8120 SW THORN STREET ADDRESS:
is rds\mirrollm\targets\huilding.doc
CITY OF TIGARD BUS' DING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phon 3. 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Coiling Plu
Post/Beam Mach, Shear/Sheath Framing -Mach.
Plbg.Und/Fir/Slab Pibg.lop Out Insulation -Elect.
Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line 'Appr/Sdwlk Reins.
Other:
Data: _ _ A.M. --P.M. Entry:
Address: -2L--L ---
Tenant: _— __—_—. Ste:_— MST:
BUP:
/ MEC:
Con/Own:. —� ------ PLM _
ELC:
THE FOLLOWING FOLLOWING CORRECTiONS ARE REQUIRED: ELR:
Inspectors - --
-APPROVED _ DISAPPROVED/CALL FOR A5INSP, CF CO
A CITY CSF T°IGARD
DEVELOPMENT SERVICES PLUMBING PERMI'I*
PERM I'T #. . . . . . . : PLM96-03831
13,25 SW Hall Blvd., Tigard,OR 97223 (503)639-4171
DATE ISSUED: 12/2'3/96
PARCEL.: 1S136CB-00226
1-4 1)1)R L:,
081 4!i SW 'THOR I ST
SUBDI VISTON. . . . SHANNONDOW ZONING: R-4. 5
I
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :25
CLASS OF WORK. . : Rr-r-" (3nRBA(3E DISPOSALS. MOBILE HOME SIDACES. - 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . .. 0
STORIES. . . . . . . . : 0 WATER HEA1"ERS. . . . . : 0 CATCH BASING;. . . . . . „ : 0
F I X TIJ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRq. INS. . . . . : 0
SINKS. . . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . . : 0 OTHER FIXTURES. . . . : 0
TUR/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS..: IP WAITER LINE (i:t ) - - - - 11,10
PfSHWASHERS. . . . 0 RAIN DRAIN (ft) . . . a
[Renjar-l-(s : Install ing water- service
Owner:— FEES
LINDA 5CHULTZ type amount by data t-ecpt
19105 NE HWY 240 r-"RMT $ R 1.2/23/96 9F.-288073
5PCT $ 1. 50 P 12/23/96 96-288073
NEWBE-RG OR 971.32
Phone #i 537--2917
Cont t-a(-t0r-:
MICHAEL & CO PLUMBING
P 0 BOX 2300A
T16ARD OR 97281
Phone #: 631-318', $ 31. 50 TOTAL
Reg #- . - 67877 REOUTRED INSPECTIONS
This perp t is issued subject tr the regulations contained in the Water- Line Insp
Tigard Municipal Code, State of Ore, Specialty Codes and all tither FinA) inspection
-1olicable law-. All r;ark will be done in accordance with
app,•oypd plans. chis peroit will expire if work is not started
within 180 days of issuance, or if work is suspended fat, ear@
than 180 days.
Pet-mittee
By :
Call for inspection 639-4.175
I ITY OF TIGARD Plumbing Application Recd By
3125 SVV HALL BL VE). Commercial airUate Recd ( /-' Residential Date to P.E.
IGARD, OR 97223 Date to DST
503) 539-4171 Permit ilt R
Print or Type Related SWR e
Incomplete or illegible applications will riot be accepted Called_ _
Name of Development/ ld
Proiect —�--� FIXTURES (Indlvual) CITY PRICE AMT
Sink 900
Job
Street Address Suite Lavatory 9.00
Address Tub or rub/Shower Comb i 9.00
Bldg# Cilyistate Zip
/ Shower Only 9.00
7&4A7 U �/ -7 ' `l Water Closet — 900
Name litid.4 ` Dishwater _9.00
�Nai/f z
i Garbage Disposal 9.00
Owner Mailing Address / Suite —__—
�f/ f'A/C Washing Machine 9.00
CityrState Zip Phone Floor Drain 2" 9.00
n/h,,lS U C/2 <i 713 L ti,3 7- .J i'/ 7 3" '— 900
Name 4" 9.00
Occupant Mailing Address Suite Water Heater 900
Laundry Room Tray 9.00
City/State :Zip Phone Unreal 900
Other Fixtures(Specify) 9.00
Name � /7 900-
Contractor Ma,ling Address Suite _ _9.00
'-16 e" e13 G J'�- 900
City/Stale-/ Zip — Phone 900
6 %7��/ Cr3ci-34-i 9.00
Oregon Const.Cont.Board Lir 0 Exp Date __. ___—_� _
Attach Copy of 6,7 7 7 61-,-'✓ --7 — 9.00 _--I
Current Plumbing Lic,1t /���— Exp. Dare Sewer- 1st 100" 30.00
Licenses of(, --}j j/-"a `/- Yv - -/ -7 Sewer-each additional 100' 25.00
COT Business Tax or Metro ft Grp.Date
7 Water Service- 1st 100' C, 3000 3O _
-------
Water Service-each additional 200' 250
Name _ - -
Storm&Rain Drain- 1st 100' ,0 00
,'.I or
—
Mailing Address Suite Storm&Rain Drain-eacn additional 100' 25.00
Or Mobile Home Space 2500
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 2500
Pollution Device _
Describe work "•w O Addition O Alteration O Repair Residential Backflow Prevention Device* 1500
to be done. Pesidenlial O Non-residential O _ Any Trap or Waste Not Connected to a Fixture 9.00
i Additional description of work Catch Basin _ 8.00
Insp.of Existing Plumbing 4000
4000
Specially Inspections 40 00
listing use of per/hr
gilding or property_ Aj--Y, "r 7 7 _ - -_. Rain Drain.single ramly dwelling 3000
,reposed use of Grease Traps _ 900
building or property__ _ —_ — -
CIUAN'i ITY TOTAL
-� Isomotnc or riser diagiam s renuvM d Quart"Totals >9
Are you capping, moving or replacing any fixtures? Yes[INoxf -- -
(If yes see back of form) _ _ "SUBTOTAL O ti
I hereby acknowledge that I have Pad this application.that the information ---- -
given is correct.that I am the ownet or authom d agent of the owner.and 5% SURCHARGE 7 5 v
that pla submitted are in compliance with Oregon State Laws - PLAN REVIEW 25%OF SUBTOTAL
Sig t bf OwnerlAgent Oate
Rewired only it fixture 4-ty-1 aI-s>9
3—9c( TOTAL. 3� tiZ
ct Person Name Phone —
'Mlnimum permit fee is S25• 5%surcharge,except Residential Backflow
,� �z r Gf S,_ - /rf`� Prevention Device,which is S15+ 5%surcharge
-/i�/rN (- U�i��1 t — i.klslslplmapp.doc 8/98
PLEASE C�MPLE_T__�A$ APPROPRIATE (?PROJECI:
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 main 2"
Water Heater
Laundy Room Tray
'Jrinal
Other ',fixtures (Specify) ___�
-
COMMENTS REGARDING ABOVE: