Permit CITY TIGARD PLUMBING PERMIT
,I 'v DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2000 -00417
..�,�J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/9/00
SITE ADDRESS: 15905 SW QUEEN VICTORIA PL PARCEL: 2S110CC -11600
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 029 JURISDICTION: KIN
CLASS OF WORK: REP 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: 50 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 50 feet of sanitary sewer line.
FEES
Owner:
Type By Date Amount Receipt
SHAY, RONALD E AND MARLYN J PRMT DEB 11/9/00 $72.50 KING CITY
15905 SW QUEEN VICTORA PL SPOT DEB 11/9/00 $5.80 KING CITY
KING CITY, OR 97224
Total $78.30
Phone 1:
Contractor:
MICHAEL + CO PLUMBING
P 0 BOX 23008
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone 1: 639 -3189 Sewer Inspection
Reg #: LIC 67877 Final Inspection
PLM 26 -333PB
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 in copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued y: _ j ,/ / i Perrnittee Signature: „1/4 �i p
all (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bu • ess day
NOV.-09 -00 THU 03:59 PM City of King City FAX:503 639 3771 PAGE 2
TRI- COUNTY OFFI USE ONLY
SfRVICF l Bing Pe .1 ' t Application /�
w , Clt t �� Date received: /f q -d 0 4 Permit no.: h 11p.gp/j - 007/
i f y King City T
\ 13 125 S Hall Blvd- Sewer permit no.; Building permit no.:
,
'"-S.`„;:: Tigard, O' - 7223 Project/appl. no.; Expire date:
Ciaekamas Phone: (503) 63` - FAX: (503 • Z. -7297 Date issued: B rte/ Receipt no.:
Multnomah .
Washington Case file no.: Payment type; •
o„ N T, E S Land use approval: i .
TYPE OF PERMIT
ha. 1 & 2 family dwelling or accessory CI Commercial/industrial 0 Multi-family CI Tenant improvement
D New construction El Addition/alteration/replacement Cl Food service Cl Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist).
Job address: /51°S .Ss.-0 Qu.e.e -.. 1 1 c _to r'« 9 L Description Qty. Fee (ea.) Total
Bldg. no Suite no_ New 1.. and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: ^Block: Subdivision: y SFR (2) bath _
Project name: SFR (3) bath
City /county: ZIP: Each additional bath/kitchen _
Description and location of work on premises: Site utilities;
Catch basin/area drain
Est. date of completion/inspection:
line /french drain
PLUMBING CONTRACTOR !~outing drain (no. tin. ft.) ,
• Manufactured home utilities
Business name: Mte_Lae - 1 - Ce3 P tut b t`'` 1 M an h o l es W � ___
Address: Po L` , x c 7,3 a 037 Rain drain connector
City: f State: p r c1 ZIP: LP/ Sanitary sewer (no. lin. ft.) .S 5r.
Phone; .5 3°1.3185, Fax: E -mail: Storm sewer (no. lin. ft.) .
CCs no.: ( ti) 7 J ' Plumb _ bus. reg. no: -33 P$ Water service (no. tin. ft.)
Fixture or item:
City/metro lit. no.: 1 a.g` S
_ Absorption valve
Contractor's representative signatu � ,.. — Back flow preventer
Print name: 4 - 7o - ae 4arieS Date: /I - 9 -00' Backwater valve
CONTACT PERSON Basins/lavatory
Name: . 19-+ 2 Clothes washer
- Dishwasher •
Address: Drinking fountains)
_City: W. ~ State: I ZIP: V^ � Ejectors /sump - -__
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): 0 i s Floor drains /floor sinks/hub
Garbage disposal
Mailing address: /...C S uJ u-4-'2"/` L] t °1 t ck 161— , Hose bibb
City: • State: d ZIP :9722. t V _� lcc maker
Phone: / 3/S Fax: Email: 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 I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: . Date: Sump
ENGINEER . Tubs/shower /shower pan
. Urinal
Name: .. .. ...
_._ .. - Water closet „_._
Address: _ , Water heater
City: _ _ State: J ZIP: Other:
- Phone: ax.: E-mail: Total .
_.. Minimum fee $ _.. 4.19 Nut al cards, jurisdictions accept credit please cull jurisdiction for nxxe infurrnation0 Notice: This permit applicalyoa
Visa 0 MasterCard Plan review (at _ %) $
expires if a permit is not obtained S'8'G
Cr card number: / / - -- State surcharge (8%) $ within 180 days after it has been 3ti
Expires TOTAL $
- - -- ;;NTe''wf cardholder as shown on credit card accepted as complete.
$
_ ,y'w , ^���� Cardholder signatatc Amount , 440-4616 (6,00/COM)
CITYOF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 •
BUP ' • ;L
Date Requested /1-4 3 AM PM BLD
Location - 1 c � ) 4 - ) ,o t uite • MEC
Contact Person Ph 677 3/8? PLM ZlJt/o - 61t)
Contractor Ph SWR
BUILDING: ' Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN •
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
I , ath /Shear
r3
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
•
Post & Beam
Under Slab
Top Out
Water S rvice f -
Sanita we
ain Drains
Final J a
AS PART FAIL
-
k HANI,CAL r *,
• Post & Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
•
ELECTRICAL =r` ". F
Service
Rough In
UG /Slab
Low Voltage
. Fire Alarm
Final
•
. PASS PART FAIL
SITE;'
Backfill /Gradirig
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
Other Date i I Inspector 7 6 ' 7 Ext
Final
PASS PART FAIL DO NO REMOVE this inspection record from the job site. .