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11920 SW NORTH DAKOTA ST
CITY OF T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00327
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 7/14/2004
SITE ADDRESS: 11920 SW NORTH DAKOTA ST PARCEL: 1S134CA-03200
SUBDIVISION: BURLWOOD NO. 2 ZONING. R-4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES.
TYPE OF USE: SF WASHING MACH: BACKFLOW P1EVNTRS:
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: ft
WATER CLOSETS: WATER LINE: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace water service 40'.
Owner: FEES
Description Date Amount
GATHINGS,ALTON P+
MELODY A IPLUM131 Permit Fee 7/14/2004 $72.50
11920 SW NORTH DAKOTA [TAX]8°6 State Surcharl 7/14/2004 $5.80
TIGARD, OR 97223 Total $78.30
Phone: 503-590-2986
Contractor:
BUDGET PLUMBING LLC
PO BOX 69003
PORTLAND, OR 97239 REQUIRED INSPECTIONS
Phone: 503-421-4347 Water Service Insp
Final Inspection
Reg#: LIC 134355
a
This permit is issued subject to the r uletions contained in the Tigard Municipal Code State of OR.
� P ] e9 9 P ,
Specialty Codes and all other applicable lav,s. All work will be done in accordance with approved
J plans. This permit will expire if work is not stat ied 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
952-0001-0JG0._,You may obtain copies of these rules or direct questions to OUNC by calling (503)
246- 99.
Issue By: Permittee Signa
Call(503)639-4175 by 7:00 P.M.for an Inspection needed the next uslness day
p. 2
7/09. 004 14:41 FAX 5055061960 CITY OF TIGARD Q001
Plumbing PermitApulication
City of Tigard l 1 I Y V I I! 11 PI■a e:
13123 SW Hell Blvd..Tiprd.OR 9)223
Phone: 5W.639.4171 Fox502.599.1900 �illlL�lt,v^ Plan
oeMrF.rr■ieNo.
24_Hour hlspection Lits: 503.639.4179 t DW Remlymy: Jw ' a 9.r Pap a M
lalrrlel.• wrtar.oi.tiprda.us NNiNsilMseMd: fgPMsrssasl lerertallM
`` ,.2�,,vii ,Yt t r .rl i"''� -,,i - d', r 'ii r'I 1'r•. ..� ��, �t�� ... ...
)f�r7 i 1. I��,F. ••�i- i.. '�.'["TiT.il' (. i.J .�:.i' rl�'� .�{_. I ,!�'T.,,V- T'F�. ..Jil •'�
Q New construction Q Demolition' Ira dd! ■rss■daa w adrrAfrat
rrye gn Qly. E0. Tow
Addition/alsa■ion�ekerPl■oemetn [�Other: hien I.I-0■ally dweEmp(Ncluboa 100 Rb sob IuhHry coeeieenon)
Vii (.LI SFR())bath 24920
smd 2-hrinly dwell®g ❑CoromelcialAndatgi■l SFR(2)b■* 250.00
❑Accessory bioldiag ❑Muhi•famany SFR(3)beth --Y - 399.00
[I Mesta bdkin - (�Ottgr
Each additionalta►ddkitaka� 45.00
� Fire sprMW(_-sq.ft.) Pyr 2
I, I rP
i... H I- n:'+•" tilts utgllas
Job site addri _ Catch basin or area drdn 16.60
aty/Salelm: Dry-ell,leach We.or Ivmtoh drain 16.60
Swv/bldp./apt M. PttljeM rums Foatinsdrat"(no.11ncar t1Yr-J Pap 2
- MMulketumd home uliliHnr 110.00
Cross■ireet/direetions to job site __
Manholes 16.60
Rain drdn connector 16.60 e
�- Sanitary scwcr(m Omar h.:_� Page 1
Storm sewer(no.linger ft: i•sr 1
Weser servlet(no.liner Il: I ego 2 '-
Subdivision: Let m.: �.._.
- Fi■tare er lan
Tax map !mol W.: -' -'-
Abomplett valve 16.60
ki,4 l f� i r' �� „w/-# ' Dy�• _" i1 4' f.:tn( 'i J.1 Baekflowpreventer Fsge2
Back-aterVAN* t6.60
(ladles-her 16.60
`- Dishabher 16.6n
DrinUns fountan 16.60
ik
$recoordsumP 16.00
Expansion tank _ 1660
Address: Flzturrlea.rer cep 16.60
City,/sm"clZIP: /ld,pf7 -A-11 2Ai Floes draiMflom sinWlwb - 16.60
Phone:( yFLCar JPS:( Garbage divpotsl 16.60
Hese bib 16.60 '
v Icenuker 16.60
Business"sent: vocg g ^(( ,. h%mmeptor/sromeVIP 1660
Contact some; r/S�sT//JN `ix7D Medicd w(v■koc 5�) Pass 1
Address: _Y. 61003
_ Rtgly - 1660
C1WStato/M OP-3 2.81 Raof dean!(oornnbrcial) 16.60
Piwne: ) �J3 - _ Sink/b■Idn/Itna 16.60
Tub/shower/shower pan 16.60
L
11•md1: thtn■1 16.60
r 1
r. 1 rt,;t�. J t �.i ... iQ illCil �-r•�} id;tly..1.�' `w' ?../�rW: Waier ckmat 16.60
D 9vsineas rmrtx:.. Water henasr 16.60
~ Address: 0 oo
Other; -
3 Cityistatcam: ' Sabaw
0 Minimum permit fee: 572.50
Pbonr! > 41" 7_ Fsx: _�L►7T-27�T Roadentid_b_■defiow minimum t": 536.25
CCB Llc.: ( t� ; Plumbing Lie.no.: 3 4�8�8 Pion"avis w (1596 of permit tee)
- - Sate swdwV(VA of permit M)
Authorized siptatme. -
p p TOTAL PERMIT F'�
Pit: � _ Date: 7 4 This Fer.nle eppllmstive a Pira r a serge!Is eat obaised withis
180 daps a1Cer It hsu bases accepted a=pine.
•Fee mcthodolny set by Trireirney Building bedlmay 8ervioe Sostd.
I•�Ealldsel►KswVrMJw.,i Ayr far 12M sEC.eR167(le/alCOa/Nraa)
CITY OF TIGARD 24-Hour
BUILDING • Inspection Lias: (503)639-4175 UST
INSPECTION DIVISION Business Line: (503)630-4171
OUP
Received — Date Requ ted_ AM _PM__ OUP
Location EL V D✓1 ��guiteMEC _
ContactPersor. __ Z� PhPLM 2001--0,030L_
Contractor -- Ph(—) —_ SWR
BUILDING Tenant/Owner — ELC
Footing
Foundation Access. ELC _
Ftg Drain ELR
Crawl Drain —
Slab Inspection Notes: SIT
Post&Beam ---- —_--- —
Shear Anchors ——
Ext Sheath/Shear
Int Sheath/Shea,
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
_-
Sanitary Sewer
Rain Drains --
Catch Basin/Manhole
Storm Drain
Shower Pan
PART FAIL
HANICAL
Post&Beam
Rough-In _ —
IL Gas Line
a Smoke Dampers
H Final
N PASS PART FAIL — —
ELECTRICAL — —_
Service
Rough-In
C7 UG/Slab
JLow Voltage _
Fire Alarm
Final Reinspection fee of$__� +
PASS PART FAIL _required before next Inspection. Pay et City Hail, 13 25 SW Hell Blvd.
SITE Please rail for reinspection RE: _. Unable to Inspect—no access
Fire Supply Line
ADA ik
Approach/Sidewalk
Other:
PASS RT FAIL
Final DO NOT REMOVE this 111"ootlon Mooed boa So fob S1t1f1.
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