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Permit
A: CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: P 14120% 4 -00262 Ail I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/14/200 SITE ADDRESS: 13335 SW 107TH AVE PARCEL: 2S103DA -04103 SUBDIVISION: ZONING: R -3.5 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 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: 60 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Connect existing house to sewer service, 60'. Septic tank is to be pumped, filled and inspected. FEES Owner: Description Date Amount BEN RILEY SW 107TH 13335 SW [PLUMB] Permit Fee 6/14/2004 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 6/14/2004. $5.80 Total $78.30 Phone : 503 723 - 9309 Contractor: INTERLAKEN INC PO BOX 2010 FAIRVIEW, OR 97024 REQUIRED INSPECTIONS Sewer Inspection Phone : 971 Insp existing /capped fixtures Reg #: LIC 160018 Final Inspection 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) 24 -•699. Iss ed By: 1 1 ,�_ . 9 / 4 ' Li Permittee Signature: v. Vivvi()() 6t y u l k / v Call (5i ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day 'a Pi � Permit Application FOR OFFICE USE ONLY City of W Tigard Da e/B;. �r i��T %� Permit No.: � �/ �_ W Hall Blvd., Tigard, OR 97223 Plan Review /� � 5. 13125 S Phone: 503.639.4171 Fax: 503.598.1960 / /.. ,, Ic Date/By: Other Permit No. 7 � 24- Hour Inspection Line: 503.639.4175 � V� l I� Re Juris Internet: www.ci.tigard.or.us _..t.14- Date Rea See Page 2 for Ready /By: _ � _ .:. -- ,,.._:. .._ b...�,. <r ::, : °,�. sue,.,, -„�Su ppl e mental F. :a :z > r t"r ="rte , s�. pa x. yea, n . i, , .. ,. „ i .......,,. „ . - . ,.. ©F s�W .�, ...,...3 ° , _ , . - , i.,. ,.c„ !' _ ,�.., 'f: ; ❑ New construction 0 Demolition For special information use checklist - Description I Qty. I Ea. I Total Addition /alteration/replacement ❑ Other: ew welh (includes 100 ft. for utility connection) ::,: ., ';i:t.':G &I ✓ GORY.; :y amt dwellings m each t tty c on . O.F" C NSTR1(G° x < f SFR ( b ath •.:;•, ,_ .,:.s �Q N 249.20 n; 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building • ❑ Multi - family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 t :.» .,..._ �e • °: 0 Other: xr Fire sprinkler ( sq. ft.) Page 2 4 1 e ;�_�� tea. . • _ ,_ :,..,, .. iTEIjIFt1R f a , 7 L}3 t • u • t t • tes Q Job site address: I �3 c Sw 011'w Catch basin or area drain 16.60 City/State /ZIP: ; J 4 y / I /C�n 61-1,7,9.; Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: J Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: s w ?a( 1, I Sr. t n'I +� 7" o Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: W 0 ) fj Page 2 55 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: ,..; .,. Y �� ' H!: Absorption valve 16. -, DESG N =i....- WOR" r` � :'.;417.k, : r .i, >," . c ., „a „•,. ., ». � az ,.�.. - .: , _.... »;, - �_ a, v,� "��.,. 4.;:1-120 » � .�, ��� Backflow pre venter Page 2 �i .° / n I i hi, I S IA/ • & I n5 171 Backwater valve 16.60 4 I 1 i , / 0 i l - . 4 iS 0 i ■ ' Clothes washer 16.60 *M U Dishwasher 16.60 ,.o. Y PA) y �� `R�,�;.�� li .:;a . ^�v�.- :fr;�- .�Z;�,1 ;;�w �x,� ��• =x.:r:, s:,;,,'" s��;rl Drinking fountain si ° .RO W a, a _ ._. » D king fo 16.60 , .. . �. :QWN)ER °° �� ».`� l�'1'ElYt1NT:`: � : ,..,, _._.& . : .< Ejectors /sump 16.60 Name: �/ n l Expansion tank 16.60 Address: K ' 1j N 3'j ) � G tl k i 1)1 rh•. _ Fixture /sewer cap 16.60 City/State /ZIP: ¶ (y' ot I 6•0--- oil 's Floor drain /floor sink/hub 16.60 Phone: (e p3) 1 i aI 1,0 ,- Fax: (503) V Garbage disposal 16.60 .a ::, . :: ;a.; ,, ...�. :::, vi ,,, r Hose bib 16. * .,,,' AE ::- " _ -,._ �, ; C.Q ,V .PEI2SUN "cf5n : _ Ice maker 16.60 Business name: t tit \etf ` (n 'Lt/t n l , IA V • W Interceptor /grease trap 16.60 Contact name: �..mdl,a 11 MOO Y.G Medical gas (value: $ ) Page 2 Address: O U,fN 9 010 0 Primer 16.60 City/State /ZIP: U y v i ON I 0-y l i o - Roof drain (commercial) 16.60 Phone: 1 ly) 0 ik. ....151/1,4 500) le l �/ - lA �1 a1 Si b s h ow e r av Owe 16.60 � Fax:: ( D ' 1 Tub /shower /shower pan 16.60 E -mail: , . z, ..,:, '•:.:» .. <„ _; ,,, Urinal E;116 IV �i : 'z4 `;. `n' it ..: 'e: a„ ,, a:: s`;i Q n r =.Y- .H : 7Nii i I.l �'x�: ` is- '7' •'J�: -. � -'`Fx. £� 3 n��'s: ,•kas',k�i?=z�, ° •'ii,S'..r' ,� ;�- ..,�_..,. �: x- rt ::, "<a ;.Ns:<; w,.,..: =. a -: a . o Water closet 16.60 .. Business name: rlO 1(,,Gh `hL, Water heater 16.60 Address: j 6 11P( . 1,b10 Other: 1 City/State /ZIP: � t 2W i 0 ► ' ' ` Minimum permit fee: $72.50 Phone: (0`1 t ) �ti�., CI , 1I S Fax: ( 50) ) loth 1151°1 Residential backflow minimum permit fee: $36.25 72 ..50 . CCB Lie.: t k9 On`g Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Cj . W Authorized signature: jt+� p , TOTAL PERMIT FEE Print name: ( i\ i 1 f 1, l 1V, V n .00-Yi 'J / Date: q �` \A This permit application expires if a permit is not obtained within v Il 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Permits\PLM- PermitApp.doc 12/03 440- 4616T(10/02 /COM/WEB) CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECT:ON bIVISION Business Line: (503) 639 -4171 BUP Received Date Requested (; r AM PM BUP Location / 7' , " Suite MEC Contact Person y ` mss Ph ( ) 0 PLM� ? �' - �- —7 l=' Contractor Ph ( ) SWR BUILDING: - Tenant/Owner ELC Footing Foundation ,► �rf T j , �. ,� - . M , ELC Ftg Drain ' �` k � ;� a;C �"z6'.lrl� _ ►'�:�,,� y'�� ELR Crawl Drain tir. ..3.i ;; r... ..��:.�. .s�, n�. _���f�:� -4+ Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing �� °° Insulation Cn' iav� (4 Ads S-4-1.4.“,,..) 1`6 Jtic ,Sc'v■ we. Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm +���,i ✓ t. C In vvc a� "'I" � �., to �—` Sea�i � (.� t ■ C ck- A-" - r Susp'd Ceiling Roof Dec -4- , L Q �p'Tu : e..J u s•.. L i Pe ./ w.i"r bki S:e "Fa ... Other: Final t D; r nor e t .,, D v - ek 1.. 43<A r > �+ ' vim fi n•- . &e(—) PASS PART FAIL - =PLUMBING e; � L f t ..Ka 1. Post & Beam Under Slab • Rough -In Water Service SaXe Sewer Rain Drains Catch Basin / Manhole , Storm Drain Shower Pan er: �Fina PAS PART FAIL MECHANICAL 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 � Y) r I Inspector (lb 1 1)- -t--A I ` ,P- °' 4 °'• \ Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 ? BUP Date Requested_ Yti —C AM PM)/ BLD Location ( 5 0 — ) / 7 - U , 2J. Suite MEC Contact Person / 3335 Ph PLM.26 00 2 Contractor Ph SWR BUILDING ;4 ya == Tenant/Owner ELC Retaining Wall 0 ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm / Susp'd Ceiling At Roof orpr Misc: Final ' • / P ASS PART FAIL Post & Beam Under Slab Top Out Water Service Sanitary Sewer • Rain Drains PART FAIL Post & Beam Rough In • Gas Line Smoke Dampers Final PASS PART FAIL • ELECTR_ICALmx'' Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL 'Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA �7 Approach /Sidewalk Other Date ✓ /jJ / Inspector �� Ext 'Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.