Permit .„
CI TY OF TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00106
. , I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/16/04
SITE ADDRESS: 13570 SW SANDRIDGE DR PARCEL: 2S105DD -04500
SUBDIVISION: PACIFIC CREST ZONING: R -7
BLOCK: LOT: 021 JURISDICTION: 11G
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Backflow preventor
FEES
Owner:
Description Date Amount
CHIERLY SIN
13570 SW SANDRIDGE DR [PLUMB] Permit Fee 3/16/04 $36.25
[TAX] 8% State Surchan 3/16/04 $2.90
Total $39.15
Phone :
Contractor:
JOHN DARBY LANDSCAPE INC
13867 SW BENCHVIEW TERRACE
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 579 - 5298 RP /Backflow Preventer
Reg #: LIC 7110
PLM 12319LCL
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
Issued By: Permittee Signature: .J / _ >,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building r Ixtures
. FOR OFFICE us>: ONLY
Permit Application Re d Plumbing •
Date/By: Permit Ne unceoo'/- ) Ad‘:. _
City of Tigard Planning Approval Sewer
g Date/By Permit No.:
13125 SW Hall Blvd. R E C E I V & Plan Review Other - - '
Tigard, Oregon 97223 Date/B : Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 Post Review Land Use
�:+ I " Date/By
Internet: .vww.ci.dgard.or.us Q 1 5 H , ^ j , I Conrad Case No.:
r iuris.: - gi See Page 2 for
24 -hour Inspection Request: 503-68h9 BF Ti • - "" Name/Method: Supplemental Information,
BUILDING DIVISION `�
4' 2 ^•; :bjM1 ? :•r •' ': erl.^ 6' w . �ti i i"C fill ti 1
,��1 J o a 'ol v.,:nt;, ....: �1.� t.^�.Lf .i�', . •'�i,��.�..�:'�� Vii::. ��S9t"1 ^f .��TOTrallin
New construction M Demolition Descrl • tlon • { . Qty. Total
II Addition/alteration/re•lacement • Other: T z , ,n , t wc� Ft, :� ! , F;311
; .
2: y 'cii' ill �e �� T5fi+L1����i.t45. .i -irr: ,..,7,,,.„,,,L �'f ,.,4yl:i ' 7. .µ. .
t- r . SFR (1) bath 249.20
�� 1 & 2 -Famil dwellin: • Commercial/Industrial SPR (2) bath 350.00
• • ccessory Building • SFR (3) bath 399.00
III Master Builder • Other: Each additional bath/kitchen - 45.00
:, Li 11-0- la_f rov e ;11-ul r_.,: jc.II_ok+it 4E'I r ,e Fires . rinkler - fl.: , 2
Job site address: y L ►, ;.' ,rj T I ,;-. - 42Z? - i .L . or 1 `I;�"= h Tif
Suite #: Bldg. /Apt. #: I Catch baste/area drain 16.60
Project Name: Drywell/leach linc/trcnch drain 16.60
I - Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes _ 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
m8 / arcel #: Water service no linear ft. P e 2
Tax .� l rcn c , , { r., - -e l E :fir _
__ i 1 r ,L ,...� .
i s _y �B7',�I�. o -miJ '��'rei /�t lt ,:si +c Uzi ., i''t�i Absorption v 1'•.:.L���.i .0 c1.:Y
'''-��'' Absorption valve 16'60
Backflow preventer Page 2
VAL.' ��m ,i , • li i. AA Backwater valve _ 16.60
Clothes washer 16.60
Dishwasher 16.60
D
;� �. z � � .- i` :' �. r M .,, .. ; , f .,
Drinking fountain 16.60
� � r q ounta'
gib .
1� ( ':K, ,;. 11 ;k:.t`}iS• jE '�L': '.•' :l:� Ji�t7i ' "'= 4 ?L �'r. -Aga5 EjectorS/sump 16.60
Name: Expansion tank 16.60
Address: . . (,vA i I/ P 11' Fixture/sewer cap.. 16.60 1
City /State/Zip: 4 Floor drain/floor sir 1tub 16.60
Garbage disposal 16.60
Phone: _ ax : Hose bib • 16.60
"; r .. \: �Tt?. >, +:�i�F� �rl`c ei` , '.. •,.;:;.:�j'� 16.60
t`%' Lt3.: J`rtlia::d.:I.i2; i7::i'...s11i - C �. DTI G .�.�g'.P1�,.... Ice maker
N ame: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Cit /$tatelZl Primer 16.60
Y p : Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub/shower/shower pan 16.60
,« i e.c ` ",? r i f t +ili1W- ' .V" Urinal 16.60
, ,
Water closet _ 16.60
Business Name:
1W . A T / ,a is _ A , Water heater 16.60
Address: I, , og i i `. , t ": . Other:
Cit /State /Zi • : i e i ;'. _ t Other:
Phone ��G7 ► r `�/ _ F kcn`4.7055 r- i curr_- .'s 't"t -l=:fa7` yth Subtotal ^ It_<
$ .'- -
CCB Lac. #: 7) 0 Plumb. Lie. #: Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36,25
Signature: .�- Dater Plan Review (25% of Permit Pc) $ a • /�
v
(\ ._.,, ii A State Surcharge (8% of Permit Fee) $
(Please pri Ay TOTAL PERMIT FEE S
Notice: This permit application rapt,' if a permit is not obtained within All new commercial buildings require 2 sets or moos wit 41 1_15
etric or
ISO days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Trl- County Building Industry Service Board.
i:\Dsts\Permit Forrns\PlmPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
'3 /'z d'
Received -
" ,/4 Date Request d 3 -247-044m PM BUP
Location /3 5 70 S L GelIZ 4 . / Suite 1 --t — Z1 MEC
Contact Person Pf1( 5O- 57f - 00 11
cp
Contractor Ph ( ) SWR
BUILDING Tenan • ne -dLi/l,(/! 4A44 ELC
Footing �J
ELC
Foundation Access:
Ftg Drain 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
• er: �cE�2
rot
PART FAIL
M • ANICAL
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 El Please call for rei spection RE: ❑ Unable to inspect — no access
Fire Supply Line YY1A ADA Approach/Sidewalk Date 1 Inspector Ext
Other:
Final DO OT REMOVE this Inspection r cord from the Job site.
PASS PART FAIL