Permit 4k CI T Y, ? OF TIGARD PLUMBING PERMIT
rA DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2006 -00462
° - -- � �' II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 101912006
PARCEL: 25101 DD -00101
SITE ADDRESS: 06975 SW SANDBURG ST 290 ZONING: C -P
SUBDIVISION: TIME SQUARE LOT: JURISDICTION: TIG
Project Description: TIME SQUARE.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
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Owner: FEES
AMERICAN PROPERTY MGT.
2510 NE MULTNOMAH Description Date Amount
PORTLAND, OR 97232 [PLUMB] Permit Fee 10/9/2006 $72.50
[PLMPLN] Plan Review 10/9/2006 $5.80
Phone : 503- 284 -6133 Total $78.30
Contractor:
PENINSULA PLUMBING
PO BOX 16307
PORTLAND, OR 97216 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 761 -0500
Reg #: LIC 2244
PLM 26 -64PB
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 or 1- 800 - 332 -2344.
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Issued By: . .. _. ■ w .� ' Permittee Signature:, ��E��
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Plumbing Permit Application OFFICE USE ONLY
Date received: // " — / , Permit no.: �:iitro �y % 02_,
t p� City of Tigard R EC I' [�
Sewer permit no.: t `, Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 9 223
City of Tigard Phone: (503) 639 - 4171 (m� O c, 2006 Project/appl. no.: Expire date:
Fax: (503) 598 - 1960 Date issued: By: Receipt no.:
CITY OF TIGARD Case file no.: ' Payment type:
Land use approval: BUILDING DIVI;;lnnl
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family pA Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: (,q 75 .544/0BeR Description Qty. Fee(ea.) Total
90 New 1- and 2- family dwellings only:
Bldg. no.: I Suite no.:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: r //lIE Sg /4 SFR (3) bath
City/county: ff ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: ,D 4fiv owAt PL4'418 /'Vy CC2 . Manholes
Address: /? co . A Orr //. 3D Rain drain connector
City: PD.97'4 4WD I State: oef I ZIP: 4 7,E 9' Sanitary sewer (no. lin. ft.)
Phone: J n / - 0roel Fax�OB - t14{. mail: Storm sewer (no. lin. ft.)
CCB no.: 00 AA V V I Plumb. bus. reg. no: 44 -6 SI PB Water service (no. n. .)
City/metro lic. no.: 0000/ SO y Fixture or item:
Contractor's representative signature:
nfriedig ,t, - -2 `r�4 Absorption valve
Back flow preventer
Print name: /4/k5 _ , / - /!iY Date: /0 - D L. Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): Floor drains /floor sinks/hub
address: Garbage disposal
Mailing Hose bibb
Cit I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: 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) I /( .64 16,6O
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total ,
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Pl nImUm fee $ �� • S�
Plan review (at %) $
❑visa ❑MasterCard expires if a permit is not obtained u
Credit card number. / / within 180 days after it has been State surcharge (8%) .... $ '•r •'8 0
Expires TOTAL $ 78.30
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00/COM)
CITY OF TIGARD ,
BUILDING DIVISION - PERMIT #: PLM2006-00462
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9/2006
Phone: (503) 639 -4171 . e rI S ' i •Inspection Requests (24 Hrs.): (503) 639 -4175 ,..._,�
INSPECTION WORKSHEET FOR DATE: 11/9/2006 TIME: 7:02AM PAGE: 78
SITE ADDRESS: 06975 SW SANDBURG ST 290 CLASS OF WORK:
SUBDIVISION: TIME SQUARE LOT #: TYPE OF USE:
PROJECT NAME: TIMES SQUARE
DESCRIPTION: TIME SQUARE.
OWNER: AMERICAN PROPERTY MGT., PHONE #: 503-264 -6133
CONTRACTOR: PENINSULA PLUMBING PHONE #: 503- 761 -0500
Inspection Request Scheduled For: Date: 11/9/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 99 Plumbing final 039486 -01 503- 761 -0500 N
Corrections/Comments/Instructions: / i t
C
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ni Date: L. 11 b‘ Phone #: (503) 718- ✓ L /) /
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CITY OF TIGARD •
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BUILDING DIVISION PERMIT #: PLM2006-00462
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9 /2006
Phone: (503) 639 -4171 4,94.,,,d, &
Inspection Requests (24 Hrs.): (503) 639 -4175 7, 0!
INSPECTION WORKSHEET FOR DATE: 10/10/2006 TIME: 7 :06AM PAGE: 21
SITE ADDRESS: 06975 SW SANDBURG ST 290 CLASS OF WORK:
SUBDIVISION: TIME SQUARE LOT #: TYPE OF USE:
PROJECT NAME: TIMES SQUARE
DESCRIPTION: TIME SQUARE.
OWNER: AMERICAN PROPERTY MGT., PHONE #: 503 -284 -6133
CONTRACTOR: PENINSULA PLUMBING PHONE #: 503-761-0500
Inspection Request Scheduled For: Date: 10!1012006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 037943 -01 503 -502 -3019 N
Corrections/Comments/Instructions:
`PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector :PZ 1 �` `� Date: L 0 /6 01 Phone #: (503) 718- .2 g-(Y
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