12395 SW 68TH AVENUE ADDRESS:
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. CITY OF TIGARD C:ERTIFICATE OF
COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY
13125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)839-4171 PERMIT #. . . . . . . : BUP94-0151
u•;i ,r.L ."1 DATE ISSUED: 04/04/95
PARCEL:: ��101 AA--21dt':i00
� 1 L ADDRL.�,�. , . j 12395 W 66TH AVE
I.1PIiIVIGIf_1N. . . . : WEtET PORTLAND HEIGHT,a ?ONING:C;-F'
,_nCK. . . . . . . . . . LOT. . . . . . . . . . . . . :2E
.A t-', OF WORK.. :ALT.
YPE: Cif- USE. . . :COM
OCCUPANCY GRP. :Etc:
OCCUPANCY LOAD: 14
..:NANT' NAME. . . : RI CHARD LOU I E:. PHOTOGRAPHY
marks :
,ner: _...... ._..__._..___._ .. ........_.___ _.._..._.._ ..__.__._..._..�_..___.__.
(CHARD LOUIE
160 SW BOMAR CT.
1 GARG Of? 97223
r•r,a #: 246 -5376
,BE,R,r JOHNSON CONSTRUCTION
^', 'S. E. 322ND STREET
ul i T1UALE OR 97060
l)nne #: 663--1330
Reg #. . : 53946
Occ:ljl?nnc•y of the above referenced bl_lilding i4 hereby given, incl cart i.fies
the compliance with the state nF Oregon '3peci�:111;y Ccpies for, the gr-01.tp,
occl_1p�rncy, and use under, which the referenced per it was iSSLl +C1,,
RUIL_DING INGPECTOR _. L. I OFFICIAL _....._.__....._.._
POST IN C01'sI iP I CUOUS PLACE
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Pho� c.ne : 639-4175 Business Phone: 639-4171
Inspection:
/ e 'Q' -e
Fabling Susp. Ceiling Sprink. Rough-in Appr/Sdwik
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in INA
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. UnLlerfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: ��� Time: AM PM
Address: i� 957 6.P 7�4 , y
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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AInsp ctor:_ Date: �
PPROVED _DISAPPRC`VEC —APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appi/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in INA
Post/Beam Mech. San. Sewer Gas Line Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation Mec
Underflr. Insul. Shear Wall+ Gyp. Bd -Elect.
Date Requested: � 7?� Time: AM PM
Address: /2? ' S�� FJ ��C/s✓
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Insp torr Date: `�'-
_APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
V
_Call For Reinsp.
APPLICATION - STREET IMPROVEMENVEXCAVATION COPY TO:
ORDINANCE NO, 74-14 �, . L• X (WHITE)-FILE
(PINK) OTHER AGENCYI7ldg
(INSTRUCTIONS ON SEPARATE SHEET) (j IX (BI_UE)-APPLICANT
APPROVED ® APPLICATION NO.: 671
NOT APPROVED E CI I Y OF T'IGARD, OREGON FEC AMT.: S 16.00
PENDING FEE. PMT. [] CI I'N' HALL RECEIPT NO.: -i -,)-S 11)63
PENDING SECJRITY ❑ PUBLIC WORKS DEPARTMENT BY -. DATE�'0'1 14
-
PENDING AGENCY ''OK'' E] Applicationand PTogTcss Rccord MAINTENANCE BOND u
PENDING INFORMATION El FOR STREET IMPROVEMENT/EXCAVATION AS REQUIRED
ANNUAL
PENDING VARIANCE ❑ EXPIRATION DATE: /
PERMIT NO. DATE ISSUED (-L -1 'aBY:
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL �;'_i_ 'ELCO UNDERD __
STREET-CROSSING AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT _RiChard C. Louie - 12395 SW 68th Parkway Tigard, OR 97223 968-27:8
NAME ADDRESS CITY 'PHONE
CONTRACTOR Bob Johnson 11025 SE 322nd Ave. Troutdale OR 9X60 6.63-1330
NAME ADDRESS CITY PHONE
PLATS BY per City Standards/Smcificsations
NAM ADDRESS C17 Y PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST); $ 400.00
_ DOLLARS
(2) EXCAVATION DATA: FDR o-�i used -- MIN.
0.04 X S 400•S, _.-._ - S 16.00
STREET DESCRIPTION _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLEC ITEM DATE REMARKS/TYPE BY -
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
STREET
PENEU
Fcimiklin St. led INSPEC-
R TION
E
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ESTIMATED STREET OPENING DATE, / / - S
T ---
E^T;MATED STREET CLOSING DATE: _ / E
- -- -__ - - -- _---- D
(3) SECURITY NO. 400.00 STREET ~
-_ _ -- SECURITY AMT $ _ . GLOSEn
SURETY CO.: FINAL -
CERTIFIED CHECK CASH_? _BOND �� INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL r —�- SPECIAL PROVISIONS / CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
see attached
--
I I I 1
(SDR 94-0010 applies)
S.LJ, 68th [,a kway —
N
— -- work ar�a-Z►-
Lo I
I lSITE: 12395 SW 38th
LI Parkway
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(5) NOTE, THE CITY OF TIGARD DOES NOT. HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT (117-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON
THE ;,PPLICANT AGREES TO DEPOSIT "SHG REQUIRED SECURITItS, TU COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPEC I FFICA TIM43 PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE N.HICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE 'G DATE
r
INSPECTION NOTICE
City of Tigard Building Department /
13125 SN Hall Blvd. Tigard, Oregon 97223 /
Inspection Line (rec-O-P�hone)s 639-4175 Buaine� Phones 9 71
Inspections`_ �-
Footing Plbg. Underelab Hoch. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line INAL
Poat/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation +luml!•
Plbg. Underfloor Water Line Gyp. Bd. -Mech./
Date Requestedt / ";t"! 1 15 -Times AM __PM
Permit /i��- /� .3
Builder: "
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:
PROVED
DISAPPROVED APPROVED SUBJECT TO ABcri►t�
Call For Rainap.
jNSPECTZON NOTICE 10
City of Tigard Building Department;
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-41.75 hoie9-
l `_
Inspecticn: /�7 / �" .'C/ /'
Footing Plbg. Un4erslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line ` PINA
Poet/Beam Struct. San. Sewer Framing
Post/Beam Mach. Rain Dral.n Insulation lumb.
Plbg. Underfloor Water Line Gyp. Bd. - ech.
Date Requested:__- 1 Time: AM PM
AddrAse: l v /. j permit #I `C)I
Builders D tom" 13--36)
THE FOLLOWING OORRECTIONS ARE REQUIRED:
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Inspector: _ Dater
APPROVED DISAPPROVED APPROVED SUBJECT TO AAOVE
_Call For Reinep.
CITY OF TIGARD
rF:MPl:1
COMMUNITY DEVELOPMENT DEPARTMENT
OF OCCUPANCY
CERT I F T C�aT E.
13125 SW Hsh Blvd.Tigard,Oregon 97223.8199 (503)839-4171 Or
%x:39-'41:1. DATE IOG!JEI:r: /Z 1271 7
1ED I V I.;I ON. . .. : WU T 00 RTL_AND HEI GHTEt ZONING: r �
rlCt';. . . . . . . . . . : I-OT. . . . . . . . . . . . . :22,
411.; CA, IJUE:. . . :COM
:CI.JPA11CY GRP. :Lte?
:C:LJP0NC>' LOAD:: 14
I':1q'dNT HOME— . 'f(I CHU4110 Lr 11A PH(11'0611APl y
ama0l-,!„ f TEAPOPHRY 01.1 C11'fINLll F014 �..�»_Q DflYf_r r 1�'C.IM 111(rF tJF J;�r Ur�hli;E.
:0 Doe' TCihf'GRAPY C:f::f0 TF((7A1 f- (31' OCCUPANCY (5PANT11) ('1'! 1.2/27 4 TO AL All � !
--0
f hl l ai l ,r?13AD > htr'r>C1VF..`ML P I1" :i,; rrim,,I NG LOT, OND LfaNDI')C APING.
L1IAI I-) L.0U:h1:•.
l� r:.W 1..johj(-+I1 L 1 .
1,)i1 a i*:
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IL�1 R L J01"1N`.,rlJ (:1711•1`,I_r2(.C T I ON
A-:UP- 11c,"' OT chf•' r•I' f.'i el'iCNd 1]l,'110.1.11Ll IS hlf:'t tJlat'u,:,
,m1)J 1 -Ance 1a19:1i 1I1.? "i ate 0-f° Or-Fjn11 .apor..i,alty C .1 C1r?n for the q1'"Crupf
�.,t1-,:,ryr y, �ancl l e u,elr r atY�tc:!r hh1 - rf fevel , erl 1. f'rma , t••1a,
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TL DING CIFF" tLlic
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CITY SOF' TIGARD T #.. . .. PERMIT(
PERMIT #. . . . . . . EUF'j4--4i1's:.;
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/13/94
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 1583)¢39-41 7.i 1
PARCEL: 2S101AA-_04500
S`I TE" ADDRESS. . . : 12395 SW 68TH AVE
...UBD I V I S I ON. . . . . l.'EST PORTLAND HEIGHTS ZONING: C--F'
FLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :;_c_
REISSUE: FLOOR ARCAS- - _ -- ----- EXTERIOR WALL CONSTRUCTION--
C:LASS OF WORK. :AL_T FIRST. . . . : 1660 sf N: 1HR S: E: W.
TYPE: OF USE. . . :COM SE=COND. . . : sF PROTECT' OPENINGS?—•-------
TYPE OF CONST. :5N THIRD. . . . s; sf N:Y S: E: W:
0C.CUPANC Y GRP'. :Ia TO?Al_—_ ----s 1.G60 s f ROOF CONST:C FIRE RET :Y
JCCUPANCY LOAD: 14 BASEMENT. : S f AREA SEF'. RATED:
STOR. : 1 HT. : 16 ft GARAGE. . . : ,f OCCU SEP. RATL_D:
BSMT'' : ME:ZZ?. REGD SETPACKS-•----•---- REQUIRED- __
f-LOOR LOAD. . . . s ps; F LEF : f t RGHT: ft FIR SPI/L: SMOK DET. . :
DWELLING UNITS: FRhIT: Ft REAR: ft FIR ALRM: HNDICP ACC:Y
DLDRMS: LATHS: IMI'' SURFACE:2150 F'RO CORR: PARKING:
VALUE. $ : 6000014
:h marks . ALL SDR94--0010 CONDITIONS OF' APPROVAL MU13T' BE COMPLETE BEFORE OCCUPANC ,,
if-re applicant I^eqLiests for Site Development Review approval to ,allow tfie conveys
on
of an exi.stiriq singly family residence .o a commer-cial photographic par-trait
�t .rdio. Zoning: C--P !F'rofe�siona1 ( ismer- ial ) . Location: 12395 SW 613th fiver:
(WCTM 2S1 01AA, tax lot 4500) .
Owner,: FEES
PICHARD LOUIE type amnl-rnt by elate revpt
0860 `riW BOMAR CT. PRMT $ 313. 00 - V5/25/94 94-2527544
PLCK $ 203. 45 - 05/25/94 94-252759
'TIGARD OR 97223 5PC.r $ 1`:3. 65 SW 07/13/94 —
F'hone #. 246-5376 SSDC $ ::-'60. 00 SW 07/13/94 •-
TIV $ 474. 00 SW 07/1.?,1434
Conty uactar :
ROBERT JOHNSON CONSTRUCTION
4025 S. E. 322ND STREET
TROUT'DALE OR 97060
F'h ci n e # : 663--1330 $ 1286. 10 'TOTAL_
Reg #. . . 5.3946
REQUIRED INSPECTIONS
This perut is issued subject to the regulations contained in the Framing Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other lnsr-llation Insp
applicable laws. All work will be done in accordance with Gyp Bear•cl Insp - i-
vr--i approved plans. This permit will expire if work is not started S�lssp Ceiing Insp
within 180 days of issuance, or if work is suspended for more Final 1nspection
~ than 180 days.
f er-mi ttee Signati_rr-e :
I s Is 1.I e d B Y
Call for inspection — 639--4175
Commercial Buildinq Permit Application
City of Tigard I �
13125 SW Hall Blvd. (6`�'
Tigard, OR 97223
(503) 639-4171
Jobsite Address.
Offlce Use Only
Tenant: teviey*bToaa"MrW f_m Suite # ///
PlancklRec#
Valuation: (i0 my ff7 1 f' r
Permit # 1 y J f !t r
Owner: F= V++-4_4D UeJ I C Map & TL#
Address: iy�;1q t� 1' t1__J�p 22� _ Approvals Required lq-'d Viz'
Tte�a n �n� JIU 3 — - Planning
Phone: 2�G}' G6 I _ E=ngineering
Other_
Contractor: -re fr< i•a
!%p YOU 10 Lillis rdr, r: v
Tyla"f const:
Occupancy class:
Phone: G'(0_E;, ^�_5 _
Sprirklered? Yes
Contractor's License #_ _� 'y/ , ��
(attach copy of current Oregon ticense) Sq. ft. of project:
Story (1st 2nd, etc.)
ArchitecUEngineer. 1_9 ES-N Proposed use: yi4vrt*&tmooH Sr-VI
c;I���icH
Address: L 2 Z t a V_ Previous 11s
-1 T l• Note: Plumbing & mechanical plans
a must be suurnitted at time of
Phone: 1114 _103- 7 building permit application.
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COMMENTS: _ g It1S6 ra cr I j f e s ►�
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U LOVY(. n^ N�'IbLtS (� 41c R..,r, 3,d, I �' 'U� � (✓ r ^ 7�
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-- �,CAP t 2f,- ov LI74• 5V 71
Applicant Signature & Phone number �—
Received by; Date Received: ,s 1`S- / �t
17 (
i
Permit # Account Description Amount Amt. Pd. Bal. Due
L� ✓I' �� .%ice Bldg. Permit (BUILD) ;1 ;.. ' -(—��� /L`/S
Pi,imb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb:
Mech.
Plan Check (PLANCK)
Bldg: _
Plumb:
Mech:
rJ Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF I) _
Institutional TIF (TIF-IS)
n
L�„ Office TIF (TIF-0)
�- Water Quality (WQUAL)
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Water Quantity (WQUANT)
c�
Fire District (FIRE)
TOT ALS: —
MECHANICAL
CITYOF TIGARD PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MEC94-0190
13125 SW Hall Blvo.Tigard,Oregon 97223.8109 (90JjiMi4471 DATE ISS'JED: 08/25/94
PIARCEI-.: &:-:'iS101AA---04500
SIIE ADDRESS. . . : 12395 SW 68TH AVE
SUBDIVISION. . . . : WEST PORTLAND HEIGHTS ZONING: C-P
BLOCK. . . . . . . . . . .. LOT . . . . . . . . . . . . "ZI 2
CLASS OF WORI<. . :ALT FLOOR TURN. . . . : EVAP COOLERS:
TYPE OF USE. . . . :COM UNIT HEATERS. . : VENT' FANG. . . :
OCCUPANCY bRP. . :B1.2' VENTS 1410 OP'I---'L: 1 VENT SYSTEMS:
STORIES. . . . . . . . : 1 BOILE,tS/COMP,RESSORS HOODS. . . . . . .
FUEL TYPES0-3 ill - 1 DOMES. INCIN:
r. /GAS/ 3-15 HP. . . . COMML. INCIN:
MAX INPUT: BTU 1':,-30 HF,. REPA I R UN ITS-
FIRE DAMPE RS?. 30-50 HP. WOOE)STOVES. . :
GAS PRESSURL. 50+ I-IF,. . . . CLO DRYERS
NO. OF' AIR HANDLING UN I TS OTHER UN
FL114N ( 100R BTLj: 1 ,= 1.000171 cfm : GAS OUTLE'i S. 1
TURN ) =100K BTU: > 10000 cfm :
air, conditioner,, replace ya-, fi-tt-nace, 13 a t 1--1 r,o o in V4 t-t
Owner,: FF-LS
RICHARD LOUIE type amol-int by ciat e i,-ecpt
6860 SW BOMAR CT. PRMJ` $ 27. 00 JG 08/C-5/94
FIL-Cl' $ 6, 75 JG 08/25/94
VIGARD OR 97223 5PCT $ 1. 35 JG 08/25/94
F'Ihune #: 246-5376
o n t t,F-A c t or': --___ .._._.___. ...._. _.......____._____ ___
I1-ione
r-
11-ione #: 35. 10 'TOTAL
P e ri
REQUIRED INSPECTIONS
7his permit is issued subject to the regulations contained in the Gas Line Insp
igard Municipal :ode. State of Ore. Specialty Codes and all other Mechanical Insp
app'icable laws. Pll work will be done in accordance with Final Inspection
,
approved plans. This permit will expire if work is not started
within 180 days of issuarre. or f work is titsoprided for more
than 160 days.
V-1 "ei-mittee Signati-tr-e : P-
.i si-ted By :
Call for inspection 639-4175
UJI
City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125'sw Ball Blvd. APPLICATION Permit # i)I It G �t L1-�'��Ir!�
Tigard, OR 97223
(503) 639-4171
Table 3A Mechanical Code QTY PRICE AMT
Job 1) Permit Fee -0- -0- 1000
Address — -
�; 1 7,?2 3 2) Supplemental Permit 3.00
Furnace to 17000 BTU
—_ 1) incl ducts &vents 6.00 tY•
Furnace 100,000 BTU +
Owner 2) incl. ducts &vents 7.50
" --
Floor -urnance
3) incl. vent 6.00
rmn' Suspended heater, wa Heater
4) or floor mounted heater 6.00
Ventno inc. in
OC:U7ant 5) appliance permit 3.00
repair of heating, re ng.
6) cooling, absurpbon unit 6,00
'
Boiler or comp, eat pump, air cond.
7) to 3 HP; absorp unit to 100K BTU 6.00
° C »► ,
Boiler or comTeat pump;air cond
Contractor an. / A 11C-4L- 1 Q a) 3-15 HP; absorp unit to 500K BTU 11.00
""'°' offer or comp,Tieat pump, air con
Q �Q
446 6 ( '1 9) 15-30 HP, absorp unit .5-1 rail BTU 15.00 )
�"'"'"' "' nY '•
Boiler or comp, heat pump, air con
Q, ° 10) 30-50 HP, absorp unit 1-1.75 mil BTU 22.50
a
hereby ac now ge t hat ave readthis app icati n, that t Boiler or comp, heat pump, air con .
information given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of the owner, that plans submitted are in compliance with handling unit to
State laws, that I am registered wOh the Construction Contractor's 12) 10,000 CFM 4.50
Board. that the number given is correct (If exempt from State it an Fg unit
registration, please give reason below) 13) 10,000 CTM + 7.50
Non porta e
14) evaporate cooler 4.50
Vent tan connecte --
i 15) to a single duct 3.00
Ventilation system not
16) included in appliance permit 450
Hood s by
17) mechanical exhaust 4.50
-TTe`sc-ri5Fw-o-rF new addition aeration - repair ommercia or to us na
to be done residential O non-residential 18) type incinerator 30.00
_xis ing use of Other i.e., woodstove, water
building or property _ 19) heater solar, clothes dryers, etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00 n)
building or property
F- Type of fuel -oil Q natural gas Q LPG Q elecdre 021) More than 4-per outlet(Al
F- NOTICE
Minimum Fee $25 00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS I IOT COMMENCED WITHIN 180 DAYS, OR 5%SURCHARGE 8p
�t IF CONSTRUCTION OR WORK IS SUSPENDED OR
-' ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED --
TOTAL t/�j?t,
1 rpeclal Conditions J --
Date issued _ by
WMEC~
weAmmdn
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PLUYBING PERMIT'
PERtYIT 4. . . . . . . : F-,LM94.-018---'
DATE ISSUED- 06/25/94
PARCEL: I:-z.'SIOIAA 04500
:31TE ADDRESS. . . : 12395 SW 68TH AVE
:31JBDIVISION. . . . : WEST PORTLAND HEIGHTS ZONING: C--P
DLOCK. . . . . . . . . . 11 LOT. . . . . . . . . . . . . :22
--------------------
CLASS OF WORK. . :ALT GARBAGL DI'""OSALS. MOBILE HOME SPACES.
1'YPE OF USE. . . . :COM W(4 THING MACH. . . . . . . : BACKFLOW PREVNTRS. . . 1
-1
OCCUPANCY GRP. . :B2 FLOOR DRAINS, . . . . .. . : T RAI"S. . . . . . . . . . . . . .
0 R I E S. . . . . . , , : ICATCH BASINS. . . . . . . : 1
W A'T E R 1-1 EA T E R S. . . . . . : 1
I LAUNDRY T13AYS. . . . . . .. SF RAIN DRAINS. . . . . :
G I N K S. . . . . . . . . . : 1 URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . . .
I-AVATORIES. . . . . : 1 OTHER FIXTURF.1-S. . . . . :
'; UB/SHOWERS. . . . : SEWER LINE (ft ) . . . . ..
WATER CLOSETS. . ' WATER LINE (ft ) ., . . . -
DISHWASHERS, . . . RAIN DRAIN (ft ) . . . . : 100
Remar-k!, :
[Jwner-: FEES
131CHARD LOUIE type amcilmt by date t-ecpt
B1360 SW BOMAR CT. FIRMT $ '75. 00 JG 08/-.5/94
PLC11% $ 1B. 75 JG 00/L5/1)4
I IGARD OR 97223 5PCT $ 3. 75 JG 013/25/94
Phone #: 246--5376
CclritTactar-:
HANK' S PLUMBING
17070 BE ROCK CREEK CT
OR 9701.5
hOyl I *: $ 97. 50 TOTAL
52314
REQUIREO INSPECTIONS
This persit is issued sub)t!,:t t: '.:,t, regulations contained in the Top—al.tt Insp
Tigard Municipal Code, State of
(h-e. Specialty Codes and all other Rain Dr-ain lnsp
applicable laws. All work ;.Til be done in accordance with RP/Bar-1<f I o w i-Ir,e v
WDroved plans. This rrsit will expire if work is not started Final Inspection
Aithir 180 days of i,suance, or if work is suspended for more
than 180 days.
ei-mittt:e
cA
Call 1:ov- inspection 639-417"*j
City or Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # (b
13125 SW Hall Blvd. Permit #
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
•°'° ^^" New Single Family Residences 9Ul
rJ O
Job «. 7 ❑ 1 BATF'HOUSE$140.00 ❑ 2 BATH HOUSE$195.00
❑ 3 BATH HOUSE$225.00
Address cawe�.. m Fee includes all plumbing fixtures in the dwelling and the first 100 feet
?� 2 J of water service, sanitary sewer and stone sewer. See fees below.
°'^•""°'�"'""' FIXTURES QTY PRICE AMT
Sink r 9.00
"•"''°Q••• °A°^• Lavatory iEF 9.00
Owner Tub or Tub/Shower Comb. 9.00
r ��'•'• s^ Shower Only 9.00
Water Closet 9.00
N-id-0°"•'•••' Dishwasher 9.00
Garbage Disposal 9.00
Occupant „.04 "w
Washing Machine 9.00
Floor Drain 9.00
C"°"'• °• Water Heater 9.00 i•
Laundry Room Tray 9.00
mal _ 9.00
_deer Fixtures (Specify) 9.00
Contractor �� l of G4 9.00
.y9.00
4t q 7Q/y°' 9.00
tJ Sewer 1st 100 30.00
sur.R•p•b•tl°^No. &• T••N• Sewer-ea. Addit. 100' 25.00
^� Water Servit a 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is c.,rrect, that I :;m the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm &Rain Drain 1st 100' 30.00 ••-
I am registered with the Construction Contractor's Board, that the Storm &Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason be)ow.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti-Pollution Device 9.00 )
+�•^•� P- •o•^ a'• Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition U alteration repair O Catch Basin 9.00 C r�
to be done residential O non-residential Q Insp. of Exist. Plumbing 40.001hr
Specially Requested Inspections 407M'
Existing use of
building or property Rain Drain, single family dwelling 30.00
.r
Residential backflow prevention
a, devices 15.00
L01 Proposed use of
building or property _!
�.,., '(E)cept residential backflow
J prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL '
-' PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL
Special Conditions
_ Date Issued by