Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 -00093
III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/18/02
SITE ADDRESS: 12725 SW PACIFIC HWY PARCEL: 2S1026D -00600
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: C -G
BLOCK: LOT: 050 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 3
• OCCUPANCY GRP: UNK 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: Installation of (3) backflow preventors.
FEES
Owner:
Type By Date Amount Receipt
FUNK, JAMES H PRMT CTR 3/18/02 $139.20 27200200000
c/o BERGMANN, FLOYD H + MARINE SPOT CTR 3/18/02 $11.14 27200200000
11600 SW 90TH
TIGARD, OR 97223 Total $150.34
Phone 1:
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone 1: 503 - 771 -9449 RP /Backflow Preventer
Reg #: LIC 42671 Final Inspection
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 -0080.
You may obtain- cqpies of ► - - rules or direct questions to OUNC by calling (503) 246 -1987.
ssued B -!--
_ � (CiLtAh • Permittee Signature: ,k /
, _ Call (503) 6 • -4175 by 7:00 P.M. for an inspection needed the next business day
MAR -13 -2002 04 12 PM CROWN. PLUMBING 503 771 9454 P. 01
A • Plumbing Permit Application
_ Dero el-- received: � �.� o Permlcao.: (
City of Tl RECEl II �, W and V Sewer permit no,: Building permit no.:
Address: 13125 S Hall Blvd, Tigard, OR 9722
City of Tigard Phone: (503) 639 171 Project/appl. no.: Expire date: _
MAR
Fax: (503) 598 -1460 1 3 2002 Date issued: By: [Receipt no.:
Land use approval: Bflpt DIN— Case file no.: payment type:
U 1 & 2 family dwelling or accessory )4 Commercial industrial U Multi- family O Tenant improvement
Cl New construction I] Addition/alteration/replacement ,Food service ❑ Other.
.1011 SI.I' l Nll.tlltI l,1'1 1.1 V' St'111:I11:I.I.: (tor.spvtial inli,rin;tliuii u%r CIIV(1( ki)
Job address: I a'1 aS SO 3c- i c %' a 14 u, , Desert . , i Qty. Fee(ea.) Total
Bldg. no.: !Suite no.: J Taw 1- and 2- family ga only:
Tax map/tax lot/account no.:
(Includes 100 ft. for each villyconnection)
SFR (1) bath
Lot: Block: I Slubdivision: SFR (2) bath
Project name: LAD-C. r - 5 I?-e2st ch- wro..v� ( bath
City/county:'i ga.trd / WO- rip. I ZIP: c - 1 a2 _ Each additional bath/kitchen
Tr iton and oration of work on premises: i fr Site utilities;
. ' 100.c„L41 (no of e_ di e 5 Catch basin/area drain
Bat. date of completion/inspection: Drywells/leach line/trench drain
Footin drain (no, lin, ft.)
Mann soured irome utilities -
Business name: row v`. l u.vr. lo idv Manholes ,
Address: St.1 a,9 Se Fra,1■0_,i b Rain drain connector
City - t Lo..,v�c1 State: oR ZIP: ' L, Sanitary sewer (no. lin. ft.) -
Phone: rl r I -ek y H q J Fax:'')') _q y sii E-mail: — Storm sewer (no. lin. ft.)
CCB no.: 41(y`'1 I I Plumb. bus. reg. no: 3 y_ ?0 ,0Q Water servicetno. lin. ft)
City /metro lie. no.: I 4 I a facture or item:
Contractor's representative signature: I i ' t Absorption valve _
Back flow preventer 3 H4.4/0 /39.2P
Print name: 'ate Ittiln.rol . 'g Date: 3 - 3 -0o'1 Backwater valve
(ON I :1('I 1'l IZtiON :asins/lavatory
P , - washer
Name: -- Dishwasher •
Address: Drinking fountains)
City: , I State: I ZIP: ' Ejectors/sump '
Phone: Fax: i3 -mail: iixpansion tank
Fixture/sewer
floor sinks/hub
Name (print): F l DLO 6cY1q 1' q` "'
, y O� ge disposal
Mailing address: Sa,vv% c- Hose bibb ^,—
City: J State: !ZIP: _ Ice maker
Phone:1011 r[ 02,0 I Fax: —II 1E-mail: — 1(nte / tease trap
Owner installation/residential maintenance only: The actual installation Primer(s) I
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) .
employee on the property town as per ORS Chapter 447. Sink(s), basin(s), lays(s) ,
Owner's signature: Date: Sump
bs/showe�r power pan ,
Name: Urinal
Water closet ,
Address: Water heater
City: !State: I ZIP: Other
Phone: I Fax: 1 I E-mail: Total J3
Not all Jarirdictioea accept Crude cords. ME
M ' please call Jurion for me infer nadm Notice: This permit application Minimum fee $ 1 — 0,0
%W e tart nn v , i _ . expires' if a permit is not ohtainrd Plan review (at 96) $
I l /a8 within 1 80 days after it has been S tate surch (8%) $
I r raO.
o L`T- e accepted as complete. TOTAL $
-- ,� � , NB ;boy; on Credit Card
a+sv $ Q• 34-
eee er . . ' � - - o , II 440.4616 nii001cohn
.�Wy∎ t ct -L- ' tb ►l�.S Q_S ScJav1 0.5 c,55 I tot �. ��`
� -�� 46 - �l��se.. - fix a � P
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
? BUP
Received Date Requested J �i( AM PM BUP
Location �,� 7S Pck Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspectio otes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing l
Firewall
Fire Sprinkler nkler ' `� ��#
Fire Alarm I�
lar l /
Susp'd Ceiling l
Roof
Other:
Final
P RT FAIL ,� 'i
I /
UM
& Beam
Under Slab
-
Rough -In
Water Service
Sanitary Sewer
Rain Drains y —
Catch Basin / Manhole jz,„ v O rt al -
Storm Drain
Shower Pan
Other
Cain
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 D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA �/
Approach/Sidewalk Date () ) / 3 )3 Inspector )71 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL