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Permit .. ,..... . .• A • ,., : cry oF , TIGARD • • , „ _ : • . ‘., . „ �iH, ,, Hi�y�l�,f °�'� DEVELOPMENT SERVICES PLUMBI NG,PERMIT' ' -��+� `. 1 3125SWHallBlvd., Tigard OR'97223 (503 )639 -4 �`E MIT lk° ° ° ° ° ° ° p � a - ` " DATE , ISSLJE.D:' 06/'17/98 PARCEL: , 251 h4DD- -0180+ , ' SITE ADDRESS.,..: .12939 SW RIDGEFIELD LN , SUBDIVISION—a,: : MOUNTAIN _HIGHLANDS #2 , ZONING: R -4. a,,P'D ' BLOCK.......'...: LOT....... o. ° °:ti`S JURISDICTION: TIG CLASS OF WORK., : ALT GARBAGE' DISPOSALS.: ,0 MOBILE HOME SPACES,. 0 ' ' I, =TYPE: 'OF USE....:SF -- °- - - WA'SHIN6' MACH ° =° ° ....: ' el , BACKFLOW PREVNTRS,. ° : - 1- .-i - OCCUPANCY GRP° ° : R3 ' ' . FLOOR DRAINS. ° ., .. . ° , r „ TRAPS... °,° ° ° ° , ° , 0 'rSTORIES° ° . ° ° . ° 6 WATER' HEATERS—....: ' O „ CATCH BASINS° °'° °.° ° . ° 0 ' ' F I,XTURES-- .- _-- .__.. -__- LAUNDRY TRFlYs.'„,..7, 0 SF RAIN DRAIN a,'° . - 0 ; SI,NK.S° ° ... . ° ° 0 ' URINALS° ° ° ° ..: 0' GREASE TRAPS° ° ° ° ,0! ' LAVATORI'ES= ° ° ° ': ,O' OTHER FIXTURES° A . ° _ 0 , TUB"/SHOWERS..'.: Oa. SEWER... LINE (ft.l' ° ..: 0 " ' WATER CLOSETS.: - 0' WATER LINE (ft),..: 0 ' DISHWASHERS....: 0' RAIN DRAIN (ft i ° ° , O ' . ' • Remarks: Add residential b,ackfloya p��eve�?Tit'i.on' device. . Owner ---___ .- .- .__- _.- __-- ___--- _.._. -_ - -- __-- __ -_ -- - �..:__ v _ FEES - __•_•--- ____.___ _ JOHNNY FRIESEN by amount. by ',date 'r••ecpt _ 12939 'SW RIDGEFIELD-.LANE _- - _ -- PRMT $_,- 15° F '"GEC. _.0E/17/9E '98-306615i. TIGARD OR 97223 SPCT 3 0.75 GEO' 06/17/98 98- -306E15 ' Phone X11- ° 579 -2004 . - .. • t or ••- _- - - __- _._.__-- :- ._ - - - -_- _ -._ - . -.__ Contrac _- , . OWNER ' 1 ' ' Phone #f: , ' ' 15.75 TOTAL' . ' Red 4. - ° 000000 I, REOU I RED INSPECTIONS -; -. =____. This permit is issued subject to "the regulations contained in the ' . RP/Back f 10 tAJ Prey Tigard Municipal Code, State of Ore. Specialty' Codes and all other „ ' F ; i n a 1. I n s pact i on • _ . ' , applicable. laws. All work will be done in accordance with' . _ - _ approved pl'anis. This permit will expire if -work is not started _ ' . within 180 day,s, of issuance, or if work is suspended for more — .._..— .-..— ..___._— . _ than 180 days. ATTENTION: Oregon law requires 'yon' to, follow,rules _ .—_—.. ___.__.__... adopted„ by the Oregon Utility Notification :Center. Those rules are _ �__ set forth in OAR - 0001- 0010'through OAR, 95270001-0.080.' You may ' 'attain copies of these rules or direct questions to OUNC by calling, , - - - ` - �_� _ _ __ ' , 31 46 -1987. • . - - - — .._�.� —_`.__ .,,.._: y :,-. e . Iss�_ted wi �� _� 'Permdttee'Signat'�_tre , , ' 4 -A-+A- k--F•++q"F- ++-Fq- i -F4- i- -F -FA- -A-t,±±-h=h- 1-.-1-=1°-[ -4-- •. + +' ++ ++ +-44-A +•4 +++ i-+- F-{-- 1-+ ++-I- + + +-l- +,-l- -I- +•f-•f• +.-F• 4-A-+± ' Call 639 -4175 by 7:,00 p.m, forte an ' inspect i.'o.n nee'd,ed the, next 'hu•siness ',da'y' .. ' • + + + ++ + ++-h + ++ + +• --} + + +++ + + -S--F+ +-F-F•++ + + + + +*+ + ++++ + ++++ +••F + +•4• + +. + ++,+ F +.-F+ +.4-t ++ +4t-F-144. 4 CITY OF TIGARD Plumbing Permit Application Plan Check # 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIGARD, OR 97223 Date Rec'd (503) 639 -4171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# 2�l $ - / Related SWR # -114---- `4---- Called Name of Development/Project On back indicate Work Performed by fixture. Job iffDrl trA/s1/ lea 2Y o? 'FIXTURES;(ndtv)dual) . 1 - -.`. ' , QTY;? • PRICE: AMT Address Street Address Suite Sink 9.00 1 4939 -SW Q,'c1 ;rlcOL9,4 _ Lavatory 9.00 Bldg # City /State Zip Tub or Tub /Shower Comb. 9.00 T : ji r ei o 2 9707a3 Name Shower Only 9.00 Sol7 Fr r r.Se 0 Water Closet 9.00 Owner Mailing Address Suite Dishwasher 9.00 S ' - e Garbage Disposal 9.00 City /State Zip Phone Washing Machine 9.00 Name Floor Drain 2' 9.00 •5 3' 9.00 Occupant Mailing Adress Suite 4' 9.00 City /State Zip Phone Water Heater 0 conversion 0 like kind 9.00 Laundry Room Tray 9.00 Name S �"`e Urinal 9.00 Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 S 't --.-e Prior to permit City/State Zip Phone 9.00 issuance, a copy Sewer - 1st 100' 30.00 of all licenses are Oregon Const. Cont. Board Licit Exp. Date Sewer - each additional 100' 25.00 required if Water Service - 1st 100' 30.00 expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00 database Name Storm & Rain Drain - 1st 100' 30.00 Architect Storm & Rain Drain - each additional 100' 25.00 Or Mailing Address Suite Mobile Home Space 25.00 Commercial Back Flow Prevention Device or Anti- 25.00 Engineer City/State Zip Phone Pollution Device Residential Backtlow Prevention Device' j 15.00 Describe work New 0 Addition 0 Alteration 0 Repair O Any Trap or Waste Not Connected to a Fixture 9.00 to be done: Residential 0 Non - residential 0 Catch Basin 9.00 Additional description of work: Insp. of Existing Plumbing 40.00 per/hr Specially Requested Inspections 40.00 per/hr Rain Drain, single family dwelling 30.00 Existing use of building or property Grease Traps 9.00 Proposed use of QUANTITY TOTAL ,;.:';' ; »:;.4: ; „A. building or property Isometric or riser diagram is required if Quanity Total Is > 9 -. e , :a_ x• *SUBTOTAL 'j:3 .:;: : �?` ':;tr `.:44 I hereby acknowledge that I have read this application, that the information ' r• given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE iisa - ;-::ry ,.„ that plans submitted are in compliance with Oregon State Laws. Slgna f Own r /Agent Date "PLAN REVIEW 25% OF SUBTOTAL .`' ?,; ?._ " R equired only if fixture qty. total Is > 9 .. • ' ai TOTAL �'h g ?`�;�c..; Co ct Pe on Name Phone _ *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow 5v� sl F7- r ' P �ti .5 7 9_a CTD t f Prevention Device, which is $15 + 5% surcharge All New Commercial Buildings require plans with isometric or riser diagram and plan review l:tastslplumbapp.doc 5!5/98 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: a sttaplumbapp.dac 5/5/99 Permit #: OC fit 9 -- ol . 5 F � �,; :„ , S D 1> ti �,: --f �'\ Address: / oZ Q,` / � G F :Mae: ; : t ,.��►,. Issued by: (2 ----- Date: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. — n 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale ._.. �J before or upon completion. 111 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Ow e - s about Construction Responsibilities on the reverse side of this form. (Si:nature of permit applicant) ( ate) (White copy to issuing agency permit file, pink copy to applicant) Ca + iu c ) Y�l . - •� �._'.S :•�9C %t II NJu JC"J la��� L' U .l _. •J:: �l.)JIti:I��ll ��� Note: This Information Notice to Property Owners about Construction Responsibilities was develop; c/ by the Construction Contractors Board in accordance with ORS 701.055(5). if you of e. acting as your owe) : ;.niractor to construct a new home o. make a substantial improvement to an existing structure, you can prevent many oroble: by being aware of tl e following responsibilities and areas of concern. If you hire persons not regisc ed with the Construction Contractors Board to do labor in constructing or assisting in the cons'ructior o: in rrmvemen° e.} a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: (:ox ?': '.. As an employer, you most withhold income taxes rrom employee wages at the time employees are paid. You will be liable foe the r, x payments even if yo:i don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945 - 8091. nsumnee As an employer, y oil are , required to pay a tax for unemployment insurance purposes on the wages e: all employees. 1~o mare in ormation, call the Oregon Employment Division at the Department of Human Resources at 378 -3524. V r i ^!'S' ecm-ce stun an cr'':nm._ c : As an employer. you are subject to the Oregon Workers' Compensation Law, and must obtain workers' co'npensatio ' • :.surance for your employee. If you fail to ob:..ain workers' compensation insurance, you may be subject t<u penalties ant-1 1."ii? '_' :'. liau 'i all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compense..ion Division ar the Department of Consumer and Business Services at 945 -7888. Rine : -t :e Seu ^r:._2: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1 -800 -829 -1040. /•'1 "'R n RFS ), .1` 5,c , r ^,R:_ „tee i-, E f Cof. e coniapriance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. r abi ty and' pn-o, :eray daernig.^ fosurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052, 503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. • prop- own .pm4 1 /94 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested I Z1 0 0 / ', AM PM BLD Location )2R q R I^et E L' 1 Suite MEC Contact Person Ph 9'g - O/ 7 S Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing A NOT REQUESTED Foundation I FOUND DURING RESEARCH FPS Ftg Drain Cr awl l Drain i NO INSPECTION(s) IN FILE SGN Crawl ( s ) Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation / .# Drywall Nailing 41/4110 / / / / I � Fire wall / � ���1 Fire Sprinkler C //� Fire Alarm '' Susp'd Ceiling d Roof Misc: Final PASS PART FAIL Po Under Slab Top Out Water Service Sanitary Sewer Rain Drains • PART FAIL CHANICAL Post & Beam Rough In Gas Smoke e Dampers r Th Final PASS PART FAIL (� J • 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 ) 1 ). Inspector 1/ Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.