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1350 SW ASH AVENUE
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
=Izaffmw 13125 SW Hall Blvd., Tigard OR 97223(503)639-4171 PERMIT #. . . . . „ . : F-ILM99-0084
DATE JSSUED: 03/23,/99
PARCEL: 2S102CA-00905
SITE ADDRESS. . . : 13350 SW ASH AYE
SURD IYISION. . . . : VILLAGE GLENN ZONING: R-4. 5
BLOCK. . . . . . . . . . : LOI.. . . . . . . . . . . . . :005 JURISDICTION: TIG
CLASS OF WORE;. . : REP GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . QF WASHING MACH. . . . . . : 0 BACKFLOW PREYNTRS. . 0
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . o
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES---___-_.__..-_—__.___ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
0 URINALS. . . . . . . . . . : 0 GREASE TRAP'S. . . . . . . . 0
LAYATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : 0. WATER LINE (ft ) . . . : 30
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . L 0
Pemarks : 301 Of WEter line
Owner: --------------------------------------- ------------ FEES
EDWARD DUAX type amount by date rerpt
1 ,3350 SW ASH ST P RMT $ 30. 00 B 03/23/99 99-313912
TIGARD OR 97223 5PCT $ 1. 50 B 03123199 99-313912
Phone Q
G o n t r act o
OWNER
Phone Q $ 31. 50 TOTAL
Reg 999999
REDUIRED INSPECTIONS
This permit is issued subject to the regulationsLine Insp
contained in the Water e t
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Service In
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 s4peWrd 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 through OAR 952-0AO1-080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246-1987.
Issued By: �WLAYL-- Permittee Signatur
++++++++++++.....................4.+++-f............4.+++++++++++++++++++++++++f-++
Call 639-4175 by 7:00 p. m. for an inspection needed the next business day
...............................................................4..................
CITY OF TIGARD Plumbing Permit Application Plan Chec #
13125 SW,LIALL BLVD. Commercial and Residential Recd Bya�
TIGARD, OR 97223 -~ Datr;Recd '1
(503) 639-4111 Dale to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# ImIq
Related SWR
Called
Narfte I Development/Pruiect FIXTURES (individual) -- QTY PRICE AMT
Job � I , � i � �pI( (�i �� Sink -- * ' 9.00
Address Street AddresW Suite lavatory __�-- 9.00
f A ;f 77 A'j�-- Tub or Tub/Shower Comb. 9.00
Bldg# City/Sia Zip v Shower Only — --- 9,00
---- ---- I Water Closet 9.00
Nam r n — ----
I, If%$ /l Dishwasher - — -- — 9.00 --
Owner Mailing Address I� Suite Garbage Disposal goo
'�>n✓r r} �!>• Washing Machine 9.00
City/Stale ZIP Phone Floor Drain/Floor Sink 2" 9.00
— —-- 3" 9.00
N
6 Ow 4" 9.00
Occupant Mailing AddressA Suite Water Heater O conversion O like kind 9.00
I.33sa 5W A-o' kx _ —__ Gas piping requires a separate mechanicalPermit.
IStatP..` ^ Zip Phone Laundry Room Tray 900
L �Ci t✓tZ 1"lLL?. b?4-QFit-I Urinal — --- -- 9.00
Name — Other Fixtures(Specify)
9.00
- -- --
Contractor Mailing Address Suite - — 9.00
9.00
Prior to permit City/Slate Zip Phone Sewer-1 st 100' — 3000
issuance,a copy Sewer-each additional 100' 25.00
of all licenses are Oregon Cnnsl.Cont.Boats Llc.* Exp.Date M t-
required if Water Service-1 E, 30 30.00
expired in COT Plumbing Lic # Exp.Date—� Water Service-each additional 200' — 25.00
database _ _ _ Storm&Rain Drain-1 st 100' 3000
Name—� Storm&Rain Drain-each additional 100' — 25.00
Architect Mobile Home Space 2500
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be.done: �- restricted energy permit.)
New O Repair Q Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential O Commercial O _ _ Catch Basin 9.00
Additional description of work Insp,of Existing Plumbing 40.00
erRtt
Specially Requested Inspections 40.00
per/hr
------ Rain Drain,single family dwelling — 30.00
Are you capping, moving or replacing any fixtures? -- — —
Yes O Na Grease Traps 9.00
If yes,see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAILURE rO ACCURATELY REPORT FIXTURE Isometric or riser diagram Is required If Ouantlty Tala1 Is >9
WORK COULD RESULT IN INCREASED SEWER FEES. 'SUBTOTAL
1 hereby acknowledge that I have read this application,that the information
given Is correct.that I am the owner or authorized agent of the owner,and 5% SURCHARGE
that Hans submitted are in compliance with Oregon State Laws.
S�i ngtlue�t Own rlAq � Dae "PLAN REVIEW 25%OF SUBTOTAL
.e uired onl it facture qty total is>9 -
�__�_,. -� TOTAL
Contact Person Name Ph ne __ �I Y
'Minimum Device tee is$25 1 5+ surcharge,except`?esidential Backflow
Device
Prevention ,which is$15+5%surcharge
**All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I ldslstplumapp doc 7!2198
PLEASE COMPLETE:
Fixture Type ^� _ -Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink-
Lavatory
Tub or Tub/Shower Combination
Shower Only �_—
_Water Closet
_Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink
411
Water Heater
-Laundry Room Tray
Urinal_ — _
Other Fixtures (Specify) _
COMMENTS REGARDING ABOVE:
Lx----:ACV-,
,,c nn,mac P doe 1l1AIt
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639.4171 ---
BUP
— — —
Date Requested — � C� AM PM _ WD --_Location— 74,5 74,5��� — Suite —_ MEC
Contact Person !J'Au�,,, u ''6, ck_ Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining'JVall ELR
Footing Access.
Foundation FPS _ -_—
Ftg Drain SGN
Crawl Drain Inspection Notes. -- --—
Slab — - ---------- SIT
Post& Beam ---""
Ext Sheath/Shear
Int Sheath/Shear - -
Framing --_-
Insuitition
Drywall Nailing
Firewall --------------^---_.-
Fire Sprinkler --
Fire Alarm
Susp'd Ceiling _----_-------_—__ -
Roof
Misc:
Final
PASS PART FAIL. --- -- - - ---- -----
U
Post&Beam --- - _ - - - - ----- - ------ __-_ —..---------
Under Slab
TopOut - _ _ _-- - -----._.--.__---.-------__-_--__-____
San ary Sewer --------- -------_-.-.-----_-__...-____
Rain Drains
F'
A PART FAIL
Post& Bear" __ -- __ - -----_--__---__-_-
Rough In
GasLine - ----- - ------- --- -- ---.
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL --- --_..---_.. . ....------ ------ --
Service
Rough In t.
UG/Slab --- -- \ _---- --- ---- ----- - -- ---- - _
Low Voltage
Fire Alarm _� _—�---- --------_-------
Final
PASS PART FAIL
SITE
Backfill/Grading - -- - ------
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$— - required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ )Please call for reinspecti n RE' [ J Unable to inspect -no access
Fire Supply Line ---
ADA J/ a
Approach/Sidewalk Date L �l Inspect o Ext
Other -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.