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CITY OF TIGARD PILUMBING PERMIT
SERVICES 17,E
.RMIT #. . . . . . ,
13125 SW Hai!Blvd., Tigard,OR 97223 1'503)639.4171
DATE ISSUED: 10/27/98
PARCEL: 15135DB--10100
SITE ADDRESS. . , : rtjCno SW 95-TH AVE
SUBDIVISION. . . . : MAYFAIR ZONING: R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . ..00`; JURISDICTION: TIG
-------------------------------
CLASS OF WORK. . :REF' GARBAGE DISPOSALS. 0 MOBILE HOME SF ACES. 10
FYF-'E OF USE:. . . . .SF WASHING MACH, . . . . . 0 BACKFLOW P,REVNTRS. . 0
11
OCCUPANCY GRP,. R", FLOOR DRAINS. . . . . . . 0 TRAP'S. . . . . . . . . . . . . . 0
STORIES. . . . . . . . 0 WATER HEATERS.....: 0 CATCH BASINS. . . . . . . : 0
FIXTURES— ____.__..__._.__.-- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . 0
S I NKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . 0 GREASE TRAFTS. . . . . . , 0
I.-AVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
IUB/SHOWERS. . . ; 0 SF:WER LINE ( ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : ;?o
DISHWASHERS. . . . 0 RAIN DRAIN (ft ) . . , : 0
Remar-4(s : Repair, of water ie.
FEES
GARY R ANDERSON type amoi.int by date t-ecpt
1. 11.60 SW 95TH AVE 'RMT $ 30. 00 DEB 10/27/98 98-310308
TIGARD OR 97223 5r-,CT $ 1 . 50 DEB 1.0/27/98 98-310308
Plhone #: 639--1671
Contractor r-------------------------_--.....____.
(OWNER
r'-,hone $ 31. 50 TOTAL
Reg #. ,. I 9XXX ------- REQUIRED INSPIECTIONS -------
This permit is issued subject to the rp.gCations cnntainpd in the Water-, Line Insp
Tigarf' Municipal Code, State of Ore. 3pecialty Cndps and all other Final Ins pert ion
applicable laws. All work will be done in accor2ance with ------
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules
aOopted by the Oregon Utility Notification Center. [hose rules are
set forth in OAR 952-000I-0010 through OAR You may
obtain cnpies of these rules or direct question; to OUNC by calling
(,43)246-1987.
I
S i g n a t i.t r e a
By Permittee L_r
........4-+4.......................................................................
Call 639-4175 by 7:00 p. m. for an inspection needed the next business
ness day
++4+4-++4-4-4 +--++++++++4-++-+-+4-+++4.++++++•++++++++++++++++4•...........................
CITY OF TIGARD Plumbing Perm: Application Plan Che
13125 SW HALL BLVD. Commercial and Residential Rec'dBc'dDate Re
Jn-a7'I�
TIGARD, OR 97223 mate to P.E.
(503) 639-4171 Dale to DST
Print or Type permit ft P�M98-03 ,'0
;ncornplete or illegible applications will not be accepted Related SWR#
Called
Name of Development/Project _ FIXTURES (Individual) QTY PRICE AMT
id
Sink9 00
Job Lavatory � 9.00
Address Street Address Suite —
1 5 W 9 S� R ve- Tub or Tub/Shower Comb. 9.00
Bldg 0 City/State Zip Shower Only 9.00
'f/6 A4 GQ. 57zz
Water Closet 9.00
Name Dishwasher 9.00
Mailing Address Suite Garbage Disposed 9.00
Owner .r�� -- — �.oe
s J-?* Washing Machine
City/State Zip Phone Floor DrainlFloor Sink 2" 9.00
flLNn✓9 oIL 'i7ss3 dj9 /L 9.00
_ 3"
Name 4" 9.00
Malling Address Suite Water Heater O conversion O like kind 9.00
Occupant Gas piping requires a separate mechanical permit.
City/State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name Other Fixtures(Specify) 9.00
`IA 1� _ 9.00
Contractor Mailing Address Suite _ _ --- - 9.00
Prior to permit City/Slate Zip Phone Sewer-1st 100' 30.00
Issuance,a copy Sewer-each additional 100' 25.00
of all licenses are Oregon Const,Cont.Board Llc.tlt Exp.Date Water Service-1 at 100' 30.00
required II25.00
expired in COI Plumbing Lic.0 Exp,Date Water Service each additional 200'
database Storm&Raln Drain-1 at 100' 30.00
Name Mobile
&Rain Drain-each additional 100' 25.00
Architect Mobile Home Space 25.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Phone Residential Backflow Prevention Device' 15.00
City/State Zip
Engineer (IMgation timing devices require a separate
restrf_tedener permit.)
Describe work lobe done. Any Trap or Warte Not Connected to a Fixture 9.00
New O Repair 4 Replace with like kind Yes O No O 9.00
Residential A Commercial O v_� Catch Besln
Additional description of work: Ins p of Existing Plumbing 40.00
ier/hr
r' 40.00 I
Specially Requested Inspections
per/hr
Rain Drain.single family dwelling 30.00 I
rIfyes,
you capping, O moving o replacing
ing any fixtures? Grease Traps _ p 9.00
see back of form to indicate work performed by QUANTITY TOTAL
re. FAILURE TO ACCURATELY REPORT FIXTURE Isom etdcorriser diagram isrequired"QuantltyTotal is ,9
WORK COULD RESULT IN INCREASED SEWER FEES. 'SUBTOTAL /� e
I hereby acknowledge that 1 have read this application that the information
given is correct.that I am the owner or authorized agent of the owner,and 5%SURCHARG
that plans submitted are In compliance withOre og n Slate Laws.
Signature of Owner/Agetrt Data '"PLAN REVIEW 25%OF SUBTOTAL
// P.egwred only R fixture qty total Is>_9 _____
719 V- TOTAL M J
CCnnntact on Name Phone
'Minimum permit fee is$25+5%surcharge,except Residential Backtlow
Prevention Device,which Is$15+5%surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I ktslslplumapp doc 112198
PLEASE COMPLETE:
Fixture Type —^ Quantity by Work Performed
New Moved Replaced Removed/Capp,,
Sink - --- _— __. _
Lavatory
Tub or Tub/Shower Combination _ ------ --�-_._
Shower Only ----- -� ----_______
Water Closet
Dishwasher
---_--- - — --- — -__v -
Dish--------------- -
Garbage Disposal
_Washing Machine -----
Floor Drain/Floor Sink 2"
-- --
Water Heater_
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
MST
qI�(5 Date Requested / -� - UP
(�AM ?0 .vPM SLD
Location_ I I D ., L� `-i T S V
Suite MEC
Contact Person c;Q;, '(�1�(' � Ph Z G_3 L� _3
Cl.-- 7-
Contractor cr P ph ( SWR
BUILDING —' Tenant/Owner _ �_��,{,�, ELC
Retaining Wall
Footing -- --�- ELR
Foundation Access: -"'
Fig Drain FPS
Crawl Drain Inspection Notes: SGN
Slab -
Post&Beam SIT
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -
Firewall 4
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
-inal —
RT FAIL
MBING —
Post 8 Beam _
Under Slab _
To
ater Services — —
San ewer -- -- �_—_—
rains
Final- ---W — ---- __—
PART FAIL
NIECHANICAL -- — __ -- -- -----_
Post&Beam
Rough In -
Gas Line --
Smoke Dampers — -
Final
PASS PART FAIL - "-'--
ELECTRICAL - ----- -- ----- ------
Service '- -
Rough In -�-
UG/Slab
Low Voltage -Fire Alarm
Final - - - -
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer — -Storm Drain Drain ( ]Reinspection fee of$_ required before next inspection Pa at Cit Hall, 13125 SW Hell Blvd
Catch Basin p Y Y
Fire Supply Line ( )Please call for reinspection RE:-i _ ( )Unable to inspect-no access
ADA
Approach/Sidewalk `'
Other _ Date ___Inspector
Final Exit —n
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.