12075 SW 131ST AVENUE 07 S
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i:lrecords\micrcflm\targe(sV)uilding.doc
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C:fY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
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Date Requested- A.M. P.M. MST: _
Location: 12-G t �.�.( 'R� 4_ — ---
Tenant:_ Suite: Bl(-g:
Contractor: ! VCA_'l-� —` Phone: '-_�L��ct _ PLM: / r
Owner: Phone: _ rLC:, —
--� --_ - ELR:.--.
STT. _ _
BUILDING BLDG�con't) PLUMBING MECHANICAL — ELECTRICAL SITE
Sitc; Post/13ra,n stll3i'gtTl Post/lIcam Cover/Service Sewer/Storm
hooting Roof I1»dl,'Blab Rough-In Ceiling Water Line
Slab Framing Tc,Out Gas Line Rough-In I IG Sprinkle,
�oundation Insulation Sewer Hood/Duct Reconnect Vault
Ps:11t Damp Drywall Storm Furnace Temp Service M1SC.
Masmry Ceiling Rain Drain A/C UG Slab
Shear/Sheath I-ire Spkir/Alm ';rnwl/l,om31r 1 teat I'ump Low Volt
Approved Approved Approved Approved Apr
Appr/Sdwik Not Approved NotPved Not Approved Not Approved NoT roved
FINAL INAFINAL FINAL FINAL
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4 Call for reins ; Reinsp wfion fee of S cequiJed he ^�t inspection ❑listable to insly et
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Invpector s/ _,_-- �_ _ Idle: / Page of
/A CITY Off' TIGARD►
DEVELOPMENT SERVICE'S PLUMBING PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : P'LM98-0117
DATE ISSUED: 04/29/98 PARCEL: 2S14AB -
SITE ADDRESS. . . : 120 75 914 131 ST 92T k
SUBDIVISION. . . . : MORNING HILL 44 ZONING: R--4. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . : 101" JURISDICTION: TIG
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CLASS OF WORK. . :ADD GARBAGE DISPOSALS. : 0 MOBILE H01,12 SPACES. 0
TYPE OF USE. . . . Sr7 WASHTKIG MACH. . . . . . : 0 BACKFLOW PREVNTRS. . 1.
' OCCUPANCY GRP. . R:-, FLOOF DRAINS. . . . — : 0 TRAP'S. . . . . . . . . . . . . . .. 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES----------------- LALJN')RY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . .
SINKS. . . . . . . . . . it; URINOLS. . . . . . . . . . . : 0 GREASE TRAP'S. . . . . . . . 0
' l-AQATORIES. . . . e. OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Add residential backflow prevention device.
Owner: FEES --------------
ANITA G OINEILL type Amoi-int by date rerpt
12075 SW 131ST AVF PRMT $ 15. 00 GEO 04/29/98 98-305366
TIGARD OR 97223-0000 5PCT $ 0. 75 GED 04109198 98-305366
Phone #: 590-5j17
MARK C-UNDERSON LANT)Sr.,'IPE
P10 PDX 230125
TIGARD 0:1 97281 -------
Phone #: 639-8791 $ 1.5. 75 TOTAL
Reg #. . : 000110 ------- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RPI/Ba,-kflow Prev
Tigard Municipal Code, State of OrE. Specialty Codes and all other Final Inspection
ipplicabi+ laws. All work will be done 'n accordance with
approved plans. This permit will expire if work is no- started
within 180 days of issuance, or if work is suspended for more
than i8i days. ATTENTION: Oregon law requires you to follow rule;
rr adopted by the Oregon Utility Notification Center. Those rules are
Set forth in DAR through DAR 952-MI-OW. You may
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obtain copies o' these rules or direct questions to OUNC by calling
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Tss1.i-?d By : Permittee G i g n a t U r ral
#-+.+++++++++++ +++ . . ............ ....................4.+...... +++4.+++++f+++
Call 639-4175 by 7:00 p. m. for an inspection needed tree next --isiness day
+-r++++ F+-4.........4...........;.......4.......4...............4-+++4.............#-+++4-++4+
CITY OF TIGARD Plumbing ANNH ation Recd By
Cate Recd
1:3125 SW HALL BLN/D. Commercial and Residential _
Date to P.E.
TIGARD, OR 97223 Daie to D9,_
(503) 539-4171 Permit# / '!
Print or Type q-- Related SWR#
Incomplete or illegible applications will not b,3 accepted called
Name of Development/Project On back Indicate W ii!r Performed by ft,aure.
Job �v ivi
FIXTURES (Inddual) _ DTY PRICE AMT
Address Street Address Suite Sink J 00
r-zU -T ; � o/ I Lavatory _ 9.00
Bldg Att I tate__ p a;3 Tub or Tub/Shower Comb. 9.00
_-� --� Shower Only 9.00
Na e i —
t . re r Water Closet _ 9.00
Owner Matltng Address _ Suite Dishwasher 9.00
r_ 9 S� 1� 5 ' Garbage 'osal 9.00
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Cit /State Zip Phone Wasr ng Machine 9.00 —1
- a7aa3 �,0-.� _
Name Floor Drain 2" - 9.J0
Occupant Mailing Address Suite 4" v 9.0c
Water Heater O conversion O i,ke kind 9.00
City/State Zip Phone9 00
laundry Roo n Tray
Name Urinal 900
25U4 1-14 ILIa.51-Ar"'o G- 9.00 ;
Other Fixtures(Specify)
Contractor Meiling Address Suite 9.00
X70 5 — 9.00
Prior to permit Cf /State ZIP Phone - 9.00
issuance,a copy �U �� tJ i5f b 3�'s7� -
of all licenses are Oregon Const.Cont.Board Lic.* Exp.Date 9,00
required if _ Sewer- 1 st 100" 30.00
expired in COT Plumbing Lic.* Exp.D Sewer-each additional 100'
/( ?5.00
database 0i
--- - Water Service-1st 100' 30.00
Narne
Water Service-each additional 200' 25.00
Architect30.00
Mailing Address Suite Storm&Rain Drain-1 s1 100'
or Storm&Rain Drain-each additional 100' 2500
Engineer CitylState Zip Phone Mobile Home Space _ 25.00
_ Commercial Back Flow Prevention Device or Anti- 25.00
Descnbe work New O Addition O Alteration O Repair O Pollution Device
to be done: Residential O Non--esidential O Residential Backflow Prevention Device' 15.00
Additional description of work: A ,any Trap or Waste Not Connected to a Fixture 9,00
fCcrJ �0 rC c -f c'r� -Crich Basin _ 9.00
G� t E,,s C� w rsp.of Existing Plumbing — - 40,00
tr C l� ( �/v c.Ca _7 r7 f 2��'l erlhr
Existing use of Specially Requested Inspections 40.00
per/hr
building or property____
Rain Drain,single family dwelling 30.00
i1 Proposed use of — _ 9.00
Grease traps
building or property
�~ QUANTITY TOTAL
? I hereby acknowledge that I have read this application,that the Information Isometric or rifer diagram is required d Ouantty Total is >9 _
F- given is correct,that I am the owner or authorized agent of the owner,a.1d 'SUBTOTAL
I that plans submitted are in compliance with Oregon State Laws. _
Sign�t�ura ootOwner/AgOt Date c� �^ 5% SURCHARGE
w —� PLAN REVIEW 25%OF SUBTOTAL
-t contejt Person Nird , l Phone Requvr only R fixture qty total is>9
l/f�k !✓ (J/U CZS��/ 3 F7 TOTAL
'Mlnin'll permit fee is S25 + 5%surcharge,except Residential Bac flow
Prevention Devine,which is$15.5%surcharge
PLEASE COMPLETE: '
Fixture Type Quantity by Work Performed
Now Moved Replaced Removed/Capped
Sink
Lavatory — - -- --- - - —
Tub or Tub/Shower Combination
Shower Only
Water Closet —
Dishwasher
Garbage Disposal
Washing Machine_ _
Floor Drain 2"
Water Heater
Laundry Room Tray ---
Urinal -
Vther Fixtures (Specify)
COMMENTS REGARDING ABOVE:
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'dOMWOM doa 6197