Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES DATE ER #:
: PLM2000-00427
---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12100 SW KING RICHARD DR PARCEL: 2S115BC -12400
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT 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: WATER LINE: 20 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Water service line.
FEES
Owner:
Type By Date Amount Receipt
LITTLEWOOD, JOHN E + INEZ T PRMT DLH 11/21/200C $72.50 KING CITY
12100 SW KING RICHARD 5PCT DLH 11/21/200C $5.80 KING CITY
KING CITY, OR 97224
Total $78.30
Phone 1:
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD #344 REQUIRED INSPECTIONS
MILWAUKIE, OR 97267
Phone 1: 503-653-5301 Water Line Insp
Reg #: LIC 98346 Final Inspection
PLM 3 -434PB
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.
Issued By: /.0 Permittee Signature: g-,1 /1j>pLl(r ¢-7o - �✓
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
11/21/2000 09:29 5036393771 CITY OF KING CITY PAGE 02/02
TRI-COU,NT-Y p lumbing Permit Application OFFICE USE ONLY
SERVICE CENT`rR
�' City of King City Date received: - 2 ./r Permit no.:/�L/Y�QQ:7' DO a
� ' ` Sewer permit no.: Building permit no -:
• 13125 SW ball Blvd.
Tigard, OR 9722.3 ��'toject/eppl. no,; Expire date:
Clackamas Phone: (503) 639-4171, FAX: (503) 684 -7297
Multnomah Dale issued: By: Receipt no,;
Washington Case file no.; Payment type:
c o u N T i E s Land use approval:
TYPE OF PERMIT
0 I & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- fatnily 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement 0 Food service 0 Other; ,
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: \9\ `O D C K \ v.., �- v c, Descri i tion Qt . Total
Bldg. no.: Suite t3o.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax tnaj/tax lot/account no,: SFR (1) bath
Lot: Block: O' V Subdivision: SFR (2) bath
Project name: 'W4 y .Vk. CO_ SFR (3) bath
City /county: < C,i. I ZIP: , ) Each additional bath/kitchen
Description and location of wefic on premises: Djt11s5 "C- Site utilities;
r Catch basin/area drain
Est. dare of completion/inspection: Drywells/leach line/trench drain
Footing drain (no, lift. ft.) ,
Manufactured home utilities
Business name: ��_ _ rip Manholes
Address: \ 5 o' > S p r'N C._ Ltx„) t ktl, Rain drain connector
City: �` -0 ,ask State: b, I ZIP: 3 - ; Sanitary sewer (no. lin. ft.)
Phone:( } 6">.8p(;) Fax: E -mail: Storm sewer (no, lin. ft) -
CCB no.: i ur Plumb. bus. reg- rio: yam, f?c SS Water service (no. lin. ft.) \ ..,/;;IL
City/metro tic. no.: Fixture or item:
Contractor's representative signature: /�, Back flow on
1 Absorption valve
��, Bac Rreven,ter
m
Print name: Ilk &,� • tom Date: Wa 0 Backwater valve
CONTACT PERSON Basins/lavatory IMIIII
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: State: ZU): Ejectors /sump
Phone: . Fax: E -mail: ExEansion tank .
Fixture/sewer cap
Name (print): 1 {{ oor drains /floor sinks/hub
address: 42 Garbage disc Isal
Mailing {,�IQC � J_ n , Hose bibb
City: e� State: ZIP:. t , . Ice maker .
Phone: /e� 1 7 3 r � Fax: E -mail: Interceptor /grease trap
Owner inslallationfresidential 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 I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's si narure: Date: Sump •
Tubs /shower /shower pan
Urinal
Name: '
Water closet
Address: . . . .
Water heater
City: State: , ZIP: Other:
Phone: Fax: E -mail; Total �LL et
— Nom all- Jurladlcllons- accept- credig- cardx,.please -call jurisdiction- (w- for- inrormatioq Notice T rem* applieaeiQn Minimum fee $ i:�. ' .
Plan review (at %) $
❑ Visa O MasterCard expires if a permit is not obtained f g
Credit card number: f f within 180 days after it has been State surcharge (8%) $
E= wes TOTAL $ 7A
Name of cardholder as shown on crcdir card accepts as eomi7leia.
$
Cardholder signature Antrum ,, 4404616 (6100/COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
•
Date Requested /1- `2 Z AM PM BLD
Location / Z,/ Co S tra /C/ A y Z C 46 L P Suite MEC
Contact Person Ph 513 4 5 PLM 2,4co C1 Z 7
Contractor Ph SWR
BUILDING °_ °.° " r Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm .-----
Susp'd Ceiling ...!(•/ f � A1111/LII/I P -
Roof f
Misc:
Final
• ART FAIL
PLUMBING fµ as
Post & Beam
Under Slab
Top Out > J
egraic
Sanitary Sewer
Rain Drains
Final -
PART - FAIL
MECHANICA
•
Post & Beam
Rough In
Gas Line •
Smoke Dampers
Final
PASS PART FAIL
ELECTRIICALe° r a < < a, .4 `, ,'
Service
Rough In
. UG /Slab.
Low Voltage
Fire Alarm
Final
PASS PART FAIL •
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk i 6l
Other Date r Inspector ' Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.