12066 SW KING ARTHUR STREET 1
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"22066 SW KING ARTHUR DRIVE -
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Busiress Line: 639-4171 MST _
BUD
—_ Date RequestedAM� PM BLD
Location_ J_.� O (� r
' Su`- LL
MEC
Contact Person Nh
PLM
Contractor Ph _ SWR _
BUILDING Tenant/Owner ELC
Retaining Wall - `
Footing ELR
Foundation Access: y� n� --- --- —
Fig Drain I �Q�� �1 Ci� �����t:_,J FPS _ ----
Crawl Dra t — SGN _
Slab Not Iteque4ted
, Bea
Be,-,m
Found During Research
F_.,,She2ihlShear -
int:'heath/Shear No Intinection/sl In File
Fr?rung
Insulacon
Drywall Nailing
Firewa i - -_--------- -- -- ------- - — ---- ----
Fire Sr rinkler
Fire alarm ---- , -- -—- -—
Susp'd Ceiling
Roof t --
Misc _ -------
Final - — - - -- -- -
P/.:S PART FAIL _
PLUMBING — - - --
Port&Bedm
Un6ir SIGb
Top L it -
Water-:,,vice
S;nitary Sewer _
F • n Drains
IF*if- -
ASS PART FAIL--
Post 1 Beam --- -- - --- ---
Rougl In - --
Gas Liie
Smoke hampers ------ �-
Final --- ---- -- _ _
PASS PART FAIL
ELECTRICAL --------
Service - - --------------
--- -- -
Rough In - - - -
UG/Siab
Low Voltage
Fire Alarm
Final -- -- -- - --
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer - _-------- -._------------
Storm Drain I J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin - ---
Fire'L-r"y Line J Please call for reinspection RI _ [ J Unable to inspec', -no access
AJA
kpproach/Sidewalk / -
Other _ Date J Inspector 2 – Ext`'
Final -—
PASS PART FAIL DO NGT REMOVE this Inspection record from the job site.
CITY CF TIGARD
DEVELOPMENT SERVICES
13125 SW Wall Blvd.,Tla:rd,OR 971223 (503)639.4171
CITY OFTIGARD Plumbing Applicaticn Rec'dBy _ __
13125 SW HALL BLVD. Commercial and Residential Cate Recd
TIGARD, OR 9722:1 Date to P E _
D/�
(503) 639-417 Date to ST
Permit�y ��-E=-
Print or Type P.elated SVR#
Incomplete or illegible applications will not be accepted Called_— _
Name of f-2-,eicpment'Prolect — FIXTURES (Individual) _�- QTY PRICE AM-
Job Sine _ I 9.00
Address
Street Accress Suite Lavatory, 9.00
i"t< K I� kar Tuo or Tubr�hcwer Como — I 9 Go T
eldg Cdy/State_ Zip _ Shower Cr,iy -^'
/ � 9*OL
L Z � ja1er C;oset4:g X3Name t + ,c `-'n ' 1 F • l Clsnwater — �i 9._i k �N
Owner Garbage Disposal L I 9.00 1
f+lalun— guess�' Sulte,�
(, -t t�1 j C-l�� I �� Washing Yachine 9,00
C,tyrState Zip Phone F oor Cram
900
Marne
aI 9.00
Occupant Mailing Accress I Suite "/alerHeater — 900 =
_3unory R;cm Tray 90 0
City/State Zip Phone I Unnai 900
Name -� - Other Fixtures(Spec;fy) —+ 900 I�--
\ ~ I 6700
Contractor fvtadir,g Acc,-ss I Suite 9.00
2 c / �L�(f a���lll -- --- 9.00
—
CityiState Zip /Ph ne
•i• �� a XE L UJ4 ,c,Z`�i 9.00 -L
Oregon Cor, t.Cont.Board L c x Exp. Date I 9.00
Attach Copy of �' '7(-} 9.00
-- �—
Current Plumbing Uc.d Exp.[`ate — Sewer- 1st 100' g.00
Licenses L Sewer-each additional 100' 30.00
-- COT Business Tax or Metro i Exp Date Nater Service- 1st 100' — 25.00
Name later Sernce -each additional 2C0 30.00
Architect Storm&Pain Drair 1st 1C0' 25.00
or Mailing Accress Suite Storm d Pain Dsin-each additional 100 30.00 1
Mobile Home Space 25.00
Engineer City/State Zip Phone — Commercial Back Ficw Prevention Device or Anti- 25.00
Pollution Cevice
Cescnbe work New O Addition O Alteration 0 Repair O L.Pesidential Backflow Prevention Cevice' I 15.00 I to be done Pesidentlal 0 Non-residential O I Ar.y Trap or waste Not Connected to a Fixture 1 900 !
Additional cescnption of work atch Basin I 900
Insp.of Existing Plumbing 40.00
per hr
Existing use of Scecially Requested!nspections 4000
per hr _
building or prcperty Rain Drain,single famuy dwelling 30.00
Proposed use of Grease Traps 4 9.00
budding or property
QUANTITY TOTAL I ��
Are you caccing Orly fixtures? Yes❑ No Isometric or neer diagram is reau,red if:uanity To!ai s !9 _
1 hereby acknowledge that I have read this application,that the information 'SUBTOTAL _
given is correct,that I am the owner or authorized agent of the owner,and
that plan tlbmitted are in compliance with Oregon State Laws. 540 SURCHARGE 7
Sign cf Qwn A Cate
r �� 1?_ _c� PLAN REVIEW ?5V. of 5U8TOTAL
41 � "IL.VV / 'ecuved only 1 fixture^.N !otai s>9
ontact Pencn NName Phone — TOTAL
I
w e- I -r y (j�t'��T I 'Minimum permit fee is S25- 3%surcharge.except P. �flcw
I'dsts'plmapo.CC 2,!F ---- — F•evenncri Device which is S15+5%surcharge
RECEIVED
APP 14 1931
COMMUn11r ULWLLUP►rILn1