Permit 11„„
A OF TIGARD PLUMBING PERMIT
tl4' " - DEVELOPMENT SERVICES PERMIT #: PLM2002 -00480
„�! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/11/02
SITE ADDRESS: 08770 SW SCOFFINS ST PARCEL: 2S102AA -02800
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: 026 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B 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 irrigation backflow.
FEES
Owner:
Description Date Amount
TUALATIN VALLEY MENTAL HEALTH CE
8770 SW SCOFFINS RD [PLUMB] Permit Fee 12/11/02 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 12/11/02 $5.80
Total $78.30
Phone :
Contractor:
PRO SCAPE N.W., INC.
3947 SW. WAKE STREET
MILWAUKIE, OR 97222
REQUIRED INSPECTIONS
Phone : 653 - 8707 RP /Backflow Preventer
Final Inspection
Reg #: MET 00001469
LIC 0119962
PLM 00006343
•
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.
Issued By: t, l id./LJ Permittee Signature: e'n Cc - pO
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application 0„.1,-1. I SI ()NIA
4i, , ttr; : City of Tigard CEIV ED Date received: 0 - -11_6 1- Permit no.:PI,�IA ",% .09 , /
V J �. � Address: 13125 3� RE
Hall Blvd, Tigard, OR 97223 Sewer permit no.: Building permit no.:
City of Tigard Phone: (503) 639 -4171 (DEC 0 9 2002 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: en Receipt no.:
CITY OF TIGARD
Land use approval: BUILDING DIVISION Case file no.: Payment type:
11 1'1. 01= PLR 111
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Food service ❑ Other:
JOB .SI l L 1\1010111 Ill' 5( 111 1)1 II. (For special information use cltecklist ►
Job address: p ,5'W 5C0q/,e/5 = Tl 64) New 1 - and 2 �' om - , Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: � y'
Tax map/tax lot/account no.: (indudes 100 H. for each utility connection)
SFR (1) bath
Lot: 'Block: I Subdivision: SFR (2) bath •
Project name: -1 // V(' G -,5 SFR (3) bath
City /county: lI tMJLI t tir4,f # ZIP: '7 q2Z 3 Each additional bath/kitchen
Description and location of work on premises: $ Pc//JKGL12 Site utilities
0 ti S 74"14 , I/NDL- 4 04/.p Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PI l 1 R I \ ( (' O .\ I It (° I O It Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: ,pe 5 ( _._ 1 ( / 0 /WL; Manholes
Address: 314 5i- w � Rain drain connector
City: (p1 IL i 1&' I State:d ' ZIP: - L Sanitary sewer (no. lin. ft.)
Phone 3,b )- q7 - 4Fax: L I E -mail: - Storm sewer (no. lin. ft.)
CCB no.: (I C6 6 4- 1 puminim reg. no: j 6 _ 4 , 3 i 3 Water service (no. lin. ft.)
City/metro lit. no.: ( bi g 0 30 3 Fixture or item:
Contractor's representative signaturea.„,...142. # / / Absorption valve
� Back flow preventer
Print name:
LL A-L /h ' Date: L., - ♦ Backwater valve
( . 0 . N , 1 . “ I'I RO\ Basins/lavatory
Name: ' o (t.2 ( 1,f___ 4-4, /ii, Clothes washer
Address: 3al4 7- fr ii i,Irti, le-- Dishwasher
Drinking fountain(s)
City: {v41 I State:( I ZIP: '1 - 7-Z 21_ Ejectors/sump
Phone: ..- Fax: 4i -,ma -mail: - ---- -' Expansion tank
Fixture /sewer cap
Name (print): Floor drains /floor sinks/hub
Garbage disposal
Mailing address: Hose bibb
City: 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 1 own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's si ture: Date: Sump
Tubs/shower/shower pan
Name: Urinal
Address: Water closet
Water heater
City: I State: I ZIP: Other:
Phone: Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application
O Visa Cl tvlastetCard expires if a permit is not obtained Plan review (at %) $
Credit card number. / / been State surcharge (8 %) .... $ /�
Expires within 180 days after it has b 7 "✓ t 5 0
Name of cardholder as shown on credit tend accepted as complete. TOTAL $
$
Cardholder signature Amount 440-4616 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Reque ted I a- /6 AM PM BUP
Location g y 2 D � it�
Suite MEC ' 1
Contact Person /
, Ph ( ) C� a 'mod / ( 7 PLM - -050 �I gb
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: -�! SIT
Post & Beam /.t - i(J /J J
Shear Anchors
Ext Sheath/Shear 4..61/12,713
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 6
Other:
<<2121 PART FAIL
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 DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL