16485 SW KING CHARLES AVENUE 1
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1648 SW King Charles Avenue
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LIT`( OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 63, 175 Business Line- 639-4 MST
BUP
Date Requested �`G —AMPM BU
LD
Location -,etc, /
—.7 -,- Sui,e MEC _
Contact Person 7� ] _ Ph ,3 j�" ,�' ; � PLM
Cintractor Ph _ SWR
EIUIL DING "l enar,t/Owner ( yG' -7 l — ELC
F'eteining Wall ! -2 cti� ELR
FoOng _
Foundation Cess: FPS
Ftg Driin - - - - —
Crawl Drain Insl)ection Notes SGN —
Slab SIT
Post&Beam
Ext Sheath/zinear
In'Sheath/Shear --
Fraining
Insula on --
Drywad Nailing
Firewall ----
Fire sprinkler
Fire Alarm -
Susp'd Ceilirg
Roof
Final -
c�
PAS Ari" FAIL -- _
MBING _c
POSTF.Mani
Unkere-ry
--"ah
y ace
Sanitary Sev er 7�- -
Rain Drains
Fi -- --
(15
ASS ZP FAIL '
METHAMeAl
Post& Ream --- _
Rough In -
Gas Line
Smoke Dampers
rinal
PASS PART FAIL
e
ELECTRICAL -- -
Service
Rough In -
UG/Slah
Low Voltage _—
IF;re Alarm
F;nal
I PASS PART. FAIL
SITE
Backfill/Grading ------ ---- _
Sanitary Sewer
Storm Drain [ ] Reinspection fee of$ _required before next in pection Pay at City Hall, 13125 SW Hal!Blvd
Catch Basin
Fire Supply Line t Please call for reinspection RE [ ]Unable to insrect- no a.cess
ADA
Approach/Sidewsiic
Other I Date _ Inspector 'Xt
Final --- � -
I PARS PART FAIL DO 40T REMOVE this inspection re rd from the job site.
09/26/2001 07:53 15032973361 THE _�COTTS PAGE 01
•i• s u 411 15.48 FAY 6 0 1 E ti Y 19 tS 0 �~------� _
CITY CF TICARD
EVEYy Q�= T
7312.3 SW HQ'`'M1ft �IGARID �Op?
ID S:
131va. Tlgar S�RVI�C�S --� PLUM
sUB41Vl�i►ON; 16485 S,W KING CHq , OR 97 (503 83 EP RMI*.F,~'6R"14IT
�3 _
BLOCK; RLCB,4VF ) 9d1j1 DATE 1 Lh12001-Dp4
S3US ,: 9•,21/01 40
CL ....,_ SOT;
pA�:CEL: 251 1'S88-U7500
TYPE OF WO LOT,
ALT '�---_ __ Ya��vING:
OCCUPANCY USE: Sr G4.% A(3E 8!9805 JURI,9r71Cn
GIdP: R3 WASHING!ry►gVH. _"�-OIY: KIN
s oRIEs: ,Cool,DRAINS'. ^'IOell_E Ho�AE SPq��'`
F
URES BACKFI OW PREVMTRS
ES WATER H�EAT6RS:
LAUNDRYTR
'MAPS:
LAVATORIES: a rs: CATCH B
TU6 OTHER FIXTURES: SF IMN/SHOWERS; 1 ,sc�syAlS: ASIIVfiDRAINS.:
4t3
WATER CLClTS; SEWER LINE: !t GREASE TRAPS:
D1511WASHERS; WATER LINE:
!t
Remarkts: Rurnvve balhtub anrt replecslt W10 f1berrRAI DRAIor N:ft
Owner;.____--- ,----.—_.� .�,.__ —� FEE g .___ • .�
HFI FN DALYT'yp,a 159 _ Date Am!$12
unt RocQlpt
16485 SW KING CHARLES AVL PRM1" pLH 9/21!01'" 50 KIP IO IT
CY
,SING CITY. OR 97224 15PCT m H i 9121101 $5.80 KIN3 GI I
Total $79.30
Phore 1 603-620.0407 — — ----
Cont. tctQr,
Kc,'y 1HE PLUMMIER
92..U SW JNUIEb CJN RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Rough-it, Innp _
Phone V 503-297-3381 Finml Inapm inn
Reg 9: t IC 134078
PLM zA 14'PH
�.e,,,.,i►'� ieSIIP0 StJhled to the regulations contained in the Tigard Municipal Gude, State of OR
Specialty Codes and eL other applic:aDle laws. P!!work'klll be dune in acrordanoe with -tplsruved plana.
this porrnil wlll eypire 0 work is not MartAd % nIn 1 W) days of issuance, or d work I', suspended fear more
tt,sn 180 d;ys. ATTENTION. Oregon IgA, rfgUires you to follow rules adopted by Stir: Oregon U tllity
Natificat10rt Center Those rules 9re set 'urth In OAR 9"12-0001-0010 through OAR 952 9 01-UCl8f1.
You may obtain Copie3 of these rules or direct questlons to OUNC by calling (503)V*
Fecmlttee 8lynstury:
I os6 day
leeued By. -.- —
Cell(503)G]9-417'3 by 7'00 P.M.for an Inspection needed the next lr4:;t^
Plumbing P::rmit Appl�ation
City if Tigard �-4-11223,--)
��/ Datereceived: 5►/�►d� � � Permit m _
Sewer permit no.: Building permit no.:
,ddress: 13125 SW Hall Blvd,'T'igard, -
Ci y u(Tir ur`I Phone: (503) 639-4171 Projecl/appl.no.: F,pire date:
Fax: (503) 598-1960 Date issued: — liy Receipt no.:
Land use approval: Case file no.: Payment type:
U 1 k 2 family dwelling or accessory U Cminnercial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U Food service U Other-:
3011 wet t\►. tIMATI )
Joh address: 11V/G L+�-S' Description "y.I Fee(ca.) 'Total
Bldg. no.: Suite no.: _ New I-and 2-family dwellings only:
Tax map/tax lot account no.: - --- (includes 100 I'll,for each utility connection)
SFR(1)hath
Lot: —Block: - Subdivision: ---- SFR(2)bath - - — -
Project name: i _ SFR(3)bath
City/coun+v: LIP: Each additional bath/kitchen —
Desciil, i` id location of work on premises: Ef 41 CE 7-�/ Sileutllities:
W E12. 7--- basitlarea drain
Estdate of completion/inspection: Drywells/leach line/trench drain
inintivining Footing drain(no. lin. ft.) -
Business name:
Manufactured home utilities
/S�jt/ 7�f�- �% �- Manholes
Address: �/O GCl7/�SDn/ Rain drain connector
City: 1:3&e v6-IL7'0n State:d/Z ZIP: _ '70qnlg Sanitary sewer(no.lin.
Phonc_�9�J- ?M1 -'ax: E-mail: Storm sewer(no.lin.it.) _- —
CCB no.: IJY6 7 1Plumb.bus. reg.no: ,79 -3 y�–�_ Water service(no,lin. ft.)-
City/metro lic.no.: Fixture or Item:
Absorption valve
Contractor's representative signature: pn/ /° /1ili T" Back flow preventer
Print name: J Date' Backwater valvCONTACT PERSON e _
Basins/lavatory_
Name: r�/,���- � 12
(� Clothes washer
_Address: _- Dishwasher
Drinking fountain(s) — ----
City: State: LIP: —
— - -�----- Fjcctors/sump
I'honc j -gym F'ax:�S6 'O F: mail Expansion tank -
Fixture/sewer cap
Name(print): j�6 LEN _6 Floor drains% -sinksA-ub_ ----- - --`-
Mailing addre.,s7 yrPS .5u) /�1n/C 16�r - Hose ---
Garbage dispo,at--—
City: I<M1 T Vit,T __ State• �� /IP;-- Hose bihb _ -
_ ---�d�--1_-_�?�2 � Ice:naker
Phone: -Q`/v Fax �E-mail: later- _;t;reasc trap — --
(honer installation/residential maintenance only: The actual installation Pr;iner(s)
will be made by axe or toe maintenance and repair made by my regular Roof drain(commercial) _
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s) - -�
Owner's signature: Date: Sum --
Tuhs/showcn,i,:,wvr flan
Urinal
- Water closet
Address: Water heater —`
city: State: 7_IP: Other:
Phone: Fax: E-mail: Tow
Not all jurisdictitats wetpt credit cards,please call juri!diciion roe room information.oo, Notice:]his penttll application Minimum fee................$
U Vjaa U Wster"and Plan revie -(at — %) $
expires if a prrnlil is not ohtaint'd -- —
Ordit card number _ — _-_-- 1 _�-_ State�urchar a(8�7
tispircs within I Ittl days nllcr it has leen 8 ) ••••$ —,��'O -
_--- — ecce ted ns complete. TOTAL .......................$ ��• SZ-
Nome of cardholder as drown on credit card P P
S
Cardholder_ signature '--_ —� — •.mourn 4M)46t6(6rtN)JCOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES Sindividurl�— QTY as AMOUNT (Includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the inrst100 fl. QTY (ea) AMOUNT
Lavatory - 16.60 �- for arch r.ltllity connection_ _
-
Tub or Tub/Shower Comb 16.60 One(1) $249.20
bath --` '-- -�-"--
Two(2)bath $350.00
-------- - -----
Shower Only 16.60 Three(3)bath $399.00
Water Closet 16.60 - _----_ _ -- -� -
SUBTOTAL _
Urinal - 16.60 - — 8%STATE SURCHARGE
Dishwa Ther 16.60 v PLAN REVIEW 25%OF SUBTOTAL
Garbag,a Disposal 1660 __ -__,TOTAL
(1ry1rny� — 16.60 -
g Machine 16.60
Fr. ain/Floor Sink 2' 16.60
3" 16.60 PLEASE COMPLETE:
4"
1660 -
Water Heater O conversion O like kind 16,60 -- Quantit b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removedf
permit.
MrG Homo New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46,40 Lavatory
T ')or Tub/Shower
Hose Bibs 1660 Combination
Roof Drains 16�-0 - Shower Ong_-
Drinking Fountain 16.60 Water Closet - --
Other Fixtures(Specify) - 16.60 - Urinal
-- --_— _ Dishwasher
'- -- --- —
Garbage Disposal_ ---
t-aundryRooln Trate
---�--- - �- Washing Machine
Sewer-is1 1100'_- 55.00 Floor--"Drain/Sink: 2"
T__ -- -
Sewer-each additional 100' 3.40 4^
Water Service-1st 100' 55 00 - Water Heater_
Water Service-each additional 200' 46.40 -- Other Fixtures
Storm&Rain Drain-1st 100' - 55.00 S ecifyL-
--- --"—
Storm&Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 4640
Residential Backflow Prevention Device' 2755 -- -- --
Cat, Basin 16.60 -- -
Inspection of Existing Plumbing or Specially 72.53- -
Requested Inspectionsep-rRr _ COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 _
Grease Traps 16.60 _-
�_, QUANTITY TOTAL —
Isometric or riser diagram Is required If
quantity Total Is >9
"SUBTOTAL -- --- --
8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Required only If fixture qly total is>9
TOTAL _ $
"Minimum permit fee is$72 50+6%state surcharge,except Residential Backflow
Prevention Device,which Is$36 25•8%state surcharge
"All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts\forms\plm-fees.doc 08/29/01
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