11145 SW 123RD PLACE f
11145 SW 123"' Place
CITY OF T'GARD 24-Hour
BUILDING Inspection Line-. (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171 61- p
Received __.-_____ -----.-Date Hequested _ AM_- ____ PM_ BUP
Location LlLZ�'_�.�� �� L" -Suite_ ---_-___ MEC
Contact Person ___ --___ - Ph(— ) _
-- _ PLM ,�_-�� � a
95
Cor,+-actor ___—_ - Ph( _) SWR -
BUILDING Tenant/Owner ;A-- EI - - -- - _--
Footing .d57) ?5 e3 oZ-s�;� ELC
Foundation Access:
Ftg Crain ELR -_ -----_-_--_-_--
Crawl Drain
Slab Inspection Notes: SIT - -
Post&Beam
Shear Anchors -
Ext Sheath/Shear �_-
Int Sheath/Shear
Framing --
Insulation
Drywall Nailing - -Firewall
Fire Sprinkldr -- --
Fire Alarm
Susp'd Ceiling - —"—
Roof
Other: -_-- —!�
Final ------------ c � .
PASS PART FAIL
PLUMBING -- - — -�—_ - --
Pu:.t&Beam
Under Slab --- — - - --
Rough-In
Water Service --- ------------- ---.-- —
Sanitary Sewer
Rain Drains ---- --W.- ------- ----- _ _
Catch Basin/Manhole
zitorm Drain --------- ------ - - --- --- —_ -
Shower Pa ---
Other: --------- -
PART FA_II.
Mt HANICAL_—_
Post& Beam
Rough-In
Gas Line
Smoke Dampers ----- --
Final
PASS PART FAIL —
ELECTRICAL
Service - --- -�._
Rough-In
UG/Slab
L,,.y Wltaoe ------ -- _ —.
Fire Alarm
Final Relnepection fee of$ _ ___.___required before next inspection. Pay at City Hell, 13125 SW Hall Blvd
PASS PAnT FAIL
SITE Please call for reinspection RE: Unable to inspect-no access
Fire Supply LineADA \�
Approach/Sidewalk Dab t � Inspector `� �"''� Ext
Cther:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002 002.95
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/26/02
PARCEL: 1 S 13408-09100
SITE ADDRESS: 11 145 )'W 123RD PL
SUBDIVISION: ANTON PARK ZONING: R-7
CLOrK: LOT: 053 JURISDICTION: TIG
CLANS 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 DRAIN:
J� SINKS_ URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISLIWASHERS: RAIN DRAIN: ft
Remarks: Install residential backflow preventer device.
FEES _
Owner:
Type By Date Amount Receipt
RATHKE, KAREN AN NE PRMT CTR 7/26/02 $36 25 272002.00000
11145 SW 123RD PL 5PCT CTR 7/26/02 $2.90 27200200000
TIGARD, OR 97223
Total $39.15
Phone 1:
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 6112-6076 RP/Backflow Preventer
Reg #: LIC 6136 Final Inspection
PLM 11559
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 re4juires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these riles or direct questions to OUNC by calling (503) 246-1987.
Issued By: Lr✓ Permittee Signature:LTi ---
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Pli.nnbing Perinit Applicatiola
\ —
Dat received: 1 A)
city of Tigard � Sewerperr•,ri!no.: Buildingpermitno.: -
Address: 13125 SW Hall B1 +OR 9� 3 Projecdappl.no.:_ ' Expire '
Phone: (503) 6394171 i 1 .+- (r
Date issued: 13y: (�(� Receiptno.:
Fax: (503)'598-1960 - --
l ? Casefileno.: Ynymenttypc:
Land use approvalf ,.
❑ 1 &2 family dwelling or accessory . Cl CommereiaUindustrial
U Multi-i'mr, ly ❑Tenant improvement
(New construction ❑Addition/alteration/replacement ❑Food srtyice. ❑Other.
1mom ' , . Fee ea. Total
t?cscripiion Qt ( )
p�
Job address: � � __Sin1 �2 r Cf New 1-and 2-family dwcllinls only:
— — Suite no.:
Bldg.nu.: (includes 100 ft,for each utility connection)
Tax map/tax lot/account no.: SFR(1 —
Lot:
bath --
Lot: Block: Subdivision: SFR(2) path
�- SFR(3)bath
Project name: �t to Each additional bath/kitchen
City/county: a 1 �: 23
' glteutllities:
Descr}�tion an . o,.ca iof gf�rC on premises: Catch basin/area drain
13 +._1 tii Dryvve}ls�/leEeh
Est.date of completion/inspection: <' S Z- Footin drain(r.' -)
' anufactured ties
Business name: a ,rA4 S Sr__ G. Manholes
Address: -9 F-/S 4XL) Rain drain connector
State- ZIP: 70 b S��y sewer(no,lin.ft.)
_ City: j ' G Storm sewer(no.lin.ft.) _
n
Phone:(D9a-W7(6all Fax—LIZ -qel E-mail: _
Water service nolin.ft.)
CCB no.: (o/3 Co Plumb.bus.reg.no: - Fixture or item:
City/metro lic.no.: 003Z- 7 Abso2�on valve -
�1 Contractor's representative signature: Back flow preventer '
Printname:F) J1r 9P AY-rzt-tz) Date: • Backwater valve
t Basins/lavato
Clothes washer _ I
Dishwasher
� Name: ---- -
^4 Address:Q.9 Q4_s�) KLO 'A Drinking fountains;
City: y00% 1 C. State:_ �': 0 E'ectors/sum _
Fhone:fUga-(o7b oFax:(ogj wail: Ex ansion tank
Flxhlr�sewer cap
Floor drains/floor sinks/hub
Name(print):s�ra (Y)011•s e ff— /ICM tS - Garba c daa osal
Mailing address: �ZD &1tw 00d ST t.�t- t b U Hose bibb --
City: [A Kiti� bunc: - I ZIP:q ce m er --
ne: Fax: E-mail: Interco tor/ ase tra
Pho
nwner installation/residential maintenance only: The actual installation Primers) _
will be made by me or the maintenance and repair made by my regular Roof drain�,utnmercial)
per as own ORS Chapter 447. i (s),Ltrsin(s), ays(s)
employee on the property I P P
Date: _ Sum
owner's signature: shower/shower pan_ _
Urinal
Name: aler c olet
Address: M ater heater --
State: —] Other:
a
City: .._— '- E-mail: oU
Phone: Fax
_ Minimum fee................S
Not alt iuriadlcdcoa accept credit rnda,please rail Jucirdictlon ror mote lnrorma ion Notice:This permit application Plan review(at %) $ U
expires if a permit is not obtained ...$
❑visa 0 MntetCard within 190 days after it has been
Ctedit card number.__ spites - accepted as complete. TOTAL ......................
— `-t wa o eardho der u tbown oncredi cut d _ S 4404616(6rt>nCOM)
Cerdhol r d tun Amount
PLUMBING PERMIT FEES:
�,- �.��.� ' Yj,�„ � �-�,: .�. � �• '- :=, � RCE �bT�O AL'
_F1XTU .tdl 11 ;Ll a1
Sink 16.60
Lavatory 16.60 4111 o ne j
Tub or Tub/Shower Comb. 16.60 One 1 bath _ $249.20
Tw�2Lbath $350.00
Shower Only 16.60 Three(3)bath - - $399.00
Water Closst 16.60 ------
_ SUBTOTAL ."*'r._ „.� ,�,:,• >
_
Urinal 16.0 8%STATE SURCHARGE
Dishwasher 16.60 PLAN r EVIEW 25%OF SUBTOTAL y ;,,• ,rix'}.
Garbage Disposal�- _ 16.60
TOTAL
Laundry Tray - 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 T
3"- 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion O like kind 16.60 ;I I A t o e ~'%i•
Gas piping requires a separate mechanical
pe It.
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatoa
Hose Bibs 16.60 - Tub or Tub,'Shower -
_ Combination
Roof Drains 16.60 Shower Onl
Ddnkit:, Fountain 16.60 Water Closet
Other Fixtures(Spacify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray V_-
__ --_-_--- -- Washing M- -le
Sewer-1st 100' -�_ 55.00 - Flour Drain/ Ink: 2" _
- 3"
Sewer-each additional 100' 46.40 4^
Water Service- 1st 100' - 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
ecif
Storm&Rain Dain-list 100' 55.00 - -
Stolm&Rain Drain-each additional 100' 46.40
Commercial Back flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55 27,c- - - --
Catch Basin 16.60 -
Inspection of Existing Plumbing or Specially 72.50
Requested Ins ectlons erRu COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling -65.25
Grease Traps 16.60
QUANTITY TOTAL / -
Isometric or riser diagram Is required If `
Quantity Total Is >9 _
`SUBTOTAL --•--.
0% STATE SURCHARGE
yo
"PLAN REVIEW 25%OF SUBTOTAL_
Re ulred only fixture qty total la>9
TOTAL ar S
`Minimum permit fee Is$72 50♦8%state surcharge,except Residential Barkllow
Piavention Device,which Is$ae 25•8%state surcharge
"All New Commercial Buildings require plans with Isometric or ns�r d�;xgram and
plan review
1:ldstslormstplm•fees.doc 10/10/00