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11222 SI." Cottonwood Lane
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CITY OF TIGARD PLUMBING PERMIT
PERMIT#: PLM2002.00235
�. DEVELOPMENT SERVICES DATE ISSUED: 6/20/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1 S134AC-02655
SITE ADDRESS: 11222 SW COTTONWOOD LN ZONING: R-4.5
SUBDIVISION: ENGLEWOOD NO.3 JURISDICTION: TIG
BLOCK: LOT: 221 -- --- -
--
CLASS OF WORK: OTR GARBAGE DISPOSALS: S:
BACKFLOW MOBILE HOME E SPACES:
TYPE OF USE: SF WASHING MACH; TRAPS:
OCCUPANCY GRP: R3 FLOOR DRAINS;
WATER HEATERS: CATCH BASINS:
STORIES: SF RAIN DRAINS:
FIXTURES LAUNDRY TRAYS: rREASE TRAPS:
SINKS: URINALS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINT: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacement of 5U'of water service FEES__
Owner: _ _ Type By Date Amount Receipt
YOUNT, PHILIP R +DONNA MAF_. H PRMT C1 R 6/20/0 72.50 2720O'200000
11222 SW COTTONWOOD LN 5PCT CTR 6/20/02 $5.80 27200200000
TIGARD, OR 97223 Total $78.30
Phone 1:
Contractor___._ ---
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD #344 REQUIRED INSPECTIONS
MILWAUKIE,OR 97267 ---Water Line Insp
Phone 1: 503-653-5301 Water Service Insp
Reg#: LIC 138941 Final Inspection
PLM 3-434PR
This permit is issued subject to the regulations contained in the Tigard Munic pal Code. State of OR.
Specialty Codes and all other applicable laws. All work will he done in accor ance with approved plans.
This permit will expire if work is not started within 180 days of issuance, o I, work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules ad Qtt�t1 by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 thro hl(bAR 952-0001-0080.
You may obtain copies of these rules or direct questions ,o OUNG by cilli 1 ! 3) 246-1987.
I
� 0) Permittee Signature."--
Issued
%Issued BY. —
�� Call (503) 6?3-4175 by 7:00 P M. for an Inspection needed the next bu Iness day
C i7-Y aF- TICS -l�
3 ag Plumbing Permit Application.
Date receivedz�r-;2.0-p2 Permitno..?�PJ_20Z�,2 -Gba�j
-�---- j Sewer permit no.: Building pe-mit no
Address:155 N. Ist AV,Suite 350-12,Hillsboro,OR 97124 _ -
0���;or' Phone: 503-846-3470 Fax: 503-846-3993 Project/appl.no.: Expire date
Internet Address www.co.washington.or.us �/ Date issued: ii Receipt no
Land use approval: _
Case file no.: �- Payment tyhev-.__--_ -
& 2 family dwelli-ig or accessory 0 Commercial/industrial 7 Multi-family 0 Tenant improvement
11 New construction 0 Addition/alteration/replacement 0 Food service H other:
Job address: U ityl- AWDescription Qty. Nee(ea.) Total
1\ew 1-and ' family dwellings only: -
Bldg. no.: Suite no.: (Includes 100 ft. or each utility connection)
-------- - --- -------------
Tax reap/tax lot/account no.: - SFR(1)Lath - 265.00
Lot: -� Block: N/A Subdivision: SFR(2)bath -_ - _ 340.00 1__
Project name: _ SFR(3)bath 415.00
City/county _ _ ZI_ Each adeitional bath kitchen 75.00
Description and 1 etion o o ises Site utilities:
atch basin/area drain 11.00
Est. date of completion/inspection: - Drywells/leach line/trench drain - 12.00 _
Footing drain(each 'increment) 35.00
�M'M factured home uta hies 80.00
Business name:' _ Manholes 12.00 _-
Address: /� )C - L Kain drain connector 12.00
Cit -p S Sanitary sewer(each 100'increme:ct) 35.00
Phone - ` Fax: '"_ ) -mail: , Storm sewer(each 100'increme,tt) 35.00
CCB no.:��L/�_- Plttmb.bus.reg.no: ' Water service(each 100'inerentent r
Future or item:
City/metro_lic. no.:NIA 1 T _
- Absorption valve _-- -- - 12.00 _
Contractor's representative signature: Back flow prevem.r 12.00 -
Print,came:- pts;i -- Date: Backwater valve -�--- _ 12.00-
Basirz'a-,i atory -._-- 12.00
Clothes washer ^- 12.00
Name:
C --- -- Dishwasher12.00
Address_-- - Drinking fountain(s), _ - 12.00
t
City: State: 711':_ _ e� 12.00
Ejectors/sump
Phone r -A�= Fax•, _. 5 E-mail: Expansion tank _ 12.00
Fixture/sewer cap ___1100
7Nan-o!
Floa,r drains/floor sin s/hub 12.00(print): Garbagedisposa 12.00
ng address: _- Hose bibb 12.00
" - -- _- State: IP: Ice maker----- -- - 12.00
Phone: Fax: E-mail: rKRo-of
ptor'grease trap 12.00
Owner in.ctallation/residential maintenance only:3'he actual ittstallation (s) 12.00 _
will b,:made by me or the maintenance and repair made by my regular drain(commercia) -- 12.00erttpl)yee on the property I own as per ORS Chapter 447 s),basin(s),lays(s)-- 12.00
Owner's si ature: Date: __ 12.00
Tubs/s ower/shower pan 12.00
Urinal 11.00
_Name: _- --! -- _ - Water closet 12.00
Address: Waterheater 12
City: State: ZIPS
Phone: Fax: F-rrtatl: Total J,
h1urimum feeS - of
................
Notice: This permit epplication Plan review(at 65%).... S
U visa 11 MasterCard "pires ifa permit iwithin /dB days alter It hasisnot obtained o �e-
Credit card number --_ been
accepted as complete. TOTAL.State surcharge(11/o).... J
�-- _-._- -- -
a heti ......................
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A�rrio i,ici- m u i�iwn on'-credo circ--
_.-_. ---- _ .- S '-- 410•�616(A0a'C:OM
i"irafio-ldr nTputvc �t
71
CITY OF TIIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DR1SION Business Line: (503)639-4171 MST
// -SUP -----
Received `p !� _Cate Requested_��(1� -�-- A�l�!}�PM- -- BUP ----------
Location _ 1 ;qA 6 1--13 Suite MEC
Contact Person Ph( 'F5_03) 1 7_ PLM
Contractor—_ _ -- — Ph( ) -_ SWR
BUILDING Tenant/Owner __ __— _ ELC ---__--__-___ ___---
Footing
Foundation ELC
Ftg Drain -ICAccess: e /, L
Crawl Drain -
Slab Inspection Notes: SIT
Post& Beam
Shear Anchor �.r--
Ext Sheath/Stttar
Int Sheath/Shear
Framing ~-
Insulation ----
Drywall Nailing
Firewall
Fire Sprinkler ---- —---- -------- --�--------- -- ---- - -
Fire Alarm
Susp'd Ceiling — ------ _-------___.--
Roof
Other.—---- -- --- -- -- ---- ---- -
Final
PASSPART_FAIL --------- _- — ------ -- --f —
PLUMBING_ _
Fust& Beam -- — - -�-
Under Slab v
Water ServiceA 1± ----
Ser�it9ty�Wer � �
Rain Drains - ---- --- — - —---- - --
Catch Basin/Manhole
Storm Drain --- - -- ---- .-
Shower Pan ----- � -----_ --- ----
Other: -- ---
Fin
/�z
PART FAIL — --- ---- --
PAWHANICAL
Pest$Beam ---- ---_ _ ------- --__ _ ------- -- -----
Rough-In ---- -- - — ---- - -
Gas Line
Smoke Dampers --- ._..---------- --- __ _ _-- --_-_
Final
PASS PART F:IL ---
ELEC_TOICAL
SRrvic@ --- - -- _ — -- -" - - - —
Ra:loh In
UG/Slab --- - - --------
Low Voltage -
Fire Alarm
Final ❑ Reinspection fee of$__--___-a--_,_"._ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Ll Please call for reinspection RE-__ " .,ere to inspect-no access
------- -----
Fire Supply Line
ADA I / b2-07
Zy I�
Approach/Sid walk D� 2/—-�1?'�-{--- -- -- - Inspector -__._� J _---Ext
Ufho
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL