Permit C ITY OF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00215
- I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/5/03
SITE ADDRESS: 11847 SW PACIFIC HWY PARCEL: 1S135DD -00800
W
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 022 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: A3 FLOOR DRAINS: 7 TRAPS:
STORIES: 13 WATER HEATERS: 1 CATCH BASINS:
FIXTURES • LAUNDRY TRAYS: 0 SF RAIN DRAINS:
SINKS: 3 URINALS: 2 GREASE TRAPS:
LAVATORIES: 6 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 6 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement, other fixtures are (1) ice maker & (2) primers.
FEES
Owner:
Description Date Amount
SANOKEE
375 NW GILMAN BLVD STE C -203 [PLUMB] Permit Fee 6/5/03 $557.60
ISSAQUAH, WA 98027 [PLMPLN] Plan Review 6/5/03 $139.40
[TAX] 8% State Tax 6/5/03 $44.61
Phone : 425 - 391 - 0570 Total $741.61
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 - 7619 Top -out Insp
Final Inspection
Reg #: MET 00001047
LIC 12889
PLM 34 -4PB
•
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
P •
I sued By: t M / „ ' • Permittee Signature: in ` _// / I
Call (50 • • -4175 by 7:00 P.M. for an inspection needed the next business day
/ /rs 1, 243 c lOg- 3 -'m / 70
Plumbing Permit Application Or l O '
IP Date received: 5 03 Permit no.: //" ' — / 1
City of Tigard
,(,1 r -''. Sewer permit no.: Building permit no.:8ei6/4044, e,
Address: 13125 SW Hall Blvd, Tigard, OR 97223
C1ry of Tigard Phone: (503) 639 -4171 Project/appl. no.: - ' date:
Fax: (503) 598 - 1960 Date issued: eceipt no.:
•
Land use approval: Case file no.: Payment type:
l'1 PI: OF PI:1011 I
0 1 & 2 family dwelling or accessory 1l3<CommerciaWindustrial 0 Multi- family 0 Tenant improvement
0 New construction SlAddition /alteration/replacement 0 Food service 0 Other:
.1(111 •,l 11 I \IY)IZ\1 \110\ I I ; Sit 'Ill '.1)l l.I (fur.lrctial infnrmatinnu.cchcuI . li.t)
lob address: 1.3 °' ' LC, a Description Qty. Fee ea. Total
ldg. no.: Suite no.: 1- and 2- family dwellings only:
Tax map /tax lot/account no.: (includes 100 ft. for each utility connection) I SFR (1) bath
Lot: (Block: 1 Subdivision: SFR (2) bath
Project name: )(r-.) J ( y�� SFR (3) bath
City /county: rc y o ZIP: f ) T2-3 Each additional bath/kitchen
Description a n , locati of work on premises: Site utilities:
JJ L) pc CLUi3 Catch basin/area drain
Est. date of completion/inspection: Drywalls /leach line /trench drain
Footing drain (no. lin. ft.)
I' I .l 1I It 1 \ (. ((1 \ I It “. I (l It Manufactured home utilities
Business 3 ec 1 I { ; l fl)j J� ) - Manholes
Address: �t i , LI Tit", _ Rain drain connector
City: L ter,_ , Stated I ZIP: 760% Sanitary sewer (no. lin. ft.)
Phone. grammi Fax: E -mail: Storm sewer (no. lin. ft.)
CCB no.:01 1F-5 Plumb. bus. reg. no: 3 t ._ -(jy Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
` Contractor's representative signature: l .a
./ Absorption valve
to WOD( /�EN I Back flow preventer Z ylo -go 9a.
Print name: „ .. E
Backwater valve . .
(' 1 1 ( I P I It SO \ Basins /lavatory
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: I State: ',ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture /sewer cap
Name (print): ('Ex. STI 1. Floor drains/floor sinks/hub ilf, _
Mailing address: Garbage disposal
Hose bibb
City: I State: I ZIP: Ice maker ...
Phone: q(,le -0s') 0 I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s) 2.. i
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) ( 6 s ,a }' � '
Owner's si . : titre: Date: Sump
1•. \ (: I \ 1 1 It Tubs /shower /shower pan
Name: Urinal ,- 2 y "
— Water closet / (0 .
Address: Water heater
City: I State: I ZIP: Other:
Phone: Fax: E -mail: Total VP w
' d
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ /
Notice: This perm application a
O visa O Mastercard Plan review (at /o) $ ! • Yd
expires if a permit is not obtained
Credit card number: Expires within 180 days after it has bee State surcharge (8 %) $ JP/ . /o ff
Name of cardholder as shown on credit card acce ed complete. TOTAL. $ 74'/ 4 /
:; 5 P
Cardholder signature Amount t 0 L A e.,-y,. i Ori,
,' � � ` 4404616 (tY001COM)
Y a , -v1( .41.1.14)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested (o a ,j AM PM BUP
Location 1/ t Pa- Suite MEC
Contact Person 90410 Ph ( ) I!D 7.3 76 (q PLM J - w 02 /
Contractor Ph SWR
BUILDING Tenant/Owner Leiy1 tr i ELC
Footing
ELC
Foundation
Ftg Drain Access: 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
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
_ _ PART FAIL
ANICAL
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 ' O NOT REMOVE this Inspection record from the job site.
PASS PART FAIL