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12160 SW 127TH AVENUE JAIGO .�� ,42V L/R cc J i��eccrds\microflm!!a�yc�slbuildin�.doc c� w J � CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 1/ ISG BUP Date Requested AM PM BLD _ Location_ Id-I& 6) S.4) /d-_7 i`L Suite �IIEG� �`�r`�-GrL��✓� Contact Person _ �� - 1�� (U Ph PLM _ Contractor Ph _ SWR BUILDING, Tenant/Owner ELC L Retaining Wall ELR Footing Access: y __ Foundation FPS�(�S ��(ti L S Ftg Drain SGN Drawl Drain [nspection Notes: Slab -- SIT Post&Beam Ext Sheath/Shear n r 1 Int Sheath/Shp • Framing f C1, J (.� Insulation ck f (L 1 Drywall Nailing ? i-- ,��d —.__— Firewall Fire Sprinkler — -- ----- Fire Alarm Susp'd Ceiling - — -tn-- Rout Misc:Final PASS PASS PART FAIL �_ ------ --- PLUMBING Post&Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains — Final - ------- - PASS PART FAIL MECHANICAL --—_-_.T—_ ---- - Post& beam -.- - -- — Rough In Gas Line -- ----- ---- --- — — Smoke Dampers Fiinall, - -- —.--------- — — f�A55 PART FAIL, Service Rough In �z UG/Slab -- s Low Voltage v~i Fire Alarm ------- T Final �- PASS PART FAIL ---- _— --- -- ---- — SITE _ Backfill/Grading ---- —�— �— LU Sanitary Sewer -' Storm Drain [ ) Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hal Blvd Catch Basin [ ) Please call for reinspection RE: _ [ �Unable to inspect-no access Fire Supply Line -- - - — ADA ' Approach/Sidewalk Date 4 Inspector --- Ext�� t Other '— Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP _ Date Requested AM —PM BLD _ Location / L,Z, 7 �� Suite MEC Contact Person _ _ Ph _—_— — PLM Contractor — _ Ph _ SWR BUILDING Tenant/Owner � /� o:•�,t.7' "�v� - ELC ,L Retaining Wall _ ELR Footing Access: Foundai�,n FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab _ �. SIT Post&Beam — - Ext Sheath/Shear _ Int Sheath/Shear Framing - Insulation Drywal!Nailing Firewall /�- Fire Sprinkler Fire Alarm Susp'd Ceiling — Roof Final PASS PART FAIL — '--z !- �n yN 1J�� ON v a/`Q Yeti LA P�I PLUMBING 7- 13 P- � n � N? l J Post& Beam / / Under Slab .S'/jFJ vl� L2�Lir _ C ki g-- 14 e ✓C' 'q Top Out — Water Service — Sanitary Sewer Rain Drains / y- 16 Y C C r• - Final P T FAIL h — MECHANICAL Post& [ream -K�e_�,_��c� � S 1_� Rough In -/ Gas Line ---- ----- Smoke Dampers +^ Final — - -- --�- ,4%9S--PART FAIL ELECTRICAL -- _ — Rough In ----- LL UG/Stab s Low Voltage Fire Alarm 7- FI �- A 54 SSJ PART F,-1L - J S Backfill/Grading Sanitary Sewer Storm Drain ( ) Reinspection fee of$ _ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ) ) Please call for reinspection RE: I ] Inable to inspect-no access Fire Supply Line ANDA Approach/Sidewalk Date Zt l Inspector1�4-zl . _Ext Other Final PASS PART FAIL DO NOT REMOVE this Inspection record from the Job site. 7 CITY OF T!GARD BUILDING INSPECTION DIVISION ,,T 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 — --- l BUP Date Requested 4�/(_57/Q9 AMS'� PM — BLD — Location U S"t .) /d-7 Suite _ ME Contact Person )L( te(WO- - PhLPLII Contractor Ph SWR BUILDING Tenant/Owner ELC _ Retaining VVall ELR rl 0i Footing Access: Foundation �V FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing t �,( � - CIL, (L: z� i1 , t' `-1' Insulation I „ �- 2 �--� - Drywall Nailing y Firewall ` - Firewall Fire Sprinkler -{- Fire Alarm �--'f/`� ✓✓� .vim, L� ��G-. /� e��--v��Lt�..LJ� Susp'd Ceiling �L { Roof Final PASS PART FAIL - PLUMBING Posft geam - Under Slab -- Top Out Water Service _.- Sanitary Sewer - Rain Drains 1� ART FAIL -- CHANICAL Post A Beam --- Rough In Gas Line -- - --- - ----- -- Smoke Dampers Final - — --- - - - --- -- _ PASS PART FAIL ELECTRICAL -- ---- ------ ___ --- --- — __.— .——_ Service ----- Rough In UG/Slab Low Voltage ►- Fire Alarm _ - - -- - Final F PASS PART FAIL _ --- - --- - ---- _, SITE Backfill/Grading Sanitary Sewer - LU J Storm Drain [ ] Reinspection fee of$ required before next inspection. Poy at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ 1 Please call for reinspection RE: _- [ ] Unable to inspect-no access ADA ,� Approach/Sidewalk Date 1 7 `�C1 Inspector \_ Vel. L� Ext�Ll Other = -� Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITYOF TIGARD MECHANICAL PERMIT DEVELOPMENTSERVICES PERMIT#: MEC1999-00542 /1999 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/0 PARCEL: 2S 104AA- 4AA-08800 SITE ADDRESS: 12160 SW 127TH AVE SUBDIVISION: BELLWOOD NO. 2 ZONING: R-4.5 BLOCK: LOT: 097 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: _ FUEL TYPES_ 0 - 3 HP: DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: FIRE DAMPERS?: 30 -50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOOD STOVES: < 100K BTU: AIR _HANDLING UNITS CLO DRYERS: S: OTHER TS: FURN >=100K BTU: 1 <= 10000 cfm: `^ > 10000 cfm; GAS OUTLETS- 1 Remarks: Gas furnace and gas piping Owner: _ FEES _ SMITH, DONALD A Type By Date Amount Receipt 12160 SW 127TH AVE PRMT BON 12/08/19 $50.00 99-320260 TIGARD, OR 97223 5PCT BON 12/08/19 $4.00 99-320260 Phone: Total $54.00 Contractor: MIDWAY HEATING CO 12625 SE SHERMAN PORTLAND, OR 97233 REQUIRED INSPECTIONS Gas Line Insp Phonc:252-4003 Misc. Inspection Reg#:LIC 00024044 Final Inspection ORIGINAL_ This permit is issued subject to the egulations contained in the Tigard Municipal Code. State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is J no; started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189. Issue By: l 1 1," ' c -- Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for inspections needed the nVkt business day weas�aa� Plan Check 0 CITY OF TIGARD NfMGY real Permit Application Recd By e` 13125 SW HALL BLVD. DEC Cq1� gavial and Residential Date Recd TIGARD, OR 97223 Date to P E. (503) 6394'171, X304Date to DST _ COMMUNITY UEVELOPMEIVI PermitN 1�✓��=C(�i`t`I C?L7�i�(L Print or Type Called Incomplete or illegible applications will not be accepted Name of(eveiapment/Proiect Descnptl)n Table 1A Mechanical Code CITY PRICE AMT Job Street Address 3zaxes A) Permit Fee -0- -0- 1000 Address M/�;L) -id,al-' /" '7 Bags Cxyrstata Zip B) Supplemental Permit 3.00 Name,or name of business) 1 ) Furnace to 100,000 BTU 6.00 Owner L. . S enc v inr,1,ducts&vents 4 Mailing Address 2) Furnace 100,000 BTU+ 7.50 /21'7 incl.duds&vents Citylstate Zip Phone 3) Floor Furnace 6.00 I''y 7,221 -3 incl.vent N (or name of business) 4) Suspended heater,wall heater 6.00 �Y T or floor mounted heater Occupant Mailing Address 5.) Vent not incl.in 3.00 appliance permit Crtylstate Zip Phone 6.) Boiler or comp,heat pump,air cond. 6.00 to 3 HP;absorp unit to t00K BTU" Contractor Name 7.) Boder or comp,heat pump,air Gond. 11.00 (Prior to :[>Q 3-15 HP absorp unit to 500K BTU issuance Mailing Addraa! 8.) Boiler or romp,heat pump air cond 15.00 applicant �lk IW Sv -1c _15,30 HP,absorp unit.5-1 mil BTU" must provide all cvstate Zip Phone 9.) Boiler or comp,heat pump,air cond. 22.50 contractor /< �,, , 1/' J1 33 �xt 30-50 HP;absorp unit 1-1.75 mil BTU" license Oregon Conn,Cont Board Lits Exp Date 10.) Boiler or comp,heat pump,air cond. 37.50 information 4"/,-'1117-1J` d7.Z•U (,1 >50 HP;absorp unit 1.75 mil BTU" for COT COT Busom Tax or Metro 0 Exp.Date 11 ) Air handling unit to 4.50 _database) 10.000 CFM Architect Name 12) Air handling unit 7.50 10,000 CTM+ or Mailing P.(Jdress 13) Non portable 4.50 evaporate cooter Engineer crtyrState Zip Pnone 14.) Vent fan connected�v^ 3.00 to a single dud _ Describe work New O Addition O Alteration�k Repair O 15) Ventilation system not 450 to be done Resxientidl k Non-residential O included in appliance permit Additional Description of wdrtt 16) Hood served b, nitechanical exhaust 450 O 17) Domestic incinerators T-50 — Existing use of 18) Coniffwrcial or industria" 3000 building or property Pte.[-CJt`�gkPJ incinerator _ 19) Repair units 4 50 Proposed use of 20) Wuodstove 450 budding or property 41 dlGLi.ra-Cryo i_ o _ 21) Clothes dryer,etc. _ _ 4.50 Type of fug 1-oil O natural gas LPG O electric O 22) Other units i 450 I hereby acknowledge that I have read this application.That the 23) Gas piping one to four nutlets 2.00 information given is correct.that I am the owner or authorized agent of % J the owner that plans submitted are in compliance with Oregon State 24) More than 4-per outlet (each) .50 laws = Signature of Owner/Agent Data , QTY.SUBTOTAL w IJ el 'SUBTOTAL Contact Person Name Phone V!.SURCHARGE PLAN REVIEW 25%OF SUBTOTAL z=� r TOTAL Idst'mechpmt doc (rev 7196) Mlnlmum pe it fee is S25+5%surcharg "Residential A/ squires lite plan showing placerrient of unit. '�` CITE' OF T I GA R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM1999-00414 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: PARCEL: 2S 104AA-08800 SITE ADDRESS: 12160 SW 127TH AVE SUBDIVISION: BELLWOOD NO. 2 ZONING: R-4.5 BLOCK: LOT: 097 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 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: 'NATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Water heater conversion — _ FEES Owner_ Type By Date Amount Receipt SMITH, DONALD A PRMT BON 12/08/1990 $50.00 99-320260 12160 SW 127TH AVE 5PCT BON 12/08/1990 $4.00 99-320260 TIGARD, OR 97223 _ -- Total $54.00 Phone 1: Contractor: MIDWAY HEATING CO 12625 SE SHERMAN PORTLAND, OR 97233 REQUIRED INSPECTIONS Phone 1: 503-252-4003 Misc. Inspection Reg#: LIC 24044 Final Inspection PLM 26-542PB ORIGINAL Ln This permit is issued suhject 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 we rk is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9:52-0001 -0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. �t Permittee. Signature: ) �: 1Ln t It 112, Alne Issued By: g l i I(� Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next uslness day CiTY OF TIGARD Plumbing Permit Application Pla^Check* 13125 SW HALL BLVD. RECEi%IEa Commercial and Residential Recd By-, rIGARD, OR 97223 Date Recd 17 1 (503) 639-41711999 Date to P.E. -_ pE� 7 Print or Type Dato DST rini►#( ��t°�°l. C0jpgwWPW*Wlegible applications will not be accepted PeRenmit ' WR Called ----------- - ---- -- ------ - Name of Dove lopment/Project FIXTURES (Individual) ; QTY'y. PRICF• :AMT Jab Sink 11.50 Address Street Address Suite Lavatory - 11.50 I 1,1/loD /2'7 'I ub or Tub/Shower Comb. 11.50 T Bldg# at /State Zip -- - � Shower Only 11.50 /c.•ad�r ,�.e 712 - ---- -- - Name WaterClc. AlUrinal (Speci_y) _ 11.50 Dishwasher 11.50 Owner Mailing Address Suite Urinal 11.50 /.�/C /.A 7 Garbage Disposal - - 11.50 tate Zip Phone J y.7lL`3 `7'x,7 Laundry Tray - - 11.50 - N 1 Washing Machlnz/Laundry Tray (Specify) 11.50 rYLTh�� Floor DrairVFloor Sink 2" 11.50 Occupant Mailing Address Suite 3° 11.50 City/State Zip Phone a•' 11.50 Water Heater conversion O like kind 11.50 rime _ - Gas piping requires a separate mechanical ernllt. _ f�i, C2d MFG Home New Water Servlt;o - _ 28.00 COntr-Ctor Mallln',7 Add& 's ( Suite MFG Home New San/Storm Sewer - 28.00 L' -'�ja dlirl�4rifo-rsJ Hose Bibs 11.50 Prior to permit CI /Slate Zip Phone Roof Drains Issuance,a copy e-XI!�9710� Drinkfng Fountain 11.50 of all licenses are Oregon Const.Cont.Board Lic.* t=xp.Date - -- - required if ��(y�r/ '= _�� Other Futures(Specify) _ 15.00 expired In COT Plumbing Llc.* C•xp.Dale database /.z Name - Architect _ sewer-1st 100' - - 38.00 or Mailing Address Suite Sewer-each additional 100' 32.00 Engineer CltylState Zip Phone - Water Service-1st 100' 33.00 g Water Service-each additional 200' 32.00 Describe work to be done: Storm&Rain Drain-1 sl 100' 38.00 New O Repair'* Replace with like kind: Yes 0 No 0 Storm&Rain Dialn-each additional 100' 32.00 Residential X Commerclal O - Commercial Back flow Prevention Device 32.00 Addirtaio�na�l.'dpesuripllon ofwork: � Residential Backflow Prevention Device- 19.00 '"'s"'� y Catch Basin 11.50 Are you capping,moving or replacing any fixtures7 Insp.of Existing Plumbing or Specially Requested 50.00 Yes 9( No O Inspections I perthr If yes, see back of forst to indicate work performed by Rain Draln,single family dwelling 1 45.00 fixture. FAILURE TO ACCURATE-u( Z7-::'0-RT FiXTtIFtR Grna,n Traps ce t^10RK COULD ;L1L f!li INCA' ) r rrf' rS -- - - - _ -- - --- CIUAN rITY TOTAL i t rrL�n } , ,:, . • r, and I I>c-na;rl;or rlsr_r d aqam Is rnqu�rai�f Cu3nt tr int9t Is �9 w 2 PA-i' Torn!. �m 3 BATT, -=- „(Tfiln%,r,InLItldr o all pIlirnih!rtfl.fl3tv14 fn 1h d Jct ) IMI nl,num pormIt toe is E`150+67.7::uiMir,; except Restdentlal Sack1'nw PrewmVen r 100 fact al sJnttary nnwor sfurm�Sawe and veatpl Bn 0:�. . . .., ._r', ' Devlce,%bkfi 15325♦8%sur-barge "All New Commercial Pulldings require plans whh i.emetric or riser diagram and plan revinw. �dstsVoremslrlumapp.dec 1011199 .rM.. • CITY OF TIGARD DEVELOPMENT SERVICES ELECTRICAL PERMIT PERMIT #: ELC96-0664 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 10/18/96 PARCEL: 2S 1 O4AA--O88O0 SITE ADDRE'ISS. ., . 12160 SW 127TH AVEC SUED I V I S I ON. . . . : BEI__L.WOOD T I Z ON I NG:R--4. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :97 Project Descr-iption : Installing first branch circl.rit and 2 add' I branch Circr.rits ----RESIDENTIAL_ UNIT--.--•- ------TEMP SRVC/FEEDERS---- -----MISCELLANEOUS-----_-. 1.000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. 0 EACH ADD' L- 5O0SF. . . : 0 E*Vi I - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 800 amp. . . . . ., . : 0 SIGNAL./Pc)NEL. . . . . , . : 0 MANF. HM/ SVC/FDR. . : 0 601+amps--•1000 volts. : 0 MINOR LABEL ( 10) . . . : VJ -- --SERVICE/FEEDER- _. __...._._BRANCH CIRCUTTS.--.----- ----ADD' L... INSPECTIONS--- 0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 c'O1. -- 0 amp. . . .. . . . 0 Ist W/O SRVC OR FDR. . 1 PER HOUR. . . . . . . . . . . . 0 4.01 - 600 amp. . . . . , 0 EA ADD' L 5RNCH CIRC: 2 IN PLANT. . . . . . . . . . . : 0 601 - 1.O1710 amp. . . . : 0 --____._____.___.____F'l._AN REVIEW SECTION- - -__.___.___.__-____ 1000+ amp/volt. . . . . : 0 > =4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR > = 225 AMP'S. . : CLASS AREA/SPEC OCC. Ownis r: ------__._._----._..._._._.__..._...-___.______ -____--_--.___-.---------._.--- FEES FLORA LANSING type amoi.tnt by date recpt 12160 SW 127TH PRMT $ 45. 00 B 10/18/96 98-285352 5 P C T 4 El. 2F) B 10/18/96 96--285352 T I GARD 9R 972, Phone #: Contr^actor: ____________________._______..____.____.._---._--.------_--.--___----_---_--__- PORTLAND STATE ELECTRIC $ 47. 25 TOTAL PO BOX 14646 REQUIRED INSPECTIONS -- - - PORTLAND OR 97214 Ceiling Cover- Under-gr-ol.rnd Cove Phone #: 503-233-8030 Wall Cover Elect' 1. Service 96644 This permit is issued subject to the regulations contained in the t__ _ Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t t e e�S i gnat r.rre applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is ;got started within 180 days of issuance, or if work is suspended for more _�__ _ _V_ than 188 days. I s s l-red By T INISTALLA T I ON The installati.cn is being me{de on property I own which is not intended f..,r, sale, lease, sir tent. "' nWNER' S SIGNATURE: _ DATE: INSTALLATION ONLY--------------_.--------__-__ SIGNATURE OF SUPR. EI._EC' N: MW � DATE: J LICENSE N0: Call for inspection - 639-4175 • Community Development ELECTRICAL PERMIT APPLICATION / 13125 SW Hall Blvd. Tigard, OR 97223 Permit # L 1 h (C- Date Issued . I4 Phone (503) 639-4171 CITY OF TIGARD FAX (503) 684-7297 TDD No. (503) 684-27,2 Inspection (503) 639-4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development______ Number of Inspections per permit allowed Address ��_Q. 13W � �] � Service includod Items Cost(ea) Sum City/State/Zip_ �� —.___ 4a. Residential -per unit e 4 1000 sq. ft or less $11000 Name (or name swessa 11 Each additional sq ft or $25 00 r portion thereof _—�--- 1 commercial L'� Residentia Limited Energy ^_ $2500 Each Manurd Hume or Modular Dwelling Service or Feeder 388.00 2a. Contractor installation only: 4b. Services or Feeders �" Installation,alteration,or relocation Electrical Contr for �[� � �lc 1'�C• _ 200 amps or less $eo 00 _ 2 Address " x lel U l( p � 201 amps to 400 amps $$80 00 _ 2 Cit Stat K Llp_ —s� 1 U 401 amps to 800 amps $180.00 2 y r� �r�_ J�• —L 801 amps to 1000 amps Phone No..1A' NU-it ___ Over 1000 amps or volts $340 0 2 2 Reconnect only $50 00 Job NO. LL-�,(0 — -- contractor's license NO._Adg--- 'ye - 4c. To)mporary Services or Feeders Contractor's Board Reg. No. fj V Llt4 __ Installation,alteration,or relocation 2 Signature of Supr Elec'n *1 T1_ __ 200 amps or less 201 amps to 400 amps $50.00 2 License No._rtjj!5_-a Phone No.,93�• 403 Q 401 snips to 60U amps $7500 2 Over 600 amps to 1000 volts $10000 -- 2b. For owner installations: see"b'•above 4d. Branch Circuits Print Owner's Name New.alteration or extension per pane Address e)The fee for branch circuits with purchase of service or reader res. City State Zip _ Each branch circuit $5 0 Phone No. __ h)The fee for branch circuits without 2 The installation Is being made on property I own which is purchase of service or feeder fee. ' �,�,– 2 Firsnot intended for sale, lease or rent. Each branch circuli _ $ Eh additional $500 lanal branch circuit � SSW 1 r7 pp Owner's Signature _ -_- 4e. Miscellaneous (Service or feeder not included) Each pump or irrigation circle $40.00 2 3. Plan Review section (if required): Each sign or outline lighting $4000 2 Signal clrcuH(s)or a limited energy Please check appropriate item and enter fee in section 5B panel,alteration or extension $40.00 4 or more residential units in one structure Minor Labels(10) $10000 Service and feeder 225 amps or more 4f. Each additional Inspection over System over 600 volts nominal Classified area of structure containing special occupancy the allowable In any of the above — rn Per as described in N.E C Chapter 5 Per hour hourinspe(I n $35 00 p $55 00 In Plant $5500 Submit 2 sets of plans with application where any of the above apply Not required for temporary construction services. 5. Fees: r�• 5a. Ent.r total of above fees g �7• 00 04 NOTICE F A Surcharge (.05 X total fees) 5 as W subtotal g l 1• a ti J PERMITS BECOME VOID IF WORK OR CONSTRUCTION 6b. Ental 25% of line A for AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Plan Review if required (Sec.3) $ CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS - COMMENCED gym.°merww. ❑ Trust Account fl Balance Due $ CITY OF TIGARD DEVELOPMENT SERVICESPILUMBING PERMIT P,ERMIT #. . . . . . . . P,LM96-0307 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: :i0/17/96 PARCEL: 25I.Vi4AA-08800 SITE ADDRESS,, . . ;: 12160 SW 127TH AVE SILJBD I V I S I ON. . . . : BELLWOOD 11 ZONING. R 4. 5 BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :97 CLASS OF WORKI. . .ALT GARBAGE DISPOSALS. : I MOBILE HOME SP'ACE'S. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUPANCY GRP,. . : R3 FLOOR DRAINS. . . . . . . 0 TRAP'S. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 FIXTURES—___.____..__.____ LAUNDRY TrAYS. . . : 0 SF RAIN DRAINS. . . . . : 0 G.)INK5. . . . . . . . . . : I URINALS. . . . . . . . . . . : 0 GREASE TRAP'S. . . . . . . . 0 LAVATORIES. . . . . : I OTHER FIXTURES. . . . : 0 TUD/SHOWERS. . . . : I SEWER LINE (ft ) . . . : 0 WATER CLOSETS. . . 1, WATER LINE (ft ) . . . : 0 DISHW"SHERS. . . . : I RAIN DRAIN (ft ) . . . : 0 Remai-l-(s : Owriet,: FEES 1':-I-.ORA LANSING type amount by date r,ecpt 1 .,_160 SW 127TH P,RMT $ 54. 00 DRA 117.1/17/96 96-285324 5PICT $ 1--. 70 DRA 10/ 17/96 96-285324 1IGARD OR 97223 Dfione #- Contractor: ------------------------------ VAST P,LUMBING INC lw-.,6!�O SE PARK AVE MILWAUKIE OR 9722c" I.-fione 4; $ 56. 70 TOTAL Reg #. 7L629 REOUIRED TNSPIECTIONS -------- This permit is issued subject to the regulations contained in the Rai.igF in T n s p Tigard Municipal Code, State of Ore. Specialty Codes and all other PLM. Undet-f I aor- applicable laws. All work will be done in accordance with Top—oi.tt Insp approved plans. This permit will expire if work is not started Final Inspection within 180 days of issuance, or if work is suspended for more than 180 days. C4 1,M j.t t e 73,1 sp at 1-1 t-e I S S 1-1 P d Call fat, inspection 639-4175 UJ J -!TY OF'TIGARD Plumbing Application Recd By. 3 125 SW HALL BLVD. Commercial and Residential DaleRecd -f 7 -IGARD, OR 97223 Dale to P E /} a03) 639-4171 Data to DST f Permits nH -C) 7 Print or Type Related SWR a Incomplete or illegible applications will not be accepted Called Name of Development/Ptolecl [F, S (Individual) QTY PRICE AMTSJob 9.00 Street Anrress Address '1 Swte 9.00 I Z i�V >t1/ 17 '1 fes' iShower ComU. 9 00Bldg a City/stateZip ly 9.,set Name 9.00 �, 0r 4.00 Owner MaJkV Address 5uda isposal 9 00 __ ) 1_ 2�'� Washing Machine 9.00 CftylStaM ZIp Phone Floor Crain 2• 9.00 p�yry 3• 9.00 4• 9.00 C►ccupant Me"Address Suite Water Heater 900 Laundry Room Tray 900 City/State Zip Phone Unnal 9.00 Name Other Fixtures(Specify) 9 ,00 Sc,n/t rys' h r 9.00 .oAl"ctor Mad4+g Address Suite 9M :' X50 .3 Lo Ari( sop citvfstate Zip Phone 01J.J.4,1 0r0 t�777Z Sy- 9.00 Of9gor Const.Cont.Board Lica Exp.Date 9.00 AillaicA Dopy of '7 'e 2 C -2 V - - 9 00 CWMM Pkanbing Uc a Exp.Date L/ P Sewer-Ts 100• 30.00 Sewer-each additional 100' 2500 COT Business Tax or Metro s I Exp.Date _ Water Service-tst 100' 30,00 i I _ Name Water Seance-each additional 200' 25.00 Architect Storm d Ram Drain-1st 100' 3000 Or Mailing Address Si.,1e Storm 8 Rain Crain each additional t00' Y5 00 I I— Mobile Home Space 2500 EngineerI �-•MState Zip Phone Commercial Back Flow Prevention Device or Antl- 25.00 Pollution Cevice esicibe wont Vew O Addition O Alteration Repair O Residential Bacitflow Prevention Device, 15.00 I be done: Residenhal`� Von-residential Any Trap or Waste Not Connected to a Fixture 900 J �ldieonM Oescnpuon of worts Catch Basin ;.;t0 �I insp of Existing Plumbing 4000 1 dl',) i (4,j r S r I (1T r1 s r /s �r n oenhr Specialty Requested Inspections 40.00 !- sang use of oenhr -dkq or property y Rain Crain.single family dwelling 3000 ,Dosed use of Grease Traps -� -ding ar property _ _ QUANTITY TOTAL C .,got:capping. moving or replacing any fixtures? Yes) No 0 Isometric Of riser 21891`111n+a Maur"a Cuan4y Total is 9 J Yes sae back of fnrml 'SUBTOTAL ,rebv acxnowledge that I ha-,e read this application,that the information .n,s onect.:nat i am the owner or authorized agent of the owner. and 5%.SURCHARGE 70 t Clans submitted are-n compliance with Oregon State Laws. 777 , of ne t - Dat. PLAN REVIEW 25%. OF SUBTOTAL /. , , � / peauYeC pati R ilrtixe oty rotas's>_3 if)`I r?- 96 TOTAL ,hdla Pireom Name Phone fWlnlmum permit fee is S25-5%surcharge.except Residential Backflow Prevention Cev,ce.which s S 15•5%surcharge iWststplmapp doc 5198 Pt.EAS COMPLETE ASAPPROPRIATE TO PROJEC-T: Fixtures to be c� Oned, moved or replaced City Sink ' Lavatory _ Tub or Tub/Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain 2" 3" Wate, Neater _. Laundry Room Tray / Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: J J