Permit CITY OF TIGARD
„ DEVELOPMENT SERVICES PLUMBING PERMIT (J�
11. I 13125 SW Nall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # PL M96 -0 _,�, Q�
DATE ISSUED° 11/04/96
PARCEL: 1S134DD -00501
SITE ADDRESS...: 10835 SW TIGARD ST
SUBDIVISION' " ' • ZONING: R-4.5
BLOCK LOT -
CLASS OF WORK.. :NEW 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') °..: ' 200
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS ' °''0 ' RAIN, DRAIN (ft)... :, 0. . ,
Remarks: Permit for sewer lateral assembly from existing tee (Dist. 8) in easeme
nt
-to end' of easement. Lateral will be capped for. , future.: use.,; Second lateral, for ' ,
adjacent home in same ditch, by separate permit.
Owner: FEES
ROBERT FITZGERALD type amount by date recpt
10835 SW TIGARD ST PRMT $ • 55.00 JMH 11/04/96 96- 286082
SPCT $ 2.75 JMH 11/04/96 96- 286082
TIGARD OR 97223
Phone #: 620 -4761
Contractor:
CONTRACTOR. NOT ON FILE
Phone #: $ 57.75 TOTAL
Reg #.. .
-- REQUIRED INSPECTIONS -•-
This peroit is issued subject to the regulations contained in , the Sewer Inspection
Tigard Municipal Code, State of Ore..Specialty Codes and all -other ::. Final Inspect 'Inspection
applicable laws. All work will,be'gdone in accordance with
approved plans.' '.This'.perwit.'will expire', if -work' is ;not started ' ,.., , ; ,
within issuance; „ ar•i'fs'work''is , suspended "for core',,,,, . "" .
rif.,____
than 18 ®:days.
Permittee Signature:
- ' . , ,
Issued By: attli
r- . Chindetet ' - ' ” - ' ' ' .
° Cal l ' for inspect ion -• 639 -4175.
•
s� 2 cIs YOU �-&t7
, 5
CITY OF ' TIGARD Plumbing Application Recd By 0
13125 SVN HALL BLVD. Commercial and Residential Date Recd 1 ('
TIGARD 97223 Date to P E.
Date to DST
(503) 639 -4171 Permit # FL MqC, - 0330
Print or Type Related SWR # .
Incomplete or illegible applications will not be accepted Called
Name of Development/Protect FIXTURES (Individual) QTY PRICE AMT
Job Sink 9.00
Address Street Address ' n� Suite
Lavatory 9.00
/ g35 Toheb 57 Tub or Tub/Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
Water Closet 9.00
Nam _
if r e,et ae / ff Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
/p 6 vi rakg.t> sr • Washing Machine 9.00
City /State Zip Phone Floor Drain 2' 9.00
1-1 Oe 9 s 6z0- 3- 9.00
Name ?7..z.
q- 9.00
rzC.c -J
Occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City /State Zip Phone Unnal 9.00
Other Fixtures (Specify) 9.00
Name ,n - �e,,,e, /I 9.00
Contractor Mailing Address Suite 9.00
.54 I E 9.00
City /State Zip Phone 9.00
Oregon Const. Cont. Board Lic.# Exp. Date 9.00
Attach Copy of 9.00
Current Plumbing Lic. # Exp. Date Sewer- 1st 100° 30.00 / 7 30 1,
Licenses Sewer - each additional 100' 25.00 2 S
COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00 I L L
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.00
Or Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer City/St. - Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Describe work New Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00
to be done: Residen ial 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additl'onal deon of work Catch Basin 9.00
ws �� L . .....•Te.4-..." Insp. of Existing Plumbing 40.00
per/hr
Existing use of
Specially Requested Inspections 40.00
building or property /74,/// e. per/hr
/7
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property
QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes 0 No " Isometric or nser diagram is required if Quanrty Total is > 9
(If yes see back of form) 'SUBTOTAL `�
I hereby acknowledge that I have read this application, that the information •
given is correct, that I am the owner or authonzed agent of the owner, and 5% SURCHARGE Z 7 5
that plans submitted are in compliance with Oregon State Laws. l
Sign ure of Owner ge i Date PLAN REVIEW 25% OF SUBTOTAL
�/-
_p� Required only if fixture qty. total is > 9
des 7 / TOTAL S 75
C ntact Person Name Phone '° ��
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
422-0- Prevention Device, which is $15 + 5% surcharge
i:\dsts\plmapp.doc 8/96
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
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)
COMMENTS REGARDING ABOVE:
•
•
SE 1/4 SEC. 34 T1 S, R1 W, WM
CITY OF TIGARD, WASHINGTON COUNTY, OREGON
iE
00
0
3 I'
co r
: 10835 SW TICARD T
S.
151 3400 501
151 3400 BOO
PUBLIC SEWER AVAILABLE
ON 108TH AVENUE I'
NOT TO SCALE
�PR0P0SED HOUSE
NO ADDRESS
1St 3400 502
a /
/ 10805 SW TICARD ST. N
��-, 10895 SW TIGARD S �/ 1S1 3400 400 C
Z T , /
0
151 3100 700 ON SEWER V
fA //
J T. L
E- SW TIGARD ST. I r
NOTE: ALL PROPERTIES IN THE REIMBURSEMENT DISTRICT ARE ZONED R-
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested C AM, Z _PM BLD •
Location 102 7 Suite MEC
Contact Person Ph PLM 96 -0032D
Contractor Ph SWR
BUILDING Tenant/Owner /? i / �� 7j ( ELC
Retaining Wall ELR
Footing
Foundation NOT REQUESTED FPS
Ftg Drain FOUND DURING RESEARCH SGN
Slab
Crawl Drain I NO INSPECTION(S) FOUND IN FILE
SIT
Post & Beam l " P C . O
Ext Sheath /Shear - •
Int Sheath /Shear
Framing
Drywall
Drywall Nailing /I �
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling A mil' A 'a e v
Roof
Misc:
Final
PASS PART FAIL
OICTM
Post & Beam /',
Under Slab
Top Out
Water Service '47 , 40"
Sanitary Sewer
Rain Drains
o' AR FAIL
MECHA AL
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 reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date '70 Inspector Extil
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
6
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Date Reftwested V 2:2 1 4.
2 k/ AM /19'7 PM BUP
BLD
Location /(),F35" ._)a 7 - d-. rP, _ -7 Suite EC
Contact Person Ph PLM ? — 633D
Contractor pp LL � - �l Ph // -
BUILDING Tenant/Owner A�Y L411,5 7f F7l ( LC
Retaining Wall ELR
Footing A ,�. - ,
Foundation ACC i FPS
Ftg Drain 1 NOT REQUESTED ___- __ SG
Crawl Drain Ins FOUND DURING RESEARCH
Slab I
Post & Beam
NO INSPECTION(s) IN FILE f T
Ext Sheath /Shear
Int Sheath /Shear C
Framing
Insulation
Drywall Nailing ' ' _rS -v-ox i / , ... - `- __
Firewall _ /
Fire Sprinkler
Fire Alarm p r ,
Susp'd Ceiling U-4 � _- OA iC V.� . S
Roof
Misc: LANK I r ' 1
_ C1
Final ' l �
.. , T FAIL 46 4- I l....-1--e > / - CD.r o/, �°-^�
' LUM BINC (�j��
u ■ Ill: - J
1
Under Slab OU � ,�_
/, L C t 4 4 fZf
Top Out d ' + 11 z* �-��\ l9 �� a- V /
Water Sen�ice
Sanita Sewer l � �� A
Ram rains f-�-
Final e6"-"y"
PASS PART 1/4 +11k T � 1 -
MECHANICAL '$- -�
Post & Beam w`'� ^� ‘' ^
Rough In
Gas Line
Smoke Dampers CA l I ' ,1 • -/ •
Final �
PASS PART FAIL �` r g /-' �� ._ ,.., p„,,..A.- ....... ELECTRICAL �.� ° �-,
Service D •`� \ 1 •
Rough In
UG /Slab `\ i� .. Low Voltage
Fire Alarm
Final
� . ■ ` 'CSC 2 �,
PASS PART FAIL ` ; -`��
SITE r
t J2 L -
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
Approach /Sidewalk 'other Date I nspector Ext� 1
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .