Permit CITY OFTIGARD
PLUMBING PERMIT
,„_'s, . , , l l i i � DEVELOPMENT SERVI PERMIT
O3/1�i9e -007
PARCEL: 2S1O3DB -00600
SITE ADDRESS...: 11025 SW PARK ST
SUBDIVISION - MIRA PARK ZONING: R -4.5
BLOCK LOT •002 JURISDICTION: TIG
CLASS OF WORK•.:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:R3 FLOOR DRAINS 0 TRAPS • 0
STORIES • 0 WATER HEATERS • 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS • 0
SINKS • 0 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 1
DISHWASHERS • 0 RAIN DRAIN (ft)...: 1
Remarks: Install perforated pipe to redirect rain water away form residence with
in
the property.
Owner: FEES
AZADEGAN, ARASH & CAMILLE type amount by date recpt
11025 SW PARK STREET PRMT $ 55.00 GEO 03/17/98 98- 304185
TIGARD OR 97224 SPCT $ 2.75 GEO 03/17/98 98- 304185
Phone #: 624 -8926
Contractor
Phone #: $ 57.75 TOTAL
Reg #.. :
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Rain Drain Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
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 9524801-8010 through OAR 952 '% '1-0880. You may
obtain copies of these rules or direct questions to OUNC by calling
(583)246 -1987.
Issued By: � /` //, Permittee Signature• / //,, , „ /
+ + + + + + + + + + + + + + + + + + ++ +++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
• arilrmr1 - milk - - . .. - - — - .
CITY OF TIGARD Plumbing Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd
TIGARD; OR 97223 Date to P.E.
- Date to DST
(503) 639 4171 Permit* cciel/ir - 0 0 _._.3
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project On back indicate Work Performed by fixture.
Job /V /A FIXTURES (Individual) - QTY PRICE , AMT
Address Street Address ' Suite Sink - 9.00
i 025 $W � 6f . Lavatory
9.00
Bldg # Ci /State Zip
T ja(d f oa q7223 Tub or Tub /Shower Comb. - 9.00
Name /� s G1 //� Shower Only -- 9.00
/7 - e A,5/4 M/C LE 42/ (: C,Aj Water Closet - - 9.00
Owner Mailing Address Suite Dishwasher - 9.00
/102$ S Ark_ Sf Garbage Disposal _ 9.00
City /State Zip Phone Washing Machine 9.00
7" (d oR 87223 _ 62y 892
Nam6) Floor Drain 2' 9.00
50•111e- a5 40✓e- 3' - 9.00
Occupant Mailing Address Suite 4' 9.00
I 1025 scJArk -
City /State Zip Phone Water Heater 0 conversion 0 like kind -- 9.00
�, G�4 441/Z 62 y 2,2C Laundry Room Tray -- 9.00
Name w Urinal - 9.00
C
cue ( r Other Fixtures (Specify) _ 9.00
Contractor Mailing Address Suite
9.00
Prior to permit City /State Zip Phone 9.00
issuance, a copy 9.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date .r 9.00
required if Sewer - 1st 100' - 30.00
expired in COT Plumbing Lic. # Exp. Date Sewer - each additional 100' _ 25.00
database
Name Water Service - 1st 100' 30.00
Architect //A Water Service - each additional 200' - 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' I 30.00 an,
Storm & Rain Drain - each additional 100' i 25.00 25
Engineer City/State Zip Phone Mobile Home Space - 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration 0 Repair X Pollution Device
to be done: Residential Non - residential 0 Residential Backflow Prevention Device' - 15.00
Additional description of work: An Trap or Waste Not Connected to a Fixture - 9.00
TAS /1 P�" (cdt t he `o /edit in y p
Catch Basin 9.00
• Gla e( 001V /tom #401-*-- 04/ ,2(o j ' • Insp. of Existing Plumbing - 40.00
�/ I m ���JJJ per/hr
Existing use of j� ,/ _ .Specially Requested Inspections _. 40.00
building or property Prso^ ai /C ri4241 CC, . per/hr
Rain Drain, single family dwelling 30.00
Proposed use of dal Grease Traps 9.00
G�1
building or property No al E.
-
l! QUANTITY TOTAL - ... 5
'
I hereby acknowledge that I have read this application, that the information I sometric or riser diagram Is required if Quanity Total is > 9 Z '
given is • rrect, that I am the owner or authorized agent of the owner, and
that pl. '. submitt • ;, are in compliance with Oregon State Laws. SUBTOTAL .
Sign / � , of
• . IA,e t Date
5% SURCHARGE
� , / /, / _./ 3 -/y 7 S '
• n Person me Phone PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL
"�1 g
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
(/ /c-- - i t �< Prevention Device, which is $15 + 5% surcharge
,
l:tdstslpfmapp.doc 5/97
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3 „
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
1 `i
COMMENTS REGARDING ABOVE:
I:Wsts plmapp.doe 5/97
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 4171
BUP
. if 5 Date Requested 6 " ,Lg' l ? AM PM BLD
Location 110 5w •a/t -tc. Suite MEC
Contact Person A _ �
�•- i 1 i • / ! J i x Ph 4 7446, PLM
W-0073
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing . ‘
Foundation U f -3' .CX— 4 FPS
Ftg Drain f SGN
Crawl Drain Inspection Notes: L/ 4MALL-- S lab Post &Beam l �,� 4.e � , _ SIT
cia Ext Sheath /Shear w U� % / �, l p(r •
Int Sheath /Shear ( J
Framing // /// ■ / ■ i
Insulation ��-,,,,,,""
Drywall Nailing Sow, if fAi.
Firewall ^ G p
Fire Sprinkler ( �V If- - _. J �./ 1 i 1\1 IS
Fire Alarm
Susp'd Ceiling V V �-" Q - 9 G • Roo f (I-)LLH€ 1 �^'� \ Mx S at
Misc:
Final V _
(/.6 ,C— .(13-1 C-4-- 7
FAIL ry
wN5Qe-c-7‘ L-f---tr
Post &Beam 1
Under Slab C I V"
Top Out et
Water Service 1 “ 1 .e ' Q -v ,L
S Sew �/�
ain Drain 6 x , ,.„ •
Final
PASS 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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pa at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: Unable to inspect - no access
ADA
Approach /Sidewalk D Ins Inspector 1 Ext 3 t
Other p
Final
PASS PART FAIL DO NOT REMOVE. this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION ST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Date Requested d BUP
,,) Q AM PM BLD
Location //0.025 5 ' I a- i / � Suite /! MEC j (�
Contact Person c¢ -P-7// 170d�5 //
rA- Ph Lg tecf 7 ?4'! PLM Ld Q0'75
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service A • /L
Sanitary Sew fr �a
Rai ins i
F' I
P S PART FAIL
M ME ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
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 reinspects RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk / Ly
Date ate 1 /1 Inspector Ext
nspecor V_� x
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•