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14943 SW 116TH PLACE I 14943 SW 116TH PL CITY OF T'lr,,P-mARD DEVELOPMENT SERViCES 13125 9W Hall Blvd., Tigard,OR 97223 (6,13)639.4171 GERTIFIGATE: OV OCrUPA, Y #. . . . . . . s Ni J95-0400 DATE ISSUF70: 11/J,?/c)"7 PARCEL ITE ADDRESS. . . a 141.)4-3 SW PL !.IBr,p I V 1 S 1 CIN. . . . s 1-10-M HEIGHTS ZONING.-R-4. 5 I-OCK. . . . . . . . . . LOT. . . . . . . . . . . . . .002' JURISDICTION:TIV, I-ASS OF WORK. :NEW SPE OF USE. . . :SF VPE OF CONSTPi5N ,CC.L'PANCN' GRP. :R'i' �(',CUPANCY L,OAI):2 Remarks : PATH I C 1wrier: GEORGE WALL 8555 SW TURUU01q1- LP BEAVERTON OR 97007 pticille #: 524-7384 Contractor : (3LOPSE WALL (35,55 SW TUROU01GL LP [)LAVERTON OR 9700*7 r1hone #: 504-73814, :!eq #. . : 000523 ihis UertificiAtfr gr-ants occn.jpajjc-y of the ahwwp refer.,,ricpd building or' portio, :hergol And con Firms; that th9 builciing hags t)"n i",jp0(-tpjj for complianco witio for the group ' occL%pa cy, And use under Ale stato of Oregan Specialty codes for thp -f-9 ference(I pkarmit was issued. G 664-if-j- QJ I L 1)1 4(3 INSPBUILD G ECTOR POST IN CONGO"ICUOLI�i PLACE CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Phone: 639-4171 MST: • Date RequestSuite: ed: 1--0� GQ BMLocation: Bldg: MEC: _ Tenant: Phone: PLM: �& �_ Contractor: ELC: ---- Phone: — Owner: EI.R: __----- - SIT: 4 _ n DaLm ELEC'T'RICAL SITEg/ CriDG t) ULP ULpMBING MEC IA} NCI A Cover/Service Sewer/Storm BUILDING Po;t/Mi ° n' Ceiling Water Line .lite cRough-In UG Sprinkler Roof UndFUSlab Gas Line Rough-In Vault Footing To (hit Slab Framing p liood/lhrct Reconnect MISC. Insulation Sewer one� Temp Service Foundation Drywall Storm UG Slab Bsmt D+unP Raip Drain I le Low Volt ------— Masonry Ceiling I1cat Pump Approved Fire Spklr/Alm CtawUFound Ih Approved Shear/Sheath Approved pprove Not Approved Approv o nov1,1 Not Approved FINAL oved Not Approve"/ FMAL 6 9 FApwik INAL FINALQ ---— ---------------- -—. —'..—_-. - - O Unable to inspect fee of S_________--required before next inspe0irn► C1 Call for reinspecti ❑Reinspection _of r Date: f�•- /2 .. � 7 Pa..__ --- cITV OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE D JEROME ELECTRIC PO BOX 751 HILLSBORO OR 97123 Electrical Signature Form Perrriit # . • • . : MST95-0400 Date Issued. : 01/0-/96 Parcel. . . . . . . : 2S3 10t3D-02500 Site Address : 14943 SW 116TH PL Subdivision. : HELM HEIGHTS Block. . . . . . . . Int . 2 Zoning. . . . . . . R-4 . 5 Remarks : PATH I Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical ,permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below an] return this Electrical Signature Form prior to the start of work. No electrical inspections will be authorized until this completed form is received. AN INK SIGNATURE IS REQUIRED ON THIS FORM OWNER : ELLCTRICAL CONTRACTOR: GEORGE WALL L JEROME ELECTRIC 8555 SW TURQUOISE LP PO BOX 751 BEAVERTON OR 97007 HILLSBORO OR 97123 Phone # : 524-7384 Phone # : Reg # . . : 036051 Signature o u irg ectrician Please return this completed form to the address above. ATTN: Building Dept. If you have any questions, please call 639-417 1 , ext. #310 ,July 2, 1996 City of Tigard Building Division RE: SWR95-0454 AT 14943 SW 1 16TH PL Due in part to our wetter than average weather in recent months the sewer has not been completed yet, for this this reason I need to request an additional 60 days. Chris Wall inerintendent 349- 1661 ,524-739a F- PLUMBING, PERMIT CITY OF T I CARD PERMIT #. . . . . . . MST95-0401. DATE ISSUED: 12/11/95 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon 97223981199 (503)839-4171 PARCEL: 2SJIOBD-02500 1494s SW 116H PI_. ZONING: R--4. 5 SUBDIVISION. . . . : HELM HEIGHTS -2 6LOCK. . . . . . . . . . : LOT. ... OT. . . . CLASS OF WORK. GARBAGE ISPOFIALS- TYPE OF LJE-',[-. - . . :NEW WASHING MACH. . . . . . . : BACKFLOW P'RFVN*TRS. . : I 0 TRAPS. . . . . . . . . . . . . . . GRP. -SF C)r-(:Ul:--1 ANCY FLOOR DRAINS— - WATER HEATERS. . . . . . : I CATCH BASINS. . . . . . . 0 STORIES. . . . . . . . 12 5F PAIN DROINS. . . . . F I LOUNDRY TRAYq. . . . . . GRLASE TRAPS. .. . . . . : APS. . . . . . . :0 G I NKS. . . . . . . . . . . 1 0 1-.(-)VnTORIFS 5 OTHER F I XTURES3. - - -rus/SHOWERS. . . . 3 SEWER LINE (ft ) . - 0 WATER LINE (ft ) . - 01?' -4-)TER CI-05ETS). . 3 . i.)ISHWASHERS. . . . 3 1 RAIN DRAIN (ft) . . 0 PATH I --_-.,..._.____..__ TIF T 11:7 5"1 lb. 1b 0 LA 12/11/9a 95-273791t 13EORGE WALL. 9WM 180. 00 B 12/11/95 95-273790 6555 SW TURQUOISE LP St4lyl St 1017.1. 00 S Ire/11/95 95-2'73 79 111 E.L C F 21 10. 00 B 12/11/95 95-273790 FAEAVERTON OR 9717107 ELE5 117.1. '30 D 12/ It /951 95-273790 #: 524-7384 ELRP 40. 00 B 12/11/95 95--273790 1--'I R 5 21. 00 S 1c:/11/95 5 5.--27 1.3*7')0 i..t m b i Ti r I C.o n t t-a c t 0 t BPI.- " -J - -J5. 50 B 12/11/95 95-273790 I-AVILIL 1452. 08 11 ON ICA/3I/95 95-27230E, IP/11/95 95-873790 N Am f.s F3 5 P r- 34. 78 D 18/11 /95 q5-27:3790 P A R K $ 501A. 00 0 city � jvmra $ 45. 00 B 12/11 /95 95-273790 p: e uyo - �j -2 2 L) Ren tl�9 -7 Add i t i ona I fpe-. not shown here. . . . . . . . . RE,-D.UlRED INSPECTIONS Thi! hermit i.s irs'_red subject to the req- Footing Insp Low Voltage I.tIations contained in the Tigard Municipal Code, rde, S t A t P of 01-- DeCiAltV Codes d "All FPoolS.knt/iABtpai. oM n StInl'sUCo n Fir eIplan c e In s t.) other applicable laws- All work will tie clone post /BeAm Mpchat Garulat eonnIp- P in accordance with aPP1-ovpd plans. Thi s ed cv-c-Al Drain Ra yp Board Inso pet.,mit will expire if work i, not start if W01-14 is plm/undslab Insp Ran dr-ain In%P within 180 days of iss'Janf.:e- 0"- PLM/Underfloor Water Line Insp stAspended for More than 180 days. mf'chaniral Insri WAtev- sp)-Vice In Pltmb Top Out pntir/(,;dwlk Inso Elec-trit-E-0 Se"i EI ert r-i L:a I Final Flprtric.al Roklqh Mechanical Final r-r-jRminn Ti;i-i r,li..imb Final -e Cont*-A'_ Authorized Plumbing (', Contrar. 175 ,all for inspection 631) f',ontract(jr Note-, - h17R PERMIT PERMIT #. . . . . . . .. MST95-04 CITY OF T IGARD DATE ISSUED: 12/11/95 COMMUNITY DEVELOPMENT DEPARTMENT qVy H,#A Blvd.Tlgfrd,pj,@ PARCEL-- 2'G110I3D-02:1500 13125 4T R722a:81PI,_�619 OP-4171 CUED II)ISSIOhl. . . . : HELM 11EIGHTS ZONIr`*: R-4. 5 BLOCK. . . . . . . . . . . L.01.. . . . . . . . . . . . . Remarks: PATH I ------—------------------------------------------—------------ BUILDING ----------- REISSUE- STORIES.......: 2 FLOOR AREAS ........... BASEMEN;...; 0 5f FEGUIRED SETBACKS---- REQUIRED- ELASS OF WDRK.:NEW HEIGHT........: 31 FIRST—.: 1308 sf GARAGE—.: 792 sf LEFT..........: 21 SMOKE DETECTRS: Y TYPE OF USE...:SF FLOOR LOAD.... ; 40 SECOND... : 1658 sf FRONT...,,.,,,; 29 PARKING -,PACES: I TYPE OF CONST.:5,N DWELLING UNITS: I FINBSMENT: 0 sf RIGHT.........; 10 OCCUPANCY GPC.:R3 BDRM: 4 BATH: 3 TOTAL------: 0 sf VALUE..$: 204668 REAR..........: 66 -----------------------------—-—--—------------------------ PLUMBING- ----------- ------------- —------------------------ SIMS.........: I WATER CLOWTS.: 3 WASHING MACH..: I LAUNDRY TRAYS.; I RAIN DRAIN ft: 0 TRAPS.........: LAVATORIES....: 5 DISHWASHERS—: I FLOOR DRAINS.. @ SEWER LINE ft: @ SF RAIN DRAINS! I CATCH BASINS. : TUB/SHOWERS...: 3 GARBAGE DISP..: I WATER HEATERS, I WATER LINE ft; 100 PZKFLW PREVNTP- i 5REASE TRAPS.': 0 OTHER FIXTURES: 0 --------•---------------- MECHANICAL ---------------- FUEL TYPES------- --- FURN ( I OOK 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: I INSI / / FURN 1=10% I UNIT HEATERS..: 0 HOODS.........; 11 OTHER UNITS_- I MAX INP.: 0 BTU FLOOR FURNACES, 0 VENTS.........; @ WOODSTOVE-i.... 0 GAS OUTLETS...; I ------------------------------------------------------------------------------------------- ELECTRICAL --------------------------——---- UNIT--- ---SERVICE/FFEDER----- --TEMP SRYC/FEFDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADDIL INSPECTIONS- 1000 3F OF I.ESS: 1 0 1-1.00 amp., 0 @ - 200 ago..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 500SF.- 4 201 400 ago.. @ 201 - 400 ago..: 0 1st 4/0 SVC/FDR.- 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0 LIMITED ENERGY.: 0 401 600 ago..: 0 401 - 600 an.,- 0 EA ADDL BR CTR: 0 SIGNAL/PANEL...: I IN PLANT......; M4NF HM/SVC/FDR: 0 601 1000 ago.: 0 601+amos-1000 v: 0 MINOR LABEL -Ili 0 IONt amu/volt.: 0 -------------------------------------- PLAN REVIEW SECTION ----------------------- -------- Reconnect only.: 0 )-4 RES UNITS...- 'IVC/FDR)-225 A.: ) 6011 Q NOMINAL: CLS AREA/SPC OCC: ----------------------------------------------- ELECTRICAL - RESINiCTE11 ENERGY ----_---------_------__--•----------.------------_-_..- A. --------------------------------------------------- A. 3F RESIDENTIAL------------------—-------- B. COMMERCIAL- -•___----------------__----------__--__-___--------—--------—---—------- AUDIO & STEREO.: VACLJUM SYSTEM..: AUDIO 4 STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR I.NDSC LT; BURGLAR ALARM..: OTH: X BOILER.......... HVAC...........: LANDSCAPE/IRRIS: PROTECTIVE SIGNL: GARAGE OPENER,. CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR, ....... DATA/TELE COMM.: NURSE CALLS....: TOTAL. # SY-',,TFMc- 0 ------—------Contractor: ---------------------- TOTAL FFCS:$ 464.,d GEORGE WALL. GEORGE WALL 8553 SW TURGUOIS1 LP 8555 SW TURQUOISE LP BEAVERTON OR 97007 BEAVERTON OR 4700744 Phone 5�-.-4-7384 Phone 0: 524-7384 Reg #..: 52392 This oersit is issued sutiect to the regulations contained in the Tigard Municipal Code, State Of Ore. Specialty Codes and all other inlicitilt laws. All work will be done in accordance with nvoyed plans. This permit will expire if work is not started within 188 days of issuance, or if work is suspended for more than 16@ --------- REWIRED INSPECTIONS -------------------------- -- - FoOtinq Insp Pisiundtlah Ingo Electrical Rough Insulation Ingo ftorlqdiolk Iriz Erosion C—trnl oundat;on Insp PLMi'Underfloi- Framing Inso Gvo Board Insp Electrical Final lost/Beam Stroct Mechanical Insp Lori Voltage Rain drain Insp Mechanical Final cost/ pas Michan Clasti Too Out Fireplace Inso water Line Irsc Plumb Fir,31 `:,,awl Drain Electrical Servi Gas Line Inso Water Service In Puil Final er-m i i,t e FJ i n T1 CA t.1A I JAA, C yall 11 SEWER CONNECTION PIERMIT PERMIT #. . . . . . . : SWR95---.0454 CITY OF TICARD DATE ISSUED: 12/11/95 COMMUNITY DEVELOPMENT DEPARTMENT P,ARCEL: 2SI1OBD-02500 4171 F!31� EM�? jj.�(vd.Tigard,Oreq 97 _ _ t! L2�01p? SIT' . . ; 14 @m-t, 1?ialfl ZONING. R--4. 5 S1,11DIVISION. . . . : HELM HEIGHTS BLOC .. . . . . . . . . . : LOT. . . . . . . . . . . . . 2 TENANT NAME. — - ; FIXTURE UNITS. . . - 0 USA NO. . . . . . . . . . : ' DWELLING UNITS. . : I CLASS OF WORK. . - :Nr:�W NO. OF BUILDINGS: I TYPE OF USE. . . . . :5F IMP,ERV SURFACE: 0 s INSTALL TY1--E. . . . :BUSWR Reir,arks -- PATH FEES Owner. tvpe amoi.tnt t.)v dAte rcpt GEORGE WALL 8555 SW TURDUOTSE LP rDRM'T $ 2200- 00 B 12/11/95 95-272790 INS[` $ 355. 1710 B 95- 2733790 LAE.AVERTON OR 97007 5214-7384 Contractor: C(]Nl'p(-)CT'OP NOT ON FILE 12�-�35. 00 TnTAL !7'hone it: ,?eq #. . -, REQUIRED INSPIECTIONS This Applicant agrees to comply with all the rules And regulations Sewer Iris,pectiOn of the Unified Sewage Agency. The permit expires 160 days from the date issued. The total amount paid will be forfeited if the cierrit expires. 'he Anency does not guarantee the accuracy of the side sewer laterAls. If the stwer is ntc located at the measurement given, the installer shall Pt'051)ect 3 feet in all directions from the distance given. If not so located. the installer shall purchase ---------- "Tav and Side Sewer" Permit and the Agency will install a lat-al. i -ermitt-ee 5Lqpatl.irc' < ci B V r::,.,11 fare inspection 639-4175 C I^� Residential Buildin_c PermitAp cation of?y of Tigard _ w 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639-4171 Jobsite Address: !,� 4 4.3 S�✓ //4r 1ti ,Alr 6,2 Subdivision: _��,o_f,�Ale. 15 Lot# Office Use Only� — Valuation: 0q_ �f L✓� � Gcntact Date / I _Initials -- - Result New Construction Only: (Square Footage) Planck/Rec # � 7 Permit # hi5l 9�- U C/ ou _ House: _ Garage: Reissue of Corner Lot? Y NFlag Lot? Y N Map & rL # aS//L'd D 0 ?.)eu Zone Owner: Plat # '. ' ..,.��_ %�d�!/ _ r Approvals Rsuired Address: SSSS s�:l •'6rrvY9�nsr /r) — Planning Setbacks Solar_ Engineering — Phone: (s C7 ? ) s 4i 9- 13,'41' Other ----� /� Items Required A' Contnacto�: ,j'-��c G,�., _ /w'* Subcontracturs Address: Z'< r.r sc T4,s_,;._,_c //I __— •�-----�` Truss Details Other Phone: Notes Contractor's License -- (attach copy of currant Oregon license) Contact Mame: C�c ,�� ✓, i% Contact Phone: Subcontractors: Arch itect/Engineer: ,� Plumbing: _(; , /;%,,nn,nT_ Address Mechanical (attach copy of current O CR ontractoi s License) Phone JOB DESCRIPTION: i izi/,/ Applicojvtigrature Applicant Phone number Received by: 1 (� (.l_,' l' L Date Received: ri�anvney I Permit# Account Description Amount Amt. Pd. Ual, Due `YlSt 4� j vim` Bldg. Permit (BUILD) Plumb. Permit (PLUMB) Mach. Permit (MECH) f-yc t42 ..210 � � Li. cV ✓ State Tax (TAX) C' a . Bldg: -�7, 7r Plumb: Mach- 1 ► e c rZ ,'}t v Plan Check �� wy Bldg: L, or Plumb. Mech: ,,ewer Connection (,3NUSA) Vd -� Sewer Inspection (StNINSP) Parks Dev Charge (PKSDC) Sud UO Residential TIF (TIF-R) 1q 2o —4.2 Mass Transtt TIF (TIF-MY) so Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF-0) Water Quality (%.IQUAL) Water Quantity (WQUANT) Fire Life Safety (FLS) Erosion Cntrl Permit (ERPRMT) �( Erosion Planck/USA (ERPLAN) 0 Erosion Planck/COT (ERCSN) ° (� At wo Ir.r..1.we 040 —-- HELM HEIGHTS BEING A SUBWASION � OF SECTION ,(I TOWNSHIP SOUTH, RANGE 1 WEST. WILLAMETTE MERIDIAN PS Ua.' CITY OF TIGARD. WASHINGTON COUNTY, OREGON =,i5aw G h ars i , • srP�k /.5 t♦; �O ' � � ...•NOOK i X� r w FAMILY ono. 1110 w w■I.o GAkAf.E ..INING a i DEN �. loio. o.o. J PARLOR 1 u.d. 4,1 L y, CT- 11316.6 or , 4 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-417 Business Line: 639-4171 J�s ` BLIP _ — _— Date Requested S AM PM 1 l— BLP Location `[ �-1� ,� / (Q Suite MEC — Contact Person �,�,Ui ✓� Ph _ ��1l �o PLM &WO-&�O(p 3 Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall -� ELR Footing Access: Foundation I FPS Ftg Drain SGN Crawl Drain Inspection Notes: --- - Slab _--_ _ A SIT Post&Beam --� Ext Sheath/Shear I _ Int Sheath/Shear Framing Insulation ' Drywall Nailing Firewall Fire SprinklerT- Fire Alarm Susp'd Ceiling -- Roof inal Final _ — Final PASS PART FAIL P MBII�G � Post& eam Under Slab Top Out —_— Water Service Sanitary Sewer Rain Ora,, s PART FAIL — — - ---- -_.__— _ `- MECHANICAL ---V--- Post& Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service _- Rough In UG/Slab Low Voltage _—. _.__-• - -_ -_- _ __-- -- _-e Fire Alarm --.--_-�_- Final PASS PART FAIL SITE Backfill/Grading - -�---- --------- _-------__._ ___. Sanitary Sewer Storm Drain [ J Reinspection tee of$ -_ -6,required before next inspection. Pay at City Hall, 131:_5 SVS'Hill Blvd Catch Basin Fire Supply Line [ )Please call for reinspection RF — __ [ ) Unable to in 5pect no access ADA Approarh/Sidewalk Date C L Other ___— Inspactor L/r `- Ext F!nal PASS PART_-FAIL DO NOT REMOVE this inspection record from the job site. CITY OF T I GA R PLUMBING PERMIT PERMIT#: PLM2000-00063 DEVELOPMENT SERVICE DATE ISSUED: 13125 SW Half Blvd.,Tigard, OR 97223 (503) 6 01R 1 PARCEL: 2S110BD-02500 SITE ADDRESS: 14943 SW 116TH PL ZONING: R-4.5 SUBDIVISION: HELM HEIGHTS JURISDICTION: TIG BLOCK: LOT: 002 CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 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: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN. ft Remarks: Installation of back`iow prevention device. FEES Owner: Type By Date Amount Receipt JIM CLAYPOOL PRMT DEB �3/ ;00 $25.00 0000358 14943 SW 116TH PL 5PCT DEB 3/1/00 $2.00 0000358 I IGARD, OR 97223 -- Total $27.00 Phone 1: Contractor: I'RYON CREEK LANDSCAPE INC 11400 SW NORTIA DAKOTA ST HGARD, OR 97223 REQUIRED INSPECTIONS RP/Backflow Preventer Phone 1: 624-2174 Final Inspect;on Reg #: LIC 00011525 PLM 6296 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 This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to fellow rules adopted by the Oregon Utility Notification Center. Those rules are set forth �n OAR 952-0001-0010 through OAR 952-0001-0080 You may obtain copies of th-se rules or direct questions to OUNC by calling (503) 246-1987. Permittee Sjg" - Issudd By: n . ed'the next business day Call (503) 639=4175 by 7:00 P.M. for an inspection need CITY OF TIGARD Plumbing Permit Application PlanCheplr# 13125 :5W HALL BLVD. Commercial and Residential Redd By -! TIGARD, OR 97223 Date Recd 503 6394171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# Related SWR# Called Name of DevelopmenVProject FIXTURES (individual) QTY PRSCE AMT Job Sink 11 .50 Address Street Address SM& Lavatory �- ^� 11.50 1 LA 9 13 -3LJI I to tc� 1• Tub or Tub/Shower Comb. 11.50 Bldg# City/Stale Zip Shower Only 11.50 Name Water Closet/Urinal (Specify) 11.50 ✓" C-\ nip Dishwasher 11.50 Owner Mailing Address &life Garbage Disposal 11.50 I -a ro IliLot-iLA11t, Washing Machine/Laundry Tray (Specify) 11.50 City/State ZIP Phone C,(i C r i Floor Dial /Floor Sink 2" 11 50 Name 3" 11.50 �w b" 11.50 Occupant Malting Address Suite Water Heater O conversion C like kind 11.50 _ Gas piping re uiras a separate mechanical permit. City/Stale Zip Phone MFG Home New Water Service 28.00 _ MFG Home New San/Storm Sewer 28.00 Name -Tr orj L2Zr/ y Hose Bibs 11.50 `�f1Cti 2nlY C.�wncxL. Contractor Mailing Address SeRain Drains 11.50 Me t t LA OU -5 rJ&wif V.1 e-4> -5 Drinking Fountain 11.50 Prior to permit City/State ZIP Phone Other Fixtures(Specify) 15.00 - Issuance,a copy j't 22 !02`x' ZI - uf all licenses are Oregon Const.Cont Board Lic.# Exp.Date -- required if (.02 A)-'Z,1 - olo expired In COT Plumbing LIc # Exp,Date database I Z, s C, "ls1 O V Name Sewer-1st 100' 38.00 Architect _ Sewer-each additional 100' 32.00 or Matting Address e Suite Water Service-1st 100' 38.00 - Water Service-each additional 200' 32.00 Engineer Clty/state Zip Phone Storm 8 Rain Drain-1st 100' 38.00 Describe work to be done: Storm&Rain Drain-each additional 100' 32.00 New X Repair O Replace with like kind Yes O No O Commercial Back Flow Prevention Device 32.00 Residential X Commercial O _ Residential Backflow Prevention Device' 1900 Additional description of work: 1, /� Catch Basin 11.50 LA-61 e Chet K_. C C, _�rr, K_I f insp of Existing Plumbing 50.00 Are you capping,moving or replacing any fixtures? perthr Yes O No 0 Specially Requested Inspections 50.00 If yes, see back of form to indicate work performed byper/hr fixture. FAILURE'TO ACCUPA?ELY REPORT FIXTURE Rain Drain,single family dwelling 45.00 WORK COULD RESULT IN INCF EASED SEWER FEES. Gr ase Traps 11.50 I hereby acAnowledge that i have read nis application,that the information QUANTITY TOTAL given Ila correct,that I am the owner or huthorized agent of the owner,and Isomutric or riser diagram Is required H Quantity Total Is >9 that PIens submitted are In compliance with Ore on State Laws v "SUBTOTAL �-( 71 Si aturgof Owner/Agent Date Z- 7.-cl -0 U - --- 7%SURCHARGE r r Contact Person Name Phone "PLAN REVIEW 26%OF SUBTOTAL 1 BATH I(OUSE$178.00 Required only a fy ixtureqty, total is-9 _ 2 BATH HOUSE$250.00 TOTAL 3 BATH HOUSE$285.00 (This fee Includes all plumbing fixtures in the dwelling and the first 100 feet of sunitary sewnr!storm sewer and water service) 'Minimum permit fee b$50 r ac surcharge,except Residential Backflow PreventionDevice.w;.ch is$25+7%surcharge "All Now Commercial Buildings require plans wtlh Isometric or riser diagram and plan review I hdstsuor nslpiumapp doc 7/19199 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced _-Remov Capped Sink Lavatory Tub or Tub/Show r Combination Shower Only Wates Closet Dishwasher Garbage Disposal Washing Machine Floor Drain/Floor Sink 2" 3" 4" Water Heater -Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I WiWformMplumapp doc 7/19199 State of Oregon Landscape Contractors Board Contractor Report For Registration No.: 6296 Report Produced: 03/01/2000 at 10:17 AM Name: TRYON CREEK LANDSCAPE INC 11400 SW NORTH DAKOTA ST TIGARD OR 9727.3-0000 (503) 624-2174 t'tatus: Active Expiration Date: 10/31/2000 Original License Date: 10/06/1993 License Type: Sod, Seed & Irrigat only Emplo,,'er Status: NON-EXEMPT Associated Names: Name Type: Name: _ — City: Corporation TRYON CREEK LANDSCAPE INC TIGARD Corporate Officer WERNER, STACEY Corporate Officer DURRELL, KEVIN LAKE OSWEGO This report was printed from information mirroring the Landscape Contractors Board's License database as of 07/01/2000. If you have any questions or would like more current information, please call the Board at one of the following numbers: Main Telephone: Ext. 4900 Registration/Renewal/Licensing (503) 378-4621 Ext. 4910 Claims Section Ext. 4974 Order Farms (claims packets, Voice Response System: registration/licensing packets, etc.) Ext. 4026 Enforcement Section (503) 365-7484 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BLIP — Date Requested_ ��> AM____PM BLD Suite 0)(V-3eLocation — Contact Persor, "�C' �� Ph PLM Contractor — Ph �S'WR BUiLDINr Tenant/Owner — C-C) ZL, Retaining Wall ELR Footing Access FPS Foundation - Ftg Drain SGN Crawl Drain Inspection Notes: — Slab _ �-� _ _ SIT' __— Post& Beam Ext Sheath/Shear Int Sheath/Shear i Framing -- Insulation Drywall Nailing Firewall UG' Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: — Final JX C t! S PASS PART FAIL- —' PLUMBING Post Beam Under Slab ----- Top Out Water Service — Sanitary Sewer _ Rain Drains --_—_ _-- Final PASS PART FAIL — WE-CHA C A L. Post& Hearn ---�-- ---__�__...._.--------- Rough in Gas Line — [S—Mo Dampers FART AI Rough In —�--- [JG/Slab Low Voltage Fire arn -------------._ PART Backfill/;riding Sanitary Sewer Storm Drain ( J Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Unable to Inspect-no access Fire Supply Line [ j Please call for reinspection RE: __ — — [ 1 ADA Approach/Sidewalk Date Inspector �2� —Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.