $ "6iv t r " _e, -:; 41®217a ' 0 Catch basin/area drain - •
Est. date'of completion/inspection:-•- ;-- - •- -/-Q - '.i F._. r Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft )
, Manufactured home utilities .
Business name: v` is : ',F = c ; . j. i •-
C' - •irOw • -�� t.� b t -n q- ; Manholes ; - - - •
. Address: 5 'se - Proc"r� C:"∎` . - .S'�= ': : - -� --- - Rain drain connector
City � : e P t l , a vZ-c1 I State:O2l ZIP: g 1 a01:, ' Sanitary sewer (no. lin. ft.)
Phone:'rl l -ti 4 (l 9 I Fax: ? I- 9 E -mail: ; - Storm sewer (no. lin. ft.)
CCB no.: .Plumb. bus: re g. no:' Water service (no. lin. ft.) e p ,�- eIC
City/metro lic. no.: - 1 y 31. ... . _ _.__.. Fixture or item: •
Contractor's representative signature: V. GU, • -;,'' Absorption valve _
_-
Back flow- preventer
Print name: , IAJa r c l ' Date: s -03 Backwater. valve .
CONTACT PERSON Basins/lavatory ;
Name: • Q I :'.- --• Clothes washer - r. •
Address: __. . . . ) .
Dishwasher .....
Qty: . - • - .. . .. . .
�..._ I State: I ZIP:- Drinking fountain(s)
Phone: Fax: r - . !.' E- mail:' - Ex ion tank • • .
Fix sewer cap
Name (print): . .. f/Upo4 env o ' - °` t_ .' r ' . -. `' . '- --- _ -Floor drams/floor sinks/hub . • .
'_ Garbage disposal
Mailing address . .� :_. '1-1A1' . °'''' - fir' -^ S T -- Hose bibb'"t:• • .
City: %1'i o�-l� - . ' ... I State :' I ZIP: `9 Ice maker .
Phone: / n - 79 ( 'Fax: . I E -mail: - - -- - - - :
Interceptor /grease trap
Owner installation/residential maintenance only The actual installation Primer(s)- ............ S -
will be made by me or the maintenance and repair made by my regular . ' Roof drain (commercial)
employee on the property I own as per•ORS- Chapter 447. ., � " Sink(s), basin(s), lays(s) . . -
Owner's
Tubs/shower/shower pan
Name: ;..._..�._. Urinal •
.
Water closet - .
Address: • - • \ -Water heater •
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: ' Total . ' ' ' 55': crJ
Not all jurisdictions accept credit cards, please call Jurisdiction for more information. "r'" a, ap a Minimum fee $ • '7'T -9'Q
N
lCYrsa 0 MasterCard Notice: This eermit application Plan review (at %) $ `
expires if a permit is not obtained k
anal number 11 / /OS State surcharge (8%) .... $ s
r ' t l i , o n e ti Expires within 180 days after it has been
t_ TOTAL $ 7g 1- '3 O
amp • a older non credit card accepted as complete.
. - R i —A rsi '., - $
Cardholder dgnsturet / h q ti' 1 4444616 (60UC0f�
PLUMBING PERMIT FEES: ;; ; ,. ,„. q .. {.,.` _ , �: ,
;y ;f, _`- F, ,��; - : :i{ " it`:r• • _.. •}S:i ...'t'44.:,_ `' i s J ;
'r�•. . �-� ; <�,+� ,, ' � i, RIGEz OTAL �'F. .1 �:' = }x,.11 @�°Ill�i�� • w �.� ; .
.:a :. .1�:::_
=�'ti ; ti - c,s"'^':,'" , 4 % � s ..0 a as ' i' • 1 4 ' . ^ F'', .. Q 1 iii
:=!:::
•►;dn►a t:w -� �: . ,:�rr`` a . ,A><AQI�tJ,I��,, tt't� f�`i'� � xf IC' �t � : *
Sink - 16.60 • • . •.. 1 : ' 1I of � • - �r gQT1 " : ea .� r • 041. `
Lavatory „ litil '1 • '• . • • . , , :h F rI
16.60. i One (1) bath $249.20
Tub or Tub/Shower Comb, 16.60' ": ! Two (2) bath :,::::,•• . - . $350.00
Shower Only • .16.60 ,, . ; i Three (3) bath $399.00
Water Closet 16.60 ` SUBTOTAL r`-fZ'°:1,,:;��`.�`; r4.
Urinal . . 16.60; «;, ,
`': . 8 %s,STATE SURCHARGE � ,
Dishwasher f 16,60 PLAN REVIEW 25% OF SUBTOTAL "zV' z ; '``'"
Garbage Disposal 16,60 TOTAL w ; :• ; a .; •
Laundry Tray . . :16.60. .�" ;.:.3' •re•t:,::;. -!. •
.gI frrm ; :"•';�;5:, • . ..
Washing Machine. 16.60' • ,., . _ .r.� ''` . .. *: r.' # ?' „, ^.0. " .._... : ?_ „. s',p k, ' :. , _ . .
Floor Drain/Floor Sink 2" ,.16.60.. r ;: , ? .. _.
3” • .,60 -' '. PLEASE COMPLETE :' .. .
4" 16.60 . , ;..
•
1 „,"_:�" ',a ';'A, 4,,, x' `f �* tQiiantitj bViWoiikiPeifdrrried. - • '
Water Heater 0 conversion 0 like kind 16.60 - , � - r• n ,
Gas piping requires a separate mechanical , 'yrix re l" , ,eA 'Nevin ,. Mo�7e ;e1 : ;0Replaceds
"�,,�'�.°j�4� . � �$:���� : �aw,..•.,.: �..., L •
MFG Home New Water Service 46,40 • • Sink . • ' • ' ,
MFG Home New San/Storm Sewer 46.40 Lavatory • .
Tub or Tub /Shower
16.60 • . _. _ ..._ __ ' • Hose Bibs Combination - '
Roof Drains .16.60 'z -.•,. z n, . . ,,.... Shower Only.: - .•.. .• ,. • • .
Drinking Fountain 16.60 °•• Water Closet 1 '. ••.t; ;!A : , •ti. , .
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
, . Garbage Disposal - .•... ... - -. . .
• Laundry Room Tray- • -
Washing Machine , '
. ' • " " Floor Drain/Sink: 27,., ,:', '
Sewer-1st 100' „.55.00; ,.,.:,. , . 3”
Sewer - each additional 100' 7;46.40; , - :••,,. -i :, - .... - . _ . ......._ . _ ,
Water Heater ' .. • "
Water Service - 1st 100' 55.00 , .. !, is • � "= � -• • • • � - -..:
Water Service - each additional 200' 46.40 ' - .f Other Fixtures • : (Specify) ° : ;; !.io: -i .
Storm & Rain Drain - 1st 100'
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 • ,.
Residential Backflow Prevention Device' 27.55 , . „1„
Catch Basin . _. 16.60 .i tr z, j.. .. .
Inspection of Existing Plumbing or Specialty • r 72.50 ,,..r °�,c ; ;;1 = i rt:l.: >d, ;i',. •,, ,, ,,e '..,i, •. ; r : ,. : d r? ;` ; :.� = •
Requested Inspections •a . .. _. - > .• � . ; '
p per/hr: ' COMMEN A BOVE: '
Rain Drain, single family dwelling 65.25
Grease Traps 16.60 '
QUANTITY TOTAL : i• , th' ,,, .0,15.4'01.3 '4.7 `w . . •
Isometric or riser diagram is required It . . u` 7 `5; , m ' # , , •
Quantity Total Is > 9 h'.0 r. , w, fix.
"'SUBTOTAL �. = ; :•fir .; ,f, ,,,,.,....: . :, :. :. .. ,.:_ ..
• 8% STATE SURCHARGE '� ,r ° + • ' ' "" "' .
• "'PLAN REVIEW 25% :7 ` .: :':� .. `r , 'YT�` ` k <. ' ' t .,_Y : •, ,:,� . .., ,, , •,.., - .': ... ,..:
EVIEW 2 OF SUBTOTAL 5 /e ��,,� `�x'i'z,i� ? � "V,Y ' ` g� <;? �" ` '�•;" , =• , � - -
7:"`t
Required only H fixture qty. total is > 9 . . ., t�, ; . ,,� _ t- ` " • `
TOTAL : �,'n,s -.;n > i •q' '' ' '
Minimum permit'fee Is $72.50 a 8% state surcharge, except Residential Beadier ; . -- ..• .. _
Prevention Device, which is 53825 896 state surcharge. •
~ Aix New Commercial Buildings require plans with Isometric or riser diagram and :._ - __.. -..- ..�: .._... , ..... ... , _ '
. ,. • ",a -
plan review. ... ... , . •.,;;.. _ ... -, . , .
i :ldstsVorms\plm- fees.doc 10/10/00 ' .. - -
•
OCT -02 -2003 02:50 PM CROWN G. ED 503 771 9454 P, 01
' Y
CT 2 21T3
PlumbingP ermit Application
`, ,,,; c a 7 X4'77 '' _ , . ' .,1 - ' ,rr., --,...
al: -
1 ,IIL* 'I!„ :, . a Add re ss : 13123 " Sifi He1,B ` 13owerl . Building peed no:: ,
cl o17Xta�. ,,� • ? '1.' : , pr , ... -- Expire date:
.', Fax: (503) 598-_19p0: _, - • ; V i' ? ' ,, I TM . -_ sue 'i -.. 1 Receiptno.: •
• r ft�,A ' D . Land use appr Y n ype . li ... . , c� _ ... _ �........ �. y � N Payment tt
1
Q J���� � l' (11. 1'Pat1111 /��� t i,,,,,
0 1 & fa y &elfin 9t • • �. • '- C r. I.. 8llfndu stria� .,...�.. �l_ A � ! 1 M � . g �ly 1 CI Tenant linpiovement' ..*' 4 :.
O New construction -- A,dddidonhlterationFrepiaoement j CI Food service ! O Other. , ,
J(!It Si l I•: 11N1 O1 {i11A 1 1'1: `('III; 1)111.1 (I i'spec i,11 intitrnyaliim t :,e dieciclicl1 ,
Job address: 6 vv 1 i, -. ∎ - r- 1. ..: ' ,- ` :.: I tio>a Mil Fee ea. Total
Bid aa: \,. 3 _ -- •• t ";•; ; 'Suite na:. `ow . �., :i( go , •
Tax ,, , tax lot/account no.: e ; y' S. ,�. 7. 8 r--- a°rluda bat .Lo ettcmatWty voaaedior,)
SFR tYj lsath 1
' Lot::- . • ' ' Block:" Subdivision: .....
• ectname: i , .. .. 4 ..;i... t • VFr'a+ ,#0.100,40 f t ! KlJ.T )r" Im
CI /• . , . ..i.,..: ' ' AIMS" ZEN ..- - - .7.31'- t 1.. .. g,-.1nYrGtiir1•ih'rnai i •
Desai , • or} and 1 on Of N4rk • ,,_ premises: •t r ...:, .. • + . S tetidl1d .. 1 . .
5 tisr i r.4 • • :;1 , :• '+.' + ' ! catch drain 1111101 '
deta'OPcom - tiop: _____f " •"�r � r i l?IC? 111T.:,TaTir , ��
Est . .-- _../.„ : , � �'' �, � � �NM
PLUMBING \(. CO!�'I It,1("IO1t 1 � y,.,'rTTT,i 1U R1MiOn NM
�"P3i�'i.. 'r ,I'� sewer CO.' � c /� tor NE IIIIIII=1
a ' ..24.1% A i . - F r7w �p - a ' 1
se {
Phone: - - 1 J E -mail: c , , t • tor'meewet , • L � —
" 'star ono. in. �r�
sied: ea: "f a Plumb. bus. rag. no:' , , 7��
CI.. /metro lie. no.: ' ;.. --- ..... ,. .. - nature or
, : • ' 1' on valve
C o n t r a c t o r ' s _•:., , ., . vc si . . .n ii 1 . w _
Print name: Allin n TJEEINME ' ' -e3 EM ater . ve -. MINI
CON '1',U'I' NI'It;ti(1N T 1',T+i : ...,. 1111111 Min
Name: I:
Address: j....._ . , . ',.-
at : ..... {,...._., State :......._. �,..._ '. - ,. ,
_ phone: ' E -mail: . .. ' ! t L I rZ7 min MEN
OWN CH MMM11.1
=UMW MIIIIM
Name t • . . I, • . e/ G4 j' 4 to r ' 1,''Ins. }....
address: - 1t�j ?: J�"'."!1
/ State :.. • " 7110:, _ . . B. . ..
City: a NEM
Phone: ,, a - (4 EIMMEMil E -- _ �_�_
Owner installation/resldentinl main - - - - only: The actual Installation I o i"T?"�Q
will be made by me or the rnalotcuence and repair made by my regular . Roo . rt , , •„ Zi't -
employee on the property I own as per ORS. Chapter447. - ,. i .. Ern hill: Q O EMI
Owners sl --- -- ._._..... —._ ..._.- ....... - ....
.
•, ----Date:-..— ... I
i N (• l \ I I It 4 '", , ,,=±«r+,3, . �.' u � _
F
Name: M .—:... rn
' . NM MIME EON
Address: t, ...
State: .� _ NM �—.
Phone: Fax: E-mail: "� = ate
'Ha aA jadakskais �dts can* *ow ral1lo 1- fdua far UK" Igglon odoo 10.r
e�n ', :c: r. ... • Minimum gee . .......... $ . 737 , 9 0
•� Notice: ilhl permit applicedael
&vas 0 lbstmCsid =ph= 1f a pampa Isnot ebtalned Plant review (at 96) $ _
� , y • : } .-, 11 within 1110 days alter bait been surcharge (896) • - -. 8 , a
.1r "mir ?' sculpted as complete. TOTAL
-
, : , ., . Amudol 'J �� � ,10616 (6
„... . , d
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 0 — < <P AM PM BUP
Location 9C 5— &vts s4-i• Suite D 03 MEC
Contact Person Mi Ke_ Ph ( ) 77/ — 2 - ° d 5 CP
Contractor wevdA^'J P°-4 nel Ph ( MAner# S/ (o- 736$ SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:.
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: „, Oi /_ _ �S SIT
Post & Beam Vv 7-�
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
• Framing
'Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm Ale
Susp'd Ceiling ',
Roof , /�
Other:
Final
RT FAIL
'_PLUMBIN -`. °' -
Post & Beam
Under Slab . .
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi �
S 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 Hall Blvd.
PASS PART FAIL
SITE , ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
277
Approach /Sidewalk. Date , Inspector Ext
Other:
Final DO OT REMOVE this inspection record from the job site.
PASS PART FAIL