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CITY OF T.CQ�tD BUILDING INSPECTION DIVISION
MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4.71
BUR _
Date Requested ��' J ""�� AM PM BLD
Location ( 2-CO L/S I �21:�-tll ry� Suite
q MEC
Contact Person � ���? -_ Ph /_ PLMCI ' 2,�
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELF1
Footing Access: �..
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes — —
Slab �— _ --__ SIT
Post& Beam --
Ext Sheath/Shear _
Int Sheath/Shear —
Framing
Insulation
Drywall Nail'ng _—
Firewall
Fire Sprinkler
Fire Alarm ,
Susp'd Ceiling — -- --- —
Roof
Misc --- -- — — ----
Final
PASS PART FAIL --
L �
Post&Bearn —— — --
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
PART FAIL
NANICAL
Post& Beam - --- ---- -- -- --- -- ----
Rough In
Gas Line ---- --- ------- _----- ----------------
_-->>—
Smoke Dampers
Final -------
PASS PART FAIT_
ELECTRICAL —— -- -----
Service __—_—
Rough In
UG/Slab -- ---- -- — — -- -- _ -- —
l.ow Voltage
V) Fire Alarm _._-®_-- -- ------_—__�— —_ —_— ---
�- Final
~ PASS PART FAIL
SITE
Backfill/Grading — —
w Sanitary Sewer
Storm Drain I I Reinspection fee of$ -—required before next inspectien. Pa),at City Hall, 1312.5 SW Hall Blvd
Catch Basin
Fire Supply Line l I Please call for reinspection RF ____—^ ____--_ [ J Unab'e to inspect-no access
ADA
Approach/Sidewalk U
Other date 6 Insp ector _Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVILION FAST
24-Flour Inspection Line: 639-4175 Business Line: 639-4171 J�
c7r, BUP —
Date 1Requested �� / lAM PM „ BLD
Location— rye Imo` `� v 'Z` _ Suilte, cam_cy MEC
Contact Person Ph PLM
Contractor _ Ph SWR
BUILDING' Tenant/Owner ELC
Retaining Wal! ELR
Footing Access: +_
Foundation FPS
Ftg Drain -
Crawl Drain Inspection Notes: SVN
Slab __--_ SIT
Post&Beam - - -
Ext Sheath/Shear _
Int Sheath/Shear
Framing
Insulation
Drywal! Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling CC-
Roof
Misc _ --- - --- - --- - _ —
Final -
PASS PART FAIL
PLUMBING
Post&Beam --- — -^ - --
Under Slab
Top Out ------- - -- -- ---
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post& team - -- ---------- - ---- - ---- --
Rough In
Gas Line - - - --
Smoke Dampers
Final
PASS PART FAIL.
Service.
Rough In
CL UG/Slat - -- _
r Low Voltage
�- Fire Alarm
Ln - -
r ASS PART FAIL --
J
r Backfill/Grading
Sanitary Sewer
Storm Drain I ]Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin I I Please call for reinspection RE. „_- ( J Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
_
Uate ` —! Inspector ���,� Ext
Other
Final
PASS PAFT FAIL DO NOT REMOVE this Inspection record from the job site.
CITYO F I I G A R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM1999-00205
13125 SW Hal! Blvd.,Tigard, OR 97223 (503) 1 1 DATE ISSUED: 7/6/99
SITE ADDRESS: 12645 SW 135TH AVE PARCEL: 2S104BD-01000
SUBDIVISION: HANDY ACRES ZONING: R-7
BLOCK: LOT: 1-2 JURISDICTION: URB
CLASS OF WORK: GTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: 150 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connection of existing single family residence to sewer. Septic tank is to pumped, filled. and inspected or
removed.
---- - — --
Owner_ FEES— —
Type By Date Amount receipt
ALEXANDER, MARION + DOMINIQUE PRMT DEB 7/6/99 $70.00 6004
12645 SW 135TH MISC DEB 7/6/99 $4.90 6004
TIGARD, OR 97223 i —
Total $74.90
Phone 1:
Contractor:
PENGUIN TRACTOR
PENGUIN TRACTOR AND EXCAVATING
1184 NE SUNRISE LN REQUIRED INSPECTIONS
HILLSBORO, OR 97124
Phony 1: 681-0319 Sewer Inspection
Reg #: LIC 104182 Insp existing/capped fixtures
PLM 26-316PB Final Inspection
a
r�
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
=; Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
L This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
UJ than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Cente. . Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Isdued By: ) ! Permittee Signature: :'�;' !i(�(14� ICC A �
Call(503) 639-4175 by 7:00 P.M. for an Inspection needed the next buslness day
CITY OF TIGARD Plumbing Permit Application Planc ck#--}—��—
13125 SW HALL BLVD. Commercial and Residential Recd
TIGARD, OR 97223 Date Recd
(503) 639-4171 Date to P.E. -----
Print or Type Date to D'T=--
Incomplete or illegible applications will not be ce Permit# e.H i999_��S
1 Related SWR#_
Called
Na e of Devefopment/Project L FIXTURES lindivldua QTY PRICE AMT
/ Job Sink — 11.50
Address Strreeett,A�ddre �T Suite Lavatory 11.50
Tub or Tub/Shower Comb. 11.50
Bldg# City/State Zip Shower Only 11.50
-- �i2� 1/2 X7222
Na Water Closet 11.50
le�D�xl,iufid lLr!_ Dishwasher — 11.50
1 Owner Mailing Address Suite Garbage Disposal 11.50
Washing Machine " 12
City/Slate Zip Phone
C/ 4" 712 3 519e— Floor Drain/Floor Sink 2" 11.50
Name 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater O conversion O like kind 11 50
Gas piping requires a separate mechanical permit.
City/Slate Zip A Phone Laundry Room Tray 11.50
N me Urinal 11.50
Other Fixtures(Specify) 15.00
Contractor Maili A d ess Suite
/Y,1;7 _VZ WV
- -
Prior to permit Cl yIstaI Zip Phone Phone Sewer- 1st 100' 38.00
issuance,a copy f / l �Z G7 �/Q 7 ��"
of all licenses are Oregon Const.Cont.Board Llc.# Exp Date Sewer-each additional 100' / 32.00
required if I O9 "]q r� A ari —p ( Water Service-1st 100' 38.00
expired in COT P r bing Ic.# Ex D to Water Service-each additional 200' 32.00
database .L,1-4 'A I to p �-?I_60 Storm 8 Rain Drain-1st 100' A 38.00
Name Storm&Rain Drain-each additional 100' 32.00
Architect Mobile Hong,Space 32.00
Or Mailing Address Suite Com-:_!tal Back Flow Prevention Device or Anti- 32.00
_ Pollution Device _
Engineer City/Stale Zip Phone Residential Backflow Prevention Device' 19,00
_ (Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New O Repair O Replace with like kind: Yes O No O Any Trap or Wase Not Connected to a Fixture 11.50
Residential O Commercial O Catch Basin v 11.50
Additional description of work
Insp of Existing Plumblr9 50.00
_ erRtt
Specially Requested Inspections 50.00
Are you capping, moving or replacing any fixtures? Sp _ _ mer/hr
Yea O No O Rain Gain,single family dwelling 4500
If yes, see back of form to indicate work performed by _
`3• fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11 50
l WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application,trial the information Isometric or nser diagram Is required K Quentily total is >9 _
�. given is correct.that I am the ovrner or authorized agent of the owner,and 'SUBTOTAL
�~ that plans submitted are in compliance with Oregon_ State Laws. �Q.A
y ti %of OwnerlAgon ,6 c JDa!10! 7%SURCHARGE
Co ct Pe n oName A --
Uj 11 .t C �� .Yl, , P G/eG ' PLAN REVIEW 26%OF SUBTOTAL
J Required only if/lAure qty total Is>9 —
1 BATH HOUSE$178.00 TOTAL
2 BATH HOUSE$250.00 JL�•9
3 BATH HOUSE$285.00 'Minimum permit fee is$50*5%surcharge,except Residential Eackilow
.(This fee Includes all plumbing firtures In the dwelling and the nrst Prevention Device,which Is$25+5%surcharge
100 feet of sanitary sewer storm sewer and water servlcs) "All New Commercial Buildings require plans with isometric or riser diagram
and plan review
11dtltfVomoplumapp dx s/16mg
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink _ _—
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
I Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2"
3"
-Water Heater
Laundry_Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
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07/06/2019 11:02 5904166 GMBM PAGE 01
sewerage sSANITARY* IPE[
955
®wTetera �
8,t�"��' SURFACE WATER
�N. First Ave.,4ve. Suits 270, Hillsboro, Or.,97124
503 648-8621
CONNECTION PFRM IT
ISSUE DAH: 0701.99 E.XF'.ThATTf1N DATE 122999 FC 17XP ,'_TATE: PE-RM] T 1 17 13 6
STRUCTURE APDRE.SS I'16A i FIR0..11'C 1 11,99981'F,UCTI.IRE: 8'f FcE cr SW 135TH AVE
1.0 BL OCK.
TYPE CONNECTION- EXIST OF
TYPE INSTALLATION— ( i ) NUILDIN6 FWF'P ONL Y
TYPE OCCUPANI'Y-- ( 1 ) 3INGI F FAMILY PARCEL 251 00 1000
QTR; SFC 4315 MH 17646
OWNER MARTON ALEXANDER
ADDRESS 12645 SW 1337H AVE; TRF'ATMFNT PLANT DURHAM
TITiAPP OR 97?23
PHONE. 90 --4063 WA1FR DISTkirT TIGARD
FIXTURE EQUIVALEN'r DWF:1.1 I.HG RESIDFNTIAL Y ~
ONIIS SE*RV'ti E ('1411'S 0. 0 UNIT, 1 SERVICE UNITS
CONNECT ;CON FEES '.i(IRFACE WATT R DFVFl 0Pm .N'f F v F3
SEWER CONNEt M)PI 2.300. 00 WATER I;JUALITY 0100
LESS CRE:'DIT t 10.00'
WATER OUANTITY 0 .00
1..,k5S C R E LII1' 0 . 00
EPOS ION CONTROL
,UYTOTAl. 2300100 CSU PT0TAC 0 .00
TOTAL 2300.00
nPPI NAML: MARION PHONE _._,_....._. .._._
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At=V I L L t A 1 ION UWNF_F'
I EMAF+Kk3 HOOK UIQ EAI5T SFR
J
t'IGNATURE .ted: .;, t', r c %r:� '3S
_. __..__. ... ......_.�w___.____ ... _.__ _._. � lat=e By uRassrr
Permit Condmns, The awhearit agrees to comply with an rules and regutatforts of the Unified Sewerage Agency,including those regarding erosion controi.
A 2a.hour notice Is required for erosinn control inspections.The Inspection request number II 8"9444,When telling for an Inspection,please rater to
the permit.project and lot numbers.
The permit expires ori;hundred eighty(180)days from the date of issuance.The Agency does not guarantee the accuracy of the location •f cida;1W;, ,t,,,,i
793 MNITS - USA. BLUR - Accounting, anaaN -inspection, YRLLON - Customer
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT#: EI-C1999-00410
t DEVELOPMENT SERVICES DATE ISSUED: 7/9/99
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S104BD-01000
SITE ADDRESS: 12645 SW 135TH AVE
SUBDIVISION: HANDY ACRES ZONING: R-7
BLOCK: LOT : 1-2 JURISDICTION: URB
Proiect Description: Installation of two 200 amp or less services, one 201 to 400 arnp service and 1 branch circuit.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS
1000 SF OP LESS: 0 - 2C0 amp: �PUMPPRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
A1ANF HMI SVC/FDR. 601-amps - 1000 volts: MINOR LABEL (10):
SERVICE!FEEDER _BRANCH CIRCUITS ADD'L INSPECTIONS _
0 200 amp: 2 W/SERVICE OR FEEDER: 1 PER INSPECTION:
201 400 amp: 1 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: FA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+a,mp/volt: _ >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: _ SVC/FDR >=.225 AMPS: CLASS AREA/SPEC OCC:
Own*,-r: Contractor:
ALEXANDER, N,ARION + DOMINIQUE MIKE'S ELECTRIC
12645 SW 135TH 17050 SW SHAW STREET
TIGARD, OR 97223 BEAVERTON, OR 97007-1813
Phone: Phone: 649-6991
Reg #: LIC 00050209
SUP 4230S
ELE 34-18c
FEES — Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT DEB 7/9/99 $219.35 99-2-16737 Elect'I Final
5PCT DEB 7/9/99 $15.35 99-316737
Total $234.70
L ---- I -- —1
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance,or 9 work is
suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these ales or direct questions to OUNC at(503)
0- 246-1987
it `r
Ln Permit Signature: Issued y:
~ OWNER INSTALLATION ONLY
—' The installation is being made on property I own which is not intended for sale, lease, or rent.
L
w OWNER'S SIGNATURE: DATE:__
J
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: / a� J� �C DATE:__
LICENSE NO:
Call 639-4175 by 7:00pm for ao inspection the next business day
P -(; E®
CITY OF TIGARD Electrical Permit Application Plan Ch .
13125 SW HALL BLVD. " lgq�.i Rec'Dat dRec'd
TIGARD OR 97223
Phone (503)639-4171, x304 GUlwinw++i ui Ivii.IVT pp Q� Date to P.E.
Type N U Date to DST �-
Inspection (503)639-4175 Print or T)pe Permit# e` > .
Fax (503) 684 7297 Incomplete of illegible will not be ac ed Called _
F
Job Address: 4. Complete Fee Schedule Belov:
Name,of Development � � Number of Inspections per permit allowed
Name(or name of business)_D o m i n i q u e A l e n a n d e r Service included: Items Cost Sum
Address 12645 S W 135th --Ave . _ 4a. Residential-per unit
City/State/Zip T1n g @ r d OR 1000 sq,ft.or less $110.00 4
�. Each additional 500 sq.ft,or
Commercial ❑ Residential portion thereof $25.00 1
Limited Energy $25.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $66.00 2
(Attach copy of ail current If�enses) 4b.Services or Feeders `l'� g'S
Electrical Contractor MI h l': S FLECTR IC Installation,alteration,or relocation to 2,0 �b
17 0 5 0 a W t . 200 amps or less $ e6 2
Address
201 amps to 400 amps �tlU,000 2
City Beaverton State Of Zip 97007 T 401 amps to 600 amps $120.00 _ 2
Phone No. 649-6991 601 amps to 1000 amps $160.00 _ 2
Job No. Over 1000 amps or volts $34000 _ 2
Elec.Cont. Lice. No. 3 4--119 Exp.Date^ Reconnect only $50.00 2
OR State CCB Reg. No. 050209 Exp.Date 3/18401 4c.Temporary Services or Feeders
COT Business Tax or Metro No ' Exp.Date 0 Installation,alteration,or relocaticn
���� 200 amps or less $50.00 2
Signatwe of Supr. Etes--p'i� e/L 201 amps to 400 amps $75.00 - 2
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts,
Liconae Nr SExp.Date%lr� e'7 el see"b"above.
Phone Nr ..-649 FAX - 9911 -7847
- 4d.Branch Circuits
Now,alteration or oxtension per panel
2b. For owner installations: a)The fee for branch circuits with
purchase of service or 5,3
Print Owner's Name feeder lee. 1 ��t 1 -
=
Address Each branch circuit _
- b)The fee for branch circuits
City __. State Ztp without purchase of
Phone No. ser0ce or feeder lee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale,lease or rent. 4e.Miscellaneous
!Servlcc.i meob,-M Included)
Owner's Signature - Each pump or Irrigation circle $40.00 _
Each sign or outline lighting $40.00
3. Plan Review section (if required):* Signal circuit(s)or a limited energy
panel,alteration or extension $40.00 _-_-
_..
LL Please check appropriate item and enter fee In section 5B. Minor Labels(10) $100.00
.. _4 or more residential units in one structure 4f.Each additional Inspection over
~ Service and feeder 225 amps or more the allowable In any of the nbuve
VSystem over 600 volts nominal Per inspection $35.00 _
> Classified area or structure containing special occupancy Per hour $55.00
F- as described In N E.C.t'.hapter 5 In Plant $55.00
L *Submit 2 sets of plans with application where any of the above apply. 5. Fees: I�.
Not required for temporary construction services. 5e.Enter total above fees $ c� .
LU c arge(.05 X total fees)7�0 $ `
-t NOTICE Subtotal $
5b.Enter 25%of line$a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review If reaulred(Sec.3) $
NOT COMMENCED WITHIN 160 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 160 DAYS AT ANY
El mist a c e it M
TIME AFTER WORK IS COMMENCED.
Tota!balance Due � s �3�'7
U` I � O
- ►9, s
I0STsu=_Mas APP Rev WN