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11230 SW FONNFR ST.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business, Line: 639-4171 -
BUP
Date Requested �'��'��- -' AM PM _ BLC —
Location � ( � �'(�✓)}��(�� St Suite MEC
Contact Person �r14
iCi�l PLM 7E. � j 7
Contractor Ph SWR
LDING -�l Tenant/Owner ELC r
Retaining Wall _ ELR
Footing Access:Foundation FPS _
Ftg Drain SGN
Ciewl Drain I Inspection Notes- - -
Slab -- - ----- SIT
Post& Beamr _ —
Ext Sheath/Sath/S hear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall I /
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof ,
Misc.
Final
PASS F'iiT FAIL - —
PL MBI
Post&Beam - --
Under Slab _
Top Out
Water Sen!
Rain Drains
Fin:, _ — --
'LASP PART FAIL _
MCWHANICAL
Post&Beam - --� —
Rough In
Gas Line - —
Smoke Dampers
Final -
PASS PART FAIL
ELECTRICAL --
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm W_ _
Final
PASS PART FAIL
SITE
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 _— [ ]Unable to inspect-no access
Fire Supply Line
ADA 1 n l_-
Approach/Sidewalk Date i 'nsrector El t
Other ---- �.� ----f--
Final
PASS PART FAIL b0 NOT REMOVE this inspection record from the job site.
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2000-00111
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 05/30/2000
SITE ADDRESS; 11230 SW FONNER FT PARCEL: 2S103AC-01900
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS
CLASS OF WORK: AL1 DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection of sewer lateral. Septic tank to be pumped, filled and capped or removed, and
inspected.
Owner: --"
-- - - - _ FEES
ROGERS, PAUL Type By Date Amoint Receipt
112.30 SW FONNER ST
TIGARD, OR 97223 PRMT KJP 05/30/200C $2,300.00 0002525
INSP KJP 05/30/200C $35.00 0002525
Phone: Total $2,335.00
Contractor:
Phone.
Reg 1:
Required Inspections
Sewer Inspection
Septic Tank Filled
ORIGINAL
-i his Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires
180 days frorn the date issued The total amount paid will be forfeited if the permit expir?s The Agency does not
guarantee the accuracy of the side sewer laterals If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given If not so located. the installer shall purchase a "Tap and
Side Sewer' Permit and the Agency will install a lateral ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080
You may obtain co pi of these rules or direct questions to OUNC by calling (503) 246-1987
i v
Issued by: _L -� Permittee Signature:
II 03 639-4175 b 7:00 P.M. for an inspection needed the next business da
Ca (5 ► y p y
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICESPERMITM PI-l'.12000-00174
13125 SW Halt Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 05/30/2000
SITE ADDRESS: 11230 SW FONNER ST PARCEL: 2S103AC-01900
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDi"TION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of sewer line - 1 st 100 ft. No reverse plumbing required.
FEES _
Owner:
Type By Date Amount Receipt
ROGERS, PAUL PRMT KJP 05/30/200[ $50.00 0002526
11230 SW FONNER ST 5PCT KJP 05/30/2000 $4.00 0002526
TIGARD, OR 97223
Total $54.00
Phone 1:
Contrartor:
ROTO ROOTER SERVICE + PLUMBING
HOFFMAN SOUTHWEST CORP
4248 NE 148TH AVE REQUIRED INSPECTIONS
FOP,TLAND, OR 97230
Phone 1: 682-9774 Sewer Inspection
Reg #: LIC 00013989 Final Inspection
PLM 37-76PB
ORIGNAl-
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 pians.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 100 days. ATTENTION: Oreqon law requires you to f6!low 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 cp"s of these rules or direct questions to OUNC by c?lling (503) 246-1987.
Issued By: �tl � Y� e�� Permittee Signature: "lurg
Call(503) 639.4178 by 7:00 P.M. for an Inspectlon needed the next buslness da
CITY OF TIGARD Plumbing Permit Application Plan Ch2ck#
13125 SW HALL BLVD. Commercial and Residential Recd By
'TIGARD, OR 97223 Date Recd
(503) 639-4171 Date to P.E.
Print or Type Date to LAST
Incomplete or illegible applications will not be accepted Permit#P1 -LX),
Related SWR#S r-J tf Zz,
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Street Address ^ Suite Lavatory 11.50
.i ' Tub or Tub/Shower Comb. 11.50
Bldg# City/State1 Zip Shower Only 11.50
- - x ^ 1l R 7da3t Water Closet 11.50
Namect�L I�D(-+C/Z) Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
t30 ` i t P r Garbage Disposal 11.50
City/State Zip Phone 50
CI �� Cl 761M Laundry Tray 11.50
Ti CL.I-
Na __ Washing Machine/l.aundry Tray 11.50
Pt(Y\_Q C l` �V Floor Drain/Floor Sint- 2" 11.50
Occupant Mailing Address Suite 3" 11.50
City/State Zip Phone 4" 11.50
Water Heater O conversion O like kind 11.50
Nam Gas f In red_uires a separate mechanical permit.
�C JAZ, MFG Home New Water Servire 32.00
Contractor Meiling Address Suite MFG Home New San/Storm Sewer 32.00
2AIj Hose Bibs 11.50
Prior to permit City/Stale ZI Phone C Roof Drains 11.50
Issuance,a copy t �C�� �-J.1'� 77 Drinking Fountain 11.50
of all licenses are Oregon Const.Cont.Board Lica Exp.Dat
required If I ' �)J Other Fixtures(Specify) 15.00
4"
to
expired in COT Plumbing Lic.# Exp'Da e
database
Name
Architect ewer-r 1_811 O0' . 38.00
Or Mailing Address Suite - Sewer each additional 100' 32.00
Engineer City/State Zip Phone Water Service-1st 100' 38.00
Water Service-each additional 200' 32.00
Describe work to be done: Storm&Rain Drain-1st 100' 38.00
New W Repair O Replace with like kind Yes O No O Storm&Rain Drain-each additional 100' 32.00
Residential V Commercial O
Additional description of work: --" - Commercial Back Flaw Prevention Device 32.00
Residential Backflow Prevention Device' 19.00
cX\.1< t` _ _ ___ Catch Basin 11.50
Are you capping,moving eplacing any fixtures? Insp.of Existing Plumbing or Specially Requested ;0.00
Yes O No O Inspectionsper/hr
If yes,see back of form to indicate work performed by Rain Drain,single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURF Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application,that the information
given Is correct,that I am the owner or authorized agent of the owner,and ^ometrlc or riser diagram is required H Ouantfly Total Is >9 S a
that plans sugmitted are in coTgoce with Oregon State Laws "SUBTOTAL
Signature d1 V erl gent Date -
gra 8% SURCHARGE lid
Contact Person time Ph ne
**PLAN REVIEW 25%OF SUBTOTAL
1 BATH HOUSE 5178.00 Required onlyif fixturegly total is>9
2 BATH HOUSE$250.00 TOTAL c
BATH HOUSE$285.00
iIThIs fee Includes all plumbing fixtures In the dwelling and the first 'Minimum permit fee Is S50+6%surcharge,except Residential F ackttow prevention
100 feet of sanitary sewer storm sewer and water service) Device,which Is$25+8°5 surcharg(-
All New Commermlr;Buildings require plans with Isometric or riser diagram and
plan review
I Wstsvormslplumepp doe I I i I W
PLEASE COMPLETE:
Fixture Type Quantitty by Work Performed
New Moved Replaced Removed/Capped
-- -,---
Sink
Lavatory ---- - - -- --
Tub or Tub/Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher —
Garbage Disposal
Laundry Room Tray
Washing Machine _—
Floor Drain/Floor Sink 2"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1 kjetsVoamslplumspp doc 11118/99