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CITE' OF TIGARD
' PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: P 1 1/200 -00205
13125 SW "qlI Blvd., Tigard, OR 97223 (503) 639-•.171 DATE ISSUED: 5/1 (/2004
PARCEL: 2S 111 CA-'i4800
SI Tr JKFSS: 0958G SW LAKE SIDE DR
.01VISICN: SUMMEPFIELD NO.12 ZONING. R-7
BLOCK: LOT: 668 _ JURISDICTION: TIG _
CLAS; OF WORK: OTR GARBAGE DISPOSALS: AORiLC IIOME SPACES:
TYPE OF USE: SF WASHING MACH: 1ACKFLC'N PREVNTRS:
OCCUPANCY GRA': R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: t',1 HER FIXTURES:
TUB/SF!OWFR.S: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: `c
DISHWASHERS: RAIN DRAIN: tt
R^marks: Installation of(1)shower and (1)water heater,--- _ _ _
FEES _
Owner_ -'--
-- - Description Date Amount
ARDITI, RALPH V + NANCY KAY
9580 SW LAKESIDE DR i 111,0MBI Pcri1ii, I cc 5/11/2004 �.,72.50
TIGARD, OR 97224 I l'AXJ X%Statc Surcharl 5/11/2004 $5.80
Total $78.30
Phone : 503.518-1;,05
Contractor:
NELSON PLUMBING SERVICES LLC
20565 SW 1041H
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Rough-in Insp
Phone : 503-957-188.1
Final Inspection
Re�j ;4• LIC 15769
PLM 34 3,;'i
This permit is issued subject to the regulations contained ir, ine Tigard Municipal Code, State Df OR.
Specialty Codes and all other applicable laws. All wor!; will be done in accordance with approved
plans. This permit will expire if%vork is not started within 180 clays of issuance, or if work is su:;per.ded
for mole than 180 days. Al TENTION: 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
95,_-0001-01.Q0. You may obtain copies of these rules of direct questions to OUNC by calling (503)
246-6099.
Issuad Bv: WLd± Z Permittee Signature;
-` Cali (503) 639-4175 by 7:00 P M. for an Inspection needed the next business day
May 10 '14 Oy: 34a Bryan Nelson 5036910723 p. 1
Plumbing Permit ARP isRcc
City of'Tigard Mwtphy'
13125 SW Halt Blvd.,Tigard,OR 9722,3 / Pian Kev;cw
Phone: 503.639.4171 Fax. 503.598.1960 DatdHy. - rnnrt N° _
24-Hour Inspection Line: 503.639.4175 (rare Rcad>Bv -� ® S«Page 2 to,
Internet: vrvw,ci.dgard.or.us a, otifiaUMcrhat. 4LWDULN Suppleraestallnforeution
TYPE W FEE' - -
❑Newtxmstruchen ❑Dcniolition ,Fsrgrrr!Cln,0-iurmsse"naso.cherklitt -
Desai tiara Y- Ea. -Tole!
F91cilition/altenatioi, ❑llt►er: New 1.2-family dwellings(includes lou ft.for each utility connection,'
C4TEGORV OF CONSTRUCTION SFR(l)bath 249.20
t,tj-and 2-family dwr llirg [ICommerci A industrial SF'R(2)bath -T 350.00 ,--
❑Accessory buildir�_ ❑M%i-f.mily SFR(3)Lath __ 39900 -_
- Bach additional bath/kitchen 45.00
❑Master builder_ ❑rather' -� F ire sprinkler( sq.ft.l Page 2 _--
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: , Catch basin ur area drain 16.60 --
Ctty/Statel7.IP: - Ihywell,leach line,or trench Jrain 1660 -
Suitu/bldg./apL no.: Project name: Footing dna+r,1�n.linear ft.:-J .. Page 2 _--
Manufactured horw-,::iiueS 110.04 -
Cross str rtiores to job site
Manholes 1!x.60 -
Rain drain ounnector -- 16.M
- _ ^- --- -- - -' Sanitary s•:wer(no.linear ft.:-_) Page 2 ---
- - --- - Storm sewer(no.linear Il.:!J Page 2
Subdivision: -_-_-7-t,p„ Water service(no.linear ft.:_) Page 2
W Fixture or item
Tax map/parcel no.: 16,60
-- _ Absorption valve _
DESCRIPTION OF 'WORK Beckilm-preventer - Page 2
Backwater valve - 16.60
- ----- --- Clothes washer 16.60
Dishwasher 16.60---
Drinking fountain 16.60
❑ PROPERTY r,.t'NiR e❑ TENANT Ejectors/sump 16.60
Name: -1�(,7�� ,/L fJZ Expansion tank - 16.60
Address: V rl xturdscwer cap 16.60 -
C'ty/State/%IP; -� - - I Floo,drainll'Imir sink/nub -, 16.60 ---
Phone:Q_W7) Cj/8 C) As -_ Fax:( ) Oartra:e Jispusal 16.60 ,-
r] APPLICANT CONTACT PERSON Floscbib 16.60- 1660
Ice maker _ _
Business name: --- I�taccptnr/gcasc trap ----.- - 16.60
Contact name: C _ -� S Y\ - It ledical as(value:S ) Pop 2
Address: Prim, 16.60
City/State/?IP: - Rocifdrain(commercial) _ 16.60 _ -
'" Sink/basialavatory 16.60
Phone:( ) - _ ^� Fac_; ) Tub/shower/shower pan 16.60
E-mail: _ Urine) 16.60
CONTRACTOR Water clos;l 16.60
Business name: N��S�r� 1 1 Water healer f--- 16.60 •�p(�
Address: 1 Other.
_ Subtotal
City/State/7.IP: Z, - --__-_
_ � _ �l� I SL_ Minimum permit fee: 572.50
C Fax: C Rcsidcutinl backflow minimum omit f.e: S36.25 (_-
Phone:( _T 2- (925 S ( (d 11- �j ----� ---
CCB Licr l-�r , ermil fee)
, I'umbing Lic.no.: vl '� _- --- _. Plan review (25%ofp
-- State surcharge(g°16 of permit fee) `
Authorized Mpature: _ 1'0'1'U.PERMIT Flirt Qt;
Print name: , ',� I ��.1 �1,Dale: - This permit application expires if v per ml►is nae obuinol 041
witJliv'
V-� 160 days alMr It bas been aecept�l rs complete.7$ c9UU
*Fee methodol iev set.by'rri-Caunty Ruildir.,h umaj, 'z-vice 130fs d
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST ------------- --
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received _Date Requested. S—�` AM—_--- PM - BUP _ -__—
J
Location --Cl (�— � -Q -- — Suite_._ MEC _-
-OC)a S
Contact Person Ph PLM C2�1.�_--.
Contractor _--- ---._------_—_—._ Ph(_—) ---- SV119 --- —
BUILDING TenanUOwnp _ _ ^_ _ __—�_. ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain --
Slab Inspection Notes: SIT
Onst,K 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
PLU_M81NG
Post& Beam -
Under Slab - — - - - --- - ------ -------- ---- -
erervice --- - -- — -- --- - -- --_._. ----
Sanitary Sewer
Rain Drains - --- - -- ------....--- -----
CAtch Basin/Mar hole
Storm Drain -- --- -- - ----
Shc,wer Pan
r4ht
P S PART FAIL
-----
E_CHANICAL
Post&Beam ------
Rough-In — - — --- --- - --- --
Ges Line
Smoke Dampers -- ��---
Final
PASS PART FAIL -- -----
ELELTRICAL __—
Service
Rough-In
UG/Slab
Low Voltage _ -
Fire Alarm
Final C-] Ranapection 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 Date =F -- Inspector _- - ---___ _- —Ext
Approach/Sidewalk _
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL