14852 SW 109TH AVENUE 1
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Linc: 6394175 Bus,ness Phonc: 6394171
Date Rxquected: -31- ctI A.M. P.M. MST:
Location:— ) H M-L: BtJP:-
Tenant:---------- Suite, -l3ldg- MLC-
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Contractor. .-J )(rmma )CIOAYisa) Phone: PLM: to
0-ncr:. 4�qLn mo 10�L A ,-i P t- Phone: ELC:---
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BUILDING BLDG(con't) <f7:�PLUMBING'� ) MECHANICAL, ELECTIUCAL S17E
Site PosulJearn postil3earn Cover''service Sewer/Storm
Fov Ing Roof Undl-1/81ab Rough-ln ceflong Water Line
Siab Framing Top"it , a., Line RouFl, 'n UG Sprinkler
Foundation Insulation 'Sewer f6fo,~/Duct Rec(,nnec, Vault
Bsnit Dump Drywall Storm Furnace Femp Service *—Sc.
Masonry Ccil;ng Rain Drain A/C 11G Slab
Shcar/Sheath Fire Spkir/Alm Crawl/Found Dr I lent Ptunp Low Volt
Approvedov A-,)prow,.-d Al..proved Approved
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Apr,n-/Sdwik Not Approved A Not Approved Not Approved Not Apprcved
FINAL AL FINAL FINAL FINAL
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0 Call for rcinspectionnC3 Reinspection fee required before r:�.tjnspcciion 0 Linable to inspect
inspector. Datc: PPge of
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 503)6394171 PERMIT it. . . . . . . : PLM97--0248
DATE ISSUED: 06/30/97
PARCEL: '2,1311OAD-90015
:SITE ADDRESS. . . : 1485'c-' SW 109TH ArF
SUBDIVISION. . . . : CANTERBURY WOODS CONDOMINIUM ZONING: R -12
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 15 JURISDICTION: TIG
CLASS OF WORK. . .- REP GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . : t7 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . : 0
FIXTURES------------- LAUADRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . 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 ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remar-ks : replace hot water, heAtet,
Owner,: FEES
DONNA JAMES type amoi-trit by date r,ecpt
14852' SW 109TH AVE. PRMT $ 25. 00 GEO 06/30/97 97-296598
TIGARD OR 972JR3 5F-,C'r $ 1. 25 GED 0E/30/97 97--296598
r-`hr-ne #:
GEORGE MORI-AN PLUMBING & OPLIANCES
12585 -W PACIFIC HWY
CCD (EXP 6/2002)
TIGARD OR 97223
Phone #: 624-.6895 26. 25 TOTAL
Reg #. . : 000027
------- REGUIRED INSPECTIONS
This permit is isvied subject to the r:gulatiwis contained in the Water, Line
ne Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water- Set-vice In
applicable laws. A:l work will be done in accordance with Roi-tgh—in Insp
approved plans. This purmit will expire if wer4 is not started Final Inspection
within IN days of issuance, at, if work is suspended for more
titan 180 days. ATTENTIC04. Oregon law requires ;-au to follow rules
adopted by the Uregon Utility Notification Center. Those rules are
set forth in OAR 952-000I-0010 through OAR 952-0001-0080, You may
obtain copies of these rules ^r direct questions to OtK by calling
(503)246-1987.
LLI
Issi-ted By Permittee SirInati-i-ce :
++4-+l......i-++++4.........V++4-+4...........................I........................
Call 639-4175 by 6:00 p. m. for- an inspection needed the next bi-isiness day
......................4..............4•......4•...................1-++++.,..............
Y OF TIG,ARC- Plumbing Ap lieation Recd By-
75 SW MALL BLVD. Commercial an Resident�a Pate Recd
'ARD, OR 97223 ,, Pate to P.E.
�3) 639-4171 2 Pate Psi
Permit
Print or Type Related SM A
Incomplete or illegible applications will not be accepted called
Q
Name of DavelopmanflPropFIY;'URES ndiv�dual�
rx .� . �. �+� .� 'MRS6 0
Job sink 9.00
Address
Street Address a Skate Lmvmlrxy 9.00
,,"'/
,
"/ �5,7 �,-, /6 fiLP Tub or Tub/Shower Comb. 9.0()
Bidg a citylstate ZIP 7Z2?
shower Only 0.170
Po.,WAY; ae 1 7 L Z? Water Closet
Nam. �_ 9.00
w Dishwasher 7.00
Owner Ma&V Addre" sone Garpcge Otaposal 7.00
Wow-Q Msdhkw 7.00 -_
city/St t e �!lzjP z ? Plow 3 Flow Drain r�- r 7.00
3` 7.00
Nafrhe 4• --- 7.00
S<;YHA
)CCUpant mailing Address SuB� water Hester I- 7.00
LaurKtry Room Troy 7.00
CltylStata ZJp Pf oM Unnal 9.00
N ---'--- Other Fags(Spec3fy) 2.00
��. A-1�11.9 7.0n
Contractor MahYrn7 baa /,� Suns
$ sw uli Ic rr
:.00
Prior to issuance Ct-.4tate 21p Phone /
applicant mist ?7,2� zy- ?�F!
provide all O on Const Cont.Board Lice Exp.Date 9.00
contractors o z -� � ,-/ 7.00
lune PManbihq Lic 0 -- Exp.Data Sewrw-1st 10(r 30.00
information Sewer-each additlrxial 100' 25.10
for COT COT Busirwrss Tax or Metro i Exp.Date
database). Water Service-1st 100' 30,00
Name Water Service-each additional 200' 25.00
Architect Storm i3 Rain Drain-1st 100' 30.00 -
or Makang Address Surte Sturm&Rain Drain-each additlonal 100' 25.00
Mobile Home Spans 25.00
;ngineer CityrState _ Zir - Phone Commensal Back Flow Prevention Device or Anti- 25.00
_ PoWatfon Device
scribe work New O Additic.i O Alteration O Repan O Residential Bsdttlow Preventkx.DrA-ce' 15.00
he done: Residential O Non-residential O Any Trap or Waste Not Connected to a Fixture 9.00
,30ktional description of work /C,C /lt utie/1'! //► 61 Catch Busrn 9.00
Insp.of F-,m•,ng Plumbing 40.00
'
per/hr
vrsnng use of Spec:any Requested Ins.jections 40.00
_ rodding or properly_ C'�J`u��t-r»/�fur'1 -- _. 30,00
Ran Dravk,s!ngle family dwelling 30,00
oposed use of / Grease Traps 9.00
udding or property 111
_ QUANTITY TOTAL
l i�you cappi'c . moving or replacing any fb4utes7Yes Q{ tVo L7 t_wnxar.or rmr dtsgrwn K rsquna R�+,Y Total is >9
If yes see back of form) 'SUBTOTAL
hereby aduxwAedge that I have read this application,that the into7nanon
:-n is correcL that I am the owner or authorized agent of the owner,and 5%SURCHARGE
'hat L;'vrts submitted are in cornolisnce with Oregon State Laws.
Signature of OwnerfA�geennt,/ Pats PLAN Rri1/IEW 25%OF SUBTOTAL
q"und omit f_fhtus Oty tOral is>9 -
\S/ TOTAL �.7f:or tact Pers m Marne,
/J Phots 7 1 •Mirdmum permit fee is$25•S%surcharge. ,
2,1 ,� 62 L1 r>�/ pe charge ept ReaWenfial Backflow,
/ � Prevention Devitxh,which is 31 S•S%surcharge
1:1p1mapp.doc 12j96 (dst)
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'LEA-SE COMP�.EJE AS APPROPRIATE; T__0__F ECT:
F xtur-.,s to be capped, moved or replaced Qty
Sink _
Lavatory�
Tub or Tub/Shower Combination_
Shower Oniy
_Water Closet _
Dishwasher
Garbage Disposal___
Washing Machine
Floor Dram 2"
4"
Water Heater _
_Laundry room Tray
Urinal -- --- -- -
Other Fixtures (Specify)
,OMMENTS REGARDING ABOVE:
LD
L: plmapp.doc I2/96 (dst)