13145 SW BULL MOUNTAIN ROAD�R
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AA CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
PERM TT
13125.AVN Hall Blvd.,Tigard,0R b7223 (503)6394171 PEIRMIT st. . . . . . . c SWR 37-031 E
PATE. ISSUED, . OC:•'0-7/97
PARCE1_: 2S 10':"inB--05'700
TTE ADDP[-Sf; . . . 13145 SW P.11 �'!:�)t•.I ,,"�.f �2r
r111010l !,IOK . . , si'+1LP917,_001AI ZONINC ; R
0CK,. . . . . . . , . . LOT. . . . . . . . . . . . . 1001 JURISDICTION: TIG
"'hIAN"i NAME',• . . . . .7'?Pi)N
A N0. . . . . . . . . . . 71XTIJRE LIMITS. . . .
°,F' Wofti�., l.."" DWELLTNG IJNIT"1. .
11 OP tiC7. . . . . Sf' NO. 07 BOILDINCSs
"`""lgl..l.. l'\TT.,. . . -LTPC34R I I'r r,:' R%! 7MRF.ACE:
ks; Re: P'!_M97-0 2 Must pl.tmp, filly and Cap Septic system.
,rlr.11i D ...._ .-. ,t,, type amount b-,' date 1 ei.,p,
�,P 7172; INsr- $ 7 JVD 08/07/977 -4 + i X;
I .'L 3�' ':% PO TOTAL
REC!LI I RED TN!lr,C.F:' '^la;_,
i.vp;icant agrees tp coopq Kith all '.'�e rules and regulations Sewvr
the Unified Sp.wayt Agency The pewit expires 1241 days free
date issued, The tstai awAnt paid Mill be forfeited if the
eit expires. The Agency does not guarantee the accuracy cf the
'e sewer leteralsr If the sewer is tt located at the eeasurelent
en, the installer shall prospect 3 'ret in all directio-s frog
dislince given. If net c locatau', the installer Shall purchase
"Tap and Side Sewer", Perrit and t'f Agency will install a lattral.
'ENTITh Oregon law req At ynv to follow rules adopted by the
Aon Utility Noti`ication vente-. -hose r les are jet fo',th in DAR
'.-881-@81@ through OAR 152-8881 QIP. yn+ sail obtain copies of
se rales ar direct questions - " >. ling (583)26-1387,
1..4_4.1.. F.,..{.•1.}..1. , ..1 r , e J -1 i-i••+.(,.•}.}.,..+.+.++4++4,+#++a f 1..r ,
!It-20001d t Ili:' 'l l: '•!1: t
,r++rr
Plan ;=
r OF TIGARD Residential Building Permit Application Recd By ey -
.,:s SW HALL BLVD. New Construction Additions or Alterations Date Recd
;ARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P E.
ii 3-639-4171 Date to DST
X03-684-7297 Permit 0
Print or Type Called__
Incomplete or illegible applications will not be accepted
Name of Project r— Name
Job
Address Site Address Architect Mailing Address
: l Y S (�J I( to(' City/State Zip Phcne
Name
r
rauk. r p _-- Name
Owner Mailing Address
r
:,ty/slate zip Phone 9 En ineer Mailing Address
r. Y 7L z ti/ G 3`J- S YJnL'
Na e C,tv/state —Zip Phone
general j�AW GrkDescribe work New O Addition J Alteration O Reoair OC = SE
.ontractor Mailing Address to be done
'/-?u : wJ ACK)U T ;. Additional Description of Work:
C,tyostate zip Phone /
C WdY dl) 470/3 d16-3- s `- �: t `) Z
Oregon Const.Cont. Boaid L c 0 Exp. Date _
lttach Copy of 32U 4/!(
Current C T Business Tax or Metro M Exp. Date PF'OJE'T
Licenses ,cit -los-- Vin LUATION
L$
Name _
MechanicalPIEW CONSTRUCTION_ ONLY:
Sub- Mailing Address Sq FL House: Sq. FL Garage
Contractor
C,tYi5tate lip Comer Lot TS�NO Flag Lot YES
Phone NO
(check one) (checi:one)
Oregon Conont. BE_c
oard LiC.M p. Date Restricted
st. CAudio/Stereo r Burglar
trach ropy of Energy System Alarm
Current COT Business Tax or Metro* Exo Date Installation Garage Door HVAC
-,senses
Name ____:� Ooener _ Systems
(check all that Other.
Plumbint, apply)
Sub- Mailing Address Will the electncil subcontractor wire for all YES NO
Contractor restricted energy installations?
cay/state zp !'-Phone Has the Subdivision Plat recorded? NIA YES I NO
Cregon Cinst Cont. Board L,c.At Emco Date Reissue of MST* Solar Compliance
I ctach Copy of ! __ (Calculation Attached)
Currant �P un Ding trc. r Exp Date I hearby acknowledge that l have read this application, that the
iunses I
infcrmation given is correct that I am the owner or authorized
COT Business Tax or Metros Exa Oate agent of the owner, and that plans submitted are in compliance
- --- I ,Name v_-- — with Ore pn State laws.
lectrical wner/Ag 4� Dat
ivy ?��4,
7
Sub- .tailing address Corilkct Person Name one ax
:contractor ,_'" "-le,, •t). C ,ftf e"-r�
C.tyiState Z p I Phone FOR OFFICE USE ONLY:
Plat#: MapffLit
Cregur Const Cont. Boaro L c A I Exp Date _
Mach Cony of SetbacksZone: Solar:
Current E:ec:ncat L.c. F I I Exo Cave
Licenses Engineering Aporoval: I Planning pproval: TIF.
COT Business- s`ax or MetroExo Cate i
FREMCL Oi)C inST) 3i97
MST Permit (BUILD) (UBUILC)i
Plumb Permit (PLUMB) (UPLUMB)
Mech. Permit (MECH) (UMECH)
ESCIELR Permit (ELPRMT) (UELPMT)
State Tax (TAX) (UTAX)
BLDG:
PLUMB
WIF_CH
ELC/ELR:
Plan Check
MS (BUPPLN) (UBUPLN)
Plumb. (PLUMB) (UPLUMB) ^'
Meeh:
(MECF'LN) (UMEPL N)
CDC Review (BUILD) (CDCBLD) ,UCDC)
CDC Review (PLN) (CDCPLN) N/A
Sewer Connon (SWUSA) (USWUSA)
Reimbur. District
It r
Sewer Inspectioh, (SWINSP) (USWINS)
Parks Dev Charge -_I;PKSDC) N/A
Residential TIF (TIF-R) (UTIF-R)
Mass Transit TIF (TIF-MT) (UTIF-M)
Water Quality (WQUAL) 0JWQUAL)
Water Quantity (WQUANT) (UWQANT)
Erosion Control Prmt (ERPRMT) (UERPMT)
Erosion Planck,°USA (ERPLN) (UERPLN)
Erosion PlancklCOT (ERvSN) ,'J'ROSN)
Fre Life Safety (FLS) (UFLS)
TOTALS:
I SFREMDL.COC DST) 6,97
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES rJt-.P1'11TT tt. . , . . . . : PI-M97-0322
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171 DATE ISSUED: 08/07/97
TE. ODDRE'7.11 .1711/x`.: ,;W SUL_I_.
I
Fkl)7,VISIOh1. MLP92-0001 ZONING: R--7
OCK. . . . . . . . . L CT. . . . . . . . . . . . . .00 1 TlJRTSDI17TTnt%:. TIC
Mr.JV J'., I
0 F' f71PCEG� : 0
r=:) Of- WORI% . ; ALT f7APSAGE PTS'IrTIGAL".
Or-' USE. . . . Sr- WASHING MACH. . . . . . : 0 SACf-tF .OW PREVNTRS. . : 0
ORF., . R-� -L --Ir TRW - - - ,— : Q
— . 4'r14 r -OOR DPAlt ). . . . . 0
OR I ES. . . . . . . . . 0 WATER F4rnTERS. . . . . 0 CATCH BASINS- - - 0
X TURES ',J)UNDRY TRAW73. 0 SF RAIN DRAINC'). . . . . 0
0 URTNPLF. . . . . . . . . .. . .. 0 GREASE TRAPS. . . . . . , . el
h) r-TXTUREro". 0
'P/GHOWERS. 0 SEWER LINE (ft' 01Z
1-1f'il-ER C'LOSE.T.9. c 0 W)Tr'R LTNr- (ft % V;
0 RPTN DRAIN (ft ) . . . : 0
FEES
rRAW B r-OWIN t V P -,ifflokilit by tJ,.; Pt
MOUNTAIN RD
1145 S. W. AULL PRMT $ 30. 00 JSD 08/07/97 97--C98070
V40n MP 07224 nr"C"'T I JSD 00-'07/97 97-
mts avirr'TT1173
10x I
31. 50 T07
R 00 10
R r--QU I RE 1)
pF,W. is iss,ied subject to the reiJations cc"ntair"f-, L.'Vwfll lnspec,t iori
,;i-6 Mvl'cipal Cdp, State if Ore. Specialty Codes and a!: Wer '- jtivil Trinpec-'Lim-1
Acable laws. All odrit will be done in accordance with
,ipp,oYtO plans. This pei*lt will iqvp ;;' *9,'4 is Put started
"'in IN oars of issuance, ot, if work is suspended for ave
, IW days, ATW. 10N., Orelon law requires you to follow rules
adopted by the crevon Utility Notification Center. Those rules are
set forth in OAF 7'je WI-XII thvouj� OAF 952-ONI-00. You may
obtain cipies of these rules or direct questior;j to MAC by calling
1#V24F 1987.
ITY OF TIGARD Plumbing Application Racd B1/
3125 SW HALL BLVD. Commercial and Residential oat.Raed
IGARD, OR 97223 oat.to P E.
503) 639-4171 Oats to DSTPefmlfa �k 3�
Print or Type Relate a
Incomplete or illegible applications will not be accepted
Name of Doveiopma vProlect FV(TURE9z0M,Mdual) TSP
Job _ ! sJnt 9.00
Address Street Address scats f La111Ary� 9•00
- Tub or TublShower Comb, --970-0-
Bldg 0 Gly/$lata Zip Shower Only 9.00
Water Closet 906
F
Name
F'� a�1�� ✓4 Obwnwasher 9.00
Owner Mading AOdtt n suft G"t""Disposal 9.00
/w S SL-, /3v(/►titltti W4M*V Macherte 9.00
Ctfylstato Zip Ph* , Floe Drain 2" 9.00
3"
9.00
_ 1' 9.00
Occupant Ma'ling Addre" Sudo Water Heater '-� 9.00
LJtrnlry Room Tray 9.00
CltylSlate Zip Phone urinal
9.00
Name Odd Fixtures(Specify) 9.00
('QIF► r GXrr4 /AT-1wJ9.00
Contractor m4*v baa Suite 9.00
V-,?u s• ud 4tA)or -
(Prim to issuance Gry/5tal• Zip Phone 9.00t
applicant must C& f3 Y O k Y7613 e4,3 l'�- 9.00
provide ad Oregon ConsL Cont.Board Lica F-xp.Date --
cor+tractors o -7-V G 9.00
license Plumbing Lir.• Exp.Date Sewer- ist 10(r
_ 30.00
information Salmi-each addMonal 100' 25.00
ter COT COT Business Tax or AAetro s Exp.Date 1st 1�
database). < J r Tot u �+ _ - 30.00
Name Water Service-roach addttfonal 200' 25.00
Architect Storm 6 Ran Drain•est 100' 3000
or Wilting Address Suft Sloan&Rain Dram-each addkWW tar 25.00
mood"Home Spam ---- 25.00 _
Engineer Qty's tats - Lip Phone- Conxrteraal Bade flow Preventim Devwa or Anti- 25.00
Pofk0on Device
Descnbe wort New O Addition O Alteration O Repair O Residential Batlrtnw Prevention Device' --� 15.00 -
'o br done: Residential O Wei-rasrdential O - Any Trap or Waste Not Connected to a Fixture 900
Adde.,onat desrnpfx n of work
/`!{t)vKJP setN•c Co.14/ 7t) (' Catch Ba
i,�- sin 9.00
/ Insp.of E=WV Plumb" 10.00
C'un.t,l kj U vt it[ wt, N"'Us' per/hr -
rshng f - --- Spectaity Requested Inspections 10.00
'Iding or ply perov -
--- Ram Drain•single family dwelling 30.00
;Dosed use of Greasy Traps �--- 9.00 -
.utdrnq or prop".
QUANTITY TOTAL {-yam +}
Os you Capp". movtrtg or rap"any ftxtures7 Yes p No 5? aa�+atr
. lc a nasi digw b in i.ravurretl f ouaney Total >9 t$ yam:-,�,
If yes see back of form) __ ---- -� 'SUBTOTAL •,.
_
lereby acknowledge that I have read etas application,that the intormatwn -- 5X Sl1RCHARGE C�
vct,that I am the owner or authorized agent of flat owner,and
rat planes ed ire in compliance wdh Qregon State Laws.0
ynatun of t. pate PLAN REVIEW 25%OF SUBTOTAL
tw ,
rJ� Rauyd a"R ra n Cry.t"if>_9_-___ -
rCyY; .L- GJi�i�/ TOTAL
mts lean Name P ne _
/ Minimum permit fee is S25- 5%surcharge except Residential 8acfrtlow
r�>k4v�K ��l rYICN
.2%j-3. 36-L 7 Ptevenoai Device.which is S15• 5%surcharge
l:\plmapp.doc 12/96 (dst)
'LEASE CQMP_LETF_AS APPROPRIATE ZO 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)
,OMMENTS REGARDING ABOVE:
i"plmapp.doc 12.196 (dst)
�ju—) CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Lhic: 6394175 Bushiess Phone: 639-4171
Date Requested: D / /1 ��
eq A.M. _ P.M. MST:
LL]�ocation: i BUR
Tenant: Suite: Bldg: h EC:
Contractor:_ _Phone: -U—a A �__ zrg _G) G
Owner — Phone: ELC:
ELR:
SIT:
BUILDING BLDG(con't) LUMBIN MECHANICAL ELECTRICAL SITE
Site Post/Beam Pos eam Post/Beam Cover/Service Sewer/Storm
Fooling Roof UndFl/Slab Rough-In Ceiling Water L:ue
Slab Framing To (hit Gas Line :tough-In UO Sprinkler
Foundation Insulation ewe.> Homl/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C 110 Slab <--
Shear/Sheath Fire Spklr/Alm Crawl.'Found Dr I teat Pump Low Volt JtAppr�ovccd
Approved A Prov- Approved Approved
Appr/Sdwlk Not Approved vu roved Not Approved Not Approved
FINAL TINAL FINAL FINAL
rl Call for rein 0 in ion fire of _required betlre next insf�ection O linable to inspect
hispector Page of_