11155 SW 79TH AVENUE 1
ADDRESS:
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i:lrecordslmicrollm\largetsllwilding.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour !.,spcction Line: 639-4175 Business Line: 639-4171 --
/�
SUP
113 3 Date Requested AM X M BLD
Location_ �� C� ��,� Suite MEC
Contact Person �� _ Ph
Contractor r CJ -�n Ph `���/ SWR
BUILD.,,G Tenant/Owner _ �; U by ` _ ELC
Retaining Wall ELR
Footing --
Foundation FPS _
Ftg Drain SGN
Crawl Drain Inspection Notes: -- --
Slab SIT
Post& Beam --
Ext Sheath/Shear
Int Sheath/Shear —
Framing _
Insulation �-
Drywall Nailing _�—
Firewall
Fire Sprinkler
Fire Alarm
Susa'd Ceiling
Roo,`
Misr_
Final
PASS PART FAIL
PLUMBING
Post& Beam
Under Slab
Top Out -- -
Water Service
Sanitary Sewer -
Rain Drains
F'
A8§ PART FAIL
MECHANICAL --- -��-� --- --
Post& Beam --- ——- ------ ---- —
Rough In
Gas Line - -- -
Smoke Dampers
Final - -
PASS PART FAIL
ELECTRICAL ---
Service
,z Rough In - _- - ----- ---
N UG/Slab
Low Voltage
�- Fire Alarm
Final
m PASS PART FAIL
SITE
-� Backfill/Grading
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW I401'Blvd
Catch Basin i
ll f
l
Pease call reinspection RE:
Fire Supply Line ( ] p ---- --------------- ( ]Unable to inspect no access
ADA
Approach/Sidewalk / ,' ��
Other Date v� r Inspector _-, Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD
- DEVELOPMENT SERVICES FL_l.1PERMIT
PERMIT ##.... .. .. . . . : FLM98-0-46�,
13125 SW Nall Blvd., Tigard,OR 97223(503)639.4171 DATE ISSUED.
PARCEL: 1S1-3C-,CA--0--!:'900
'3TTE ADDRES' . . . . 11155 SW 79TH AVE
SUBDIVISION. . . . : FRIENDLY ACRES ZONING: R--4. 5
BL.00K. . . . . . . . . . . LOT. . . . . . . . . . . . . :O2O ?URISDICTI.ON: TIG
CLASS OF WORi-,.. . :OTR GARBAi�i_. DISPOSALS. : 0 MOBILE HOME SPACES. :
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :r3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . . 0 Wr?TER HEATERS. . . . . . 0 CATCH BASINS. . . . . . . . 0
L.AU'VDRY TRAYS. . . . . : 0 SF RAIN DRAIN'S. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . -. 30
T)TSHWASHFRS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remark Replace 30' of water line.
Owner: --------------------------------------------------------- FEES -
RETTY BII'L.E type amol_tnt by date recpt
1. 1155 SW 79TH AVE PRMT $ .30. 00 GE-0 1F.'/i6/98 98-311580
TIGARD OR 97223 SPCT $ 1. 50 GEO 12/16/98 98--.311580
Phone #:
MICHAEL & CO PLUMBING
P 0 BOX 2 3OOE1
TIGARD OR 97281
F'h on e #: 639--3189 $ 31. 50 TOTAL_
Reg it. . : 000678
—------ REDO T RFD I NSPEcT I ONS ------
This permit is issued subject to the regulations contained in the Water Line I n s p
Tigard Municipal Ctde, State of Ore. Specialty Codes and all other Final l n y pect i on
applicable laws. All work will be done in accordance with
approved plans. "his pewit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
c� than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in DAR 952-0001-0010 through OAR 952-0001-0080. You lay M
obtain copies rf these rules or direct questions to OUNC by calling
=� (503)246-1987.
C
I s s l_t e d B _. �'2� Permittee 5 i g n a t i_i r
--+++4++++++++++++++++++++-+++++++++++++++++++++++++++++++++++++++•4.+++qt + f++4
Call 639-4175 by 7:00 p. m. for an inspection needed the next business dray
+.++++•++++4-++++++++++++++44-044•+++++++++++++++++++++++++++++++++++++++++++++++++
�l 1 Y OF TIGARD Plumbing Application Recd By
3125 SW HALL BLVD. Con lmercia('and Residential DateRec'd_��
GARD, OR 97223 Date to RE-
Date to OST
503) 639-4171 Permit$
Print or Type Related SWR si
hcomplete or illegibie applications will not be accepted Called
Name of Development/Project FIXTURES (Individual) QTY , PRICE AMT
Jcb I
Sink - 9,00
Address
Street Andress Suite Lavatory 9,00
- S L ; .7(,7 Tub or Tub/Shower Comb. 9.00
Bldg sCity/State Zip Shower Only 9.00
Q-7 ,, 23 Water Closet -
9.00
Nama
ye
K Dishwater 9,00
Owner Mailing Address Suite Garbage Disposal 9.00
///.3 j t� 7 rti d t, (? Washing Machine 9.00
(Slate lip Phone Floor Drain I 9.00
3- 9.00
Na e _
/14 e- 4- 9.00
occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Unnal 9.00
Name
Other Fixtures(Specify) 9.00
1( ��Cr F t of C tv Ou Wk L.. 9.00
Contractor Mailing Address Suite 9.00
o -a.3aC)Lfr' 9.00
City/State zi Phone -
C 9.00
Ote4 Const.Cont Board Lic.0 Exp.Date 9.00
Attach Copy cf �. 7 •y 77
cf- ",-00 9.00
Currvnt Plumbing Uc.s Exp.Dale Sewer-1st 100'
Licenses (c- -- ,3- C(- 3 C' -`f k 30.00
Sewer-each additional 100'
25.00
COI Business rax or Metro s Exp.Date t Water Service-1 st 100' 3000 u
c ' _
Name Water Service-each additional 200' 25.00
Architect Storm 6 Rain Drain- tst 100' 30.00
Mailing Address Suite Storm 3 Rain Drain-each additional 100' 25.00
or Mobile Home Space i 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Ann- 2500
Polly,n Device
.escnbe work New O Addition O Alteration O Repair JR Residential Backflow Prevention Device' '- 15.00
to be done: Residential Q Non-residential O Any Trap or Waste Not Conneced to a Fixtur. 9,00
Additional description of work -
Catch Basin 9.00
tl !nsp.of Existing Plumbing 40.00
rz 1 � r of a,rv.«
.parRrr
tJ xisting use vl Specially Requested Inspections 40.00
;ullding or property -per/hr
Rain Oram,single family dwelling 30.0
'roposed use of Grease Traps 9.00
-+ building or property
03 QUANTITY TOTAL
�.
Ln !Are you capping, moving or replacing any ffxtures9 Yes❑ No❑ Is�xrksxk°'"�'diagramrevune if puanM Tata 4 _9
(Ii yes see back of!onn) . *SUBTOTAL
I hereby acknowledge that I have read this application,that the information OU
given is correct,that I am the owner or authorized agent of the owner,and 5%SURCHARGE 15-Dthat lana submitted ar--in compliance with Oragnn Slate Laws _
Signatu ZnZerl
gent Dau PLAN REVIEW25;4 OF SUBTOTALRecured o"!fli tore(Try 'alai.f t 9
TOTAL
Con Person Kamm Phone I � ti
'Minimum permit fee is S25•5%surcharge,except Residential Backnow
,q�'e �/� ,� F.S _ 6'39-3,f Prevention Device.which is 515.5%surcharge
1.ldstslplmepp.doc&96