Permit ' 'Cm ,
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�+L� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERM s T ti�� , ° ° - ha�� 1 t : ��'
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'This permit i5, .issued subject -to 'the' r tgicaa¢.i,on 'Ibidaimed iii the R'1-'! i)ack •f 1 ow, P`re'y ' " " ":" " '' '
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ap!i%'u'J?i plans. This ;]"g it will 2X3ire if work is not : iar'i,ed _ .. -_ -, w x5. I ' ' '
within 180 .days of i= SUd>iC2. CT ,1 t ',p'o'i':{ 7..4 :tiSuErtdett, for .�tor,' . ,- _ _
than 1ao iiay5,, ATTENTIDNC Ore on law-requiree You to follow! r"!.r1e_
adopted by the Lrejort 11t11ity to;iiitai, ion Center, hose'ruie "rare __..,__________________ _ •
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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 DSh
(503) 639 -4171 Permit # (/ 97- 617517
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 - P2..v -k- i vEsz.A. ( . FIXTURES' (Individual) - ; . QTY'. PRICE AMT
Address Street Address n1 Suite Sink 9.00
�3
�C2._sw� Y'��'� Lavatory 9.00
' Bldg # City/State 1r Zip Tub or Tub /Shower Comb. 9.00
t-414 I �� w Shower Only 9.00
Name \'
a.pre L ■!J % rt.% yvCJ- Water Closet 9.00
Owner Mailing Address Suite Dishwasher
9.00
4::64ti43.., Garbage Disposal 9.00
City /State Zip Phone Washing Machine 9.00
Name Floor Drain 2" 9.00
' (U \ L \r 41 62.1 N Cr 3' 9.00
Occupant Mailing Address - Suite 4' 9.00
S p t^■' Water Heater 0 conversion 0 like kind 9.00
City/State Zip Phone
Laundry Room Tray 9.00
Name 1 Urinal 9.00
S VIL F 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 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 N 4 Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
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 0 Pollution Device
to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device' I 15.00 15 "6b
Additional description of work: Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40.00
building or property \ rck...C1 T A'^'11k.4 rrig, per/hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property . " - 1 1
QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the informa Isometric or riser diagram is required if Quanity Total is > 9 /
given is correct, that I am the owner or authorized agent of the owner, and
*SUBTOTAL
/
that plans submitted are in compliance with Oregon State Laws. .. V •.
nature of Ownor /Agent ` Date 5% SURCHARGE [ �,
\I l'‘ V:‘'-‘ REVIEW 25% OF SUBTOTAL
Contact Person Name Phone Required only if fixture qty total is > 9
TOTAL
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
I ldstslplmapp.doc 5197
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)
COMMENTS REGARDING ABOVE:
1 bstslptmapp.doc 5197
ii■
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 5/3 6 AM PM C C BLD
Location ly 3 A4 Ce li j it Suite MEC
Contact Person Ph 410 q 7-00u/Sy
Contractor/ , . 'M . . • %
, I � E Ph nif i i- 4 SWR
BUILDING Tenant/Owner / ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain ee—C a _ 6.-P,- 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
Roof
Misc: l
Final
PASS PART FAIL .
- FLOMBINd) -
– _. Post & Beam
Under Slab
Top Out
0. :I 6 : .„.7 -
Water Service
Sanitary Sewer
Rain Drains
'� . PART FAIL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk 7 ` 2 Other Date Inspector � C� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.