10905 SW TIGARD STREET-1 n
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ADDRESS:
1
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CITV OF TI GARD BUILDING INSPECTION DIVISION
24-1-lour Inspection Lina 6394175 Buziness,Phhonc: 6394171
Date Requested: tJ _ / /� A.M. f/ _ P.M. MST:
Location: J�'���'-� �( t� �A aA St- _ BUP:--
Tenant: —__ Suite: Bldg: MEC:
Contractor: I IZLA1 A, Phone: ['Q o� R ZPLM:9 7-OL1.1a
Owner: — — Phone: ELC: _
ELR: p -7_
BUILDING BLDG(con't) PLUMBING. MECHANICAL EUXTRICAL iiTE
Site Post/Beam Post/Beam Post/I3c un Covei'Service Sewer/Storm
Footing Roof UndFl/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Lias Line Rough-Li UO Sprinkler
Foundation Insulation r,weeerI lluod/Dut.t Rcconnext Vault
Rsmt Damp Drywall Storm Furnace Temp`service MISC.
Masonry Ceiling Rain Drain A/C UG SLib
Shear/Sheath Fire Spklr/Alm Crawl/Found Ir Heat Pump Low Volt
Approvedp�r itpproved Approved Approved
Appr/Sdwlk Not Approved of A= roved _ Not Approved Not Approved Not Approved
FINAL INAZ` FINAL FINAL FINAL
L
0 Call for rains tion 13 Reinspection fee of S required before i„ext inspection C3 Unehle to inspect
of
Inspector: --—_-- Dater Page-.�— ��-
CITY CF TIGARD
� DEVELOPMENT SERVICES SEWF^ CONNECTION
13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171F'E RM I T
1DE RM I T #. . . . . . . : SWR97-025 7
DATE ISSUED: 07/01/97
PARCEL-: 1 S 134DD--00800
SITE ADDRESS. . . : 10905 SW TIGARD S1"
`SUBDIVISION. . . . : ZONING: R--4.
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . . JURISDICTION: TIG
TENANT NAME. . . . . :EVANS
i_.1SA NO. . . . . . . . . . . FIXTURE UNITS. . . . 0
(:I__ASS OF WORM. . . :ALT DWEL-L I NG UN I TS. . : 1.
1 YF'E OF USE. . . . . :SF NO. OF BUILDINGS: 1.
INSTALL TYPE:. . . . :LTPSWR I MF'ERV SURFACE: 0 s f
Remarks : Sewer connection for- r-esidence. RE: F'1—M97-0;�:32
(3wr,er: -- - -- — - _--.-------_______.__..._.._--.--._..__._____.____________-____._ FEES - - — ------ ---
ROBE:RT EVANS type amol.knt by date recpt
1.0905 SW TIGARD ST (-'RMT $ 2200. 00 JSD 07/01/97 97--29663C,
TIGARD OR 97223 TNSP, $ 35. 00 JSD 07/01 /97 97-296636
f'h o n e #: 624-••8597
Contractor:
OWNER
Phone #: $ 7'_`;3`.=. 00 TOTAL.
Rey i(. . .
-------- REQUIRED I NSPECT I ONS
This Applicant ag-ees to comply with all the rales end regulations Fewer Inspec..:tion
of the Unified Sewage Agencl, The permit expires 180 days from
the date issued. The total ,.mount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect ? feet in all directions from
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" Permit and the Agency will install a lateral.
ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in DAH
952-9014010 through OAP 952-0001-0888. You may obtain copies of
these rule,.: or direct questions to OUNC by calling 15831246-1,987,
i � J
I s1_iefi by : F'ermi.ttee 5i )nature✓ s
++++++++++++++++++++++++++++++4-+++++++++++++i++4++++++++.++++++++++++ F+++;++++++
Ca). 1 639-4175 by 6:00 p. M. for an i nspect ion needed the next bi.rs i ne.:;r, d.ay
+.+•+++++-f+++++++++++++++++++++++.+++++++++++++++++++++++++t++++++++++; f+++-4...+++++
Plan C7eck e_
' OF TIGARD Residential Building Permit Application Recd By
5 SW HALI BLV ,. New Cunstruction Additions or Alterations Date Recd
'.ARD. OR 97223 Single Family Detached or Attached (Duplex) Date ro P E.
iO3-639-4171 Date to DS"i r.
iO3-684-7297 Permit r
Print or Type Called
_ incomplete or illegible applications will not be accepted
.lob
Name of Project Name
'�
Address Site Address -- Architect Mailing A.ldress
776th : 7 city/state Zip Phone
Name,/-- _
T-�(' �cr�1 C V Name
Owner. Mallin , ress
/ 7/t, k,�j ,���� > 7 En meer Mailing Address
C01549W Zip-171 Z3 Phone CC 9
��d��� City/State Zip Phone
Name
General Describe work New O Addition O Alteration O Repair O
Contractor Mailing Address to be done.
Addibonal Description of Work:
cay/state Zip Phone /
Oregon Const.Cont, Board LIc.0 Exp Date
Attach Copy of _
Current COT Business Tax or Metro for Exp. Date PROJECT
Licenses VALUATION
-ehanieal
Namia NEW CONSTRUCTION ONLY:
---- ---
Sub- Mailing Address - � Sq. Ft. House: Sq. Ft. Garage
Contractor Comer Lot YES NO Flag Lot YES NO
C,ty/State Zip Phone
(check one) _ (check one)
Oregon Const.Cont. Board L,c,O Exp Date Restricted Audio/Stereo Burglar
Attach Copy of Energy System _ Alarm_
Current COT Business Tax or Metro M Exp Date Installation Garage Door HVAC
censer _ Opener Systems
Name (crthat eck all Other.
Plurnbing � -�- - -
Sub- Mailing Address Will the a ectnc:al subcontractor wire for all Y-_S NO
:ontractor restricted energy Installations)
City/State Zip Phone
l-'as the Subdivision Plat recorded? TN/A YES NO
Cregon Const.Cont. Board L.c# I Exp. Oa,e �elssue of MST solar Compliance
Attach Copy of
_ __ (Calculation Attached) _
Current Plumping Lc s Exp. Date I hr!aiay acknowledge that I have read this application, that the _
Licenses _ information given is correct. that I am the oamer or authorized
COT Business Tax or Meire 1 i Exp agent I agent of the owner. and that plans submitted are ,n compliance
Name — — with cn Slate taws.
rS, n wre oi,:C r Date
Electrical
Sub- 'tailing address oat.fr.S Person Name Phone N
Contractor I .. L-
C,ry,State _ zip Phone I.OR OFFICE USE ONLY:
Plat 1: Map/TLrt"
Cregon Ccnst Cant Board L c 0 Exp Date I _ "—�__ _
Attach rent of _ Setbacks: I Zone —� Solar
Current E:ec:ncai L.c # I Exp Date -- _
Licensee _ _ Frgineenng Aporoval: P!anning -pproval: TIF.
CCT Business'aY ,r Metros t.p Date j
-REMDLOOC (DST) 3)97
MST Permit (BUILD) (USUtLD)
r
PIumD Permit (PLUMB) (UPLUMB)
Mech. Permit (MECH) (UMECH) —.
ELC/ELR Permit (ELPRMT) (UELPMT)
State Tax (TAX) (UTAX)
BLDG.
PLUMB:
MECH: ~
ELC/ELR:
Plan Check
MST. (BI.JPPLN) (UBUPLN)
Plumb: (PLUMB) (UPLUMB)
Mech.
(MECPLN) (UMEPLN) _
1
Review (BUILD) (CDCBLD) (UCDC)
OP
CDC fleview,(PLN) (CDCPLN) N/A _
Sewer Connon (SWUSA) (USWUSA)
Reimhur. District ( ) ( )
Sewer Inspection (SWINSP) (USWINS)
Parks Oev Charge (PKSDC) N/A --
Residential TIF (TIF-R) (UTIF-R)
Mass'Transit TIF (TIF-MT) (UTIF-M)
Water Quality (WQUAL) (UWQUAL) _–
Water Quantity (WQUANT) (UWQANT)
Erosion Control Prmt (ERPRMT) (UERPMT)
Erosion Planck/USA (ERPLN) (UERPLN)
Erosion Planck/COT (EROSN) (UEROSN) `� J
Fire Life Safety (FLS) (UFLS)
TOTALS: _
I SFREMDL DCC (DST) 6r97
�1111[w�m JEJF�
CITY OF TIGARD
DEVELOPMENT SEHi!ICES PLUMBING PERMIT
PERMIT #. . . . . . . : PLM9-/-023J.,
13125 SW Hd1l Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 06/19/97
PARCEL.: IS134nD-`A0800
S IT[,' ADDRESS, 10905 SM T I GARD
SUBD I V 15 1 01\1. . . . : ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . JURISDICTION: TIG
CLASS (IF WORK. . :AL.T GARBAGE DISPOSALS. 0 MOB IL.E HOME SPACES. : 0
TYPE OF' USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . .. 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . 0
LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . : 0 GREASE TRAPS. . . . . . . . 0
L-AVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUE/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 1.00
WATER CLOSETS. : 0 WATER LINE. (ft ) _ . : 0
1)1 SHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remavks : L-ay sewer line only. Mo-tst obtain sewev• connection pet-mi.t to conneel,
1,(; idence to line.
Owner-•; ------------------------------------------------------ FEES
ROBERT EMNS type amot-trit by da t e r-ecpt
10905 SW TIGARD ST FIRMT $ 30. 00 ,TSD 06/19/9'7 97-2'96206
TIGARD OR 97223 5PCT $ 1 . 50 JSD 06/19/97 97-296206
Phatip #: 624-8597
OWNER
Phone #: $ 31. 50 TOTAL
Reg
REGILIJRED INSPECTIONS
rhis permit is issued sub,lect to the regulations contained i^ the Sewer- Inspection
Tigard Municipal rode, State of Ore. Specialty 1.'o6es and all other Final Inspection
applicable laws. All worN will be done in accordance with
approved plans. This permit will expire if work is not sta6�,d
within 180 days of issuance, or if work is susp,!nded for more
than 180 d,iys. ATTENT19N: Oregon law requires you to follow rules
adopted b) the Oregon litility Notification Center. Those rules are
set forth in PAR 952-03011-8010 thrnugh OAR You may
obtain ccries of these pules or direct questions to RX by calling
(503)246-1987.
5
+4+_-r4++#-++_.++++4-(�........F4......................1-+++++++-r+-',++++++-I............F++4
Call 6:?9- 4 175 by 6:00 p. m. for an inspection needed the next b�is iness day
t-+.++++r++++++•1-++++............1-4.++-+-1..........#-+++4-+++-#.......f......4..........+++++++
I�
�'lumbin A lication Recd By__�__���
CITY OF TIGARD y PP Date Recd
13125 SW HALL BLVD. Commercial and Residential Date tc 'F
TIGARD, OR 97223 Date to DST_
(503) 639-4171 Permit 0�t f �-
y4a b tN L �r�PQ,��y _ Np op Print or Type Related SWR 1— s
I tM Incomplete or illegible applications w;ll not be accepted Called
(A)IM t f'"A �� IV pp
FIXTURES (Individual) QTY I PRICE AMT 1
Name of DevelopmentlProlect g 00
Sink _
JobLavatory 9.00
Address Street AAddress sU1fe— - 9 00
Tut)or TublShower Comb. _
9.00
Bldg'! 1 C�i tate Zip -- Shower Only —
//fifi> �)7LZ-� water Closet 9.00
-- Name ? r Dishwasher i-- — 900 —
�M r i s -e Disposal 900
Mailing Address Suite 9.00
Owner _ Machine
Ch,Stale Zip Phone (,,�� FF10- ..rain 2' _ 9.00
Z Z 6) r 3' 9.00
— Name 4• 9.00
!�.SME Water Heater 9.00
Suite
Occupant Mailing Address — 9.00
Laundry Room Tray
CitylState —Zip Phone Unnal 9'00
Other Fixtures(Specify) 9.00
9.00
JC --_� --- — 9.00
Contractor Mailing Address Sud, —_— — -- 900
Gty/State Zip Phone — — 9 00 ,-
__ 9 00
Oregon Const.Cont.Board L.,0 Exp.Date -- —
9.00
Attach Copy of — — —
Current Plu,nbtng Lic. Exp.Date Sewer-1st 100' —. -- f 30.00
Licenses ___ Sewer-each additional 100' 25,0
0
COT Business Tax or Metro X Exp. Date Water Seance-1st 100' 3000
------ Water Service-each additional 200' 25.00
Name — — 30.00
Storm 3 Rain Dram- tat 100'
Architect - Storm&Pain Drain-each additional 100 2500
Mailing Address Suite -- 2500
or Mobile Home Space _
rylState Zip Phone! Commercial Beck Flow Prevention Device or Anti- 25.00
Engineer Pocubr ri Device --
Resid ,ilial Backflow Prevention Devtae' 15 UO
Describe work New O Adddton O Alteration O Rep3tr O _
to be done. Residential O Non-residential O Any ip or Waste Not Connected to a Fixtwe 900
Additional desrnption of work Ca' n Basin
Insp of Existing Plumi inC 4000
per/hr
— _ Specially Fequested Inspections
4000
-- --- petfhr
Existing use of! 3000
budding or property_--_ --- Rain Drain,single family dwelling —
Gtease Traps --V-Lu
Proposed use of _
budding or property--__---__-__ ----- — QUANTITY TOTAL
Isometric or riser diagram is required A Quanity Total is >9
Are you capping , moving cr replacing any fixWres? Yes❑ No O -- -- --_- 'SUBTOTAL
(H yos see back of form) _ __ _
I hereby acknowledge that I have read this applicatirn.that the information --- 5% SURCHARGE
givens correct.that I am the owner or authonzed agent of the owner.and J
tha s ub tied are in ace with Oregon State Laws. PLAN REVIEW 25%OF SUBTOTAL
gna a Of nail nt Date Rertuired only d nxture MYtotal.s>9
- � •(a') TOTAL
r � 6LIf 1G-�J
onto Person Name Phone •Minimum permit fea s S25-5%sur,urge except Residential Backflow
Prevention Device,which is$15�5%surcharge
t _ i 1rlydstplmapp doc 8196
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PLEASE COMPLETE AS APPROP ATE T -PROJE
` Fixtures to be capped, moven or replaced Qty
Sink — --- — —
Lavatory
Tub or Tub/Shower C_c_ -nbir:ationi
Shower Only__
Water Closet
Dishwasher _
Garbage Disposal
__—�_
Washing_Machine
_ —
Floor Drain 2"
4'r
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify) p �^
COMMENTS REGARDING ABOVE: