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11400 SW Fonner Street
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639•4175 Business Line: 639-4171 - -
BUP
Date Requested 1 Z �S� --AM-----PM -- BLD -----' _
Location q(, LrYV✓t-r=�� Suite _ MEC
Contact Person uJ1 �c.� _ Ph -70 LI PLM Z G e /
Contractor �— Ph SWR
BUILDING Tenant/Owner El C - _�—
Retaining Wall ELR
Footing Access.
Foundation FPS
Ftg Drain - SGN
Crawl Drain Inspection Notes - --- - -
Slab ----- -_ -- - --------- —
- -------r—� _ SIT -- -----
Post& Beam
Ext Sheath/Sneer
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _
Firewall /
Firc Sprinkler
Fire A;arm
Susp'd Ceiling "I
Roof
Misc: -- — - -- --
Find --- —
PASS FART FAIL -- — - ---
PLUMPNNG
Post r,Beam
Under Slab
I op Out ---- - - --- -- -- --
ater Sery[�_
Sanitary Sewer -
Rain Drains
PART FAIL __--
MECHANICAL
Post&Beam --
Rough In
Gas Line --- ---- _ —
Smoke Dampers
Final �-
PASS PART FAIL
ELECTRICAL -
Service
Rough In
UG/Slab --
Low Voltage
Fire Alarm — -- -- -- - ----
Final
PASS PART FAIL — ----SITE
Backfill/Grading "—
Sanitary Sewer
Storm Drain I ]Reinspection fee of$— required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: [ ]Unable to inspect no access
ADA
Approach/Sidewalk '
Other Date ,.,_._Q — Inspector �� _qj� Ext
Final
PASS PART FAIL DCA NOT REMOVE this inspection record from the job site.
CITY OF T I GAR D ___PLUMBING PERMIT
DEVELOPMENT SERVICES
#: F'I-M2001-00670
13125 SW Hall Blvd., Tigard, OR 97223 ;503) 639-4171 DATE ISSUED: 12i27/01
SITE ADDRESS: 11400 SW FONNER ST PARCEL: 2U103AC-02200
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GAPBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS. TRAPS:
STORIES: WATER HEATERS- CATCH BASINS:
_ FIXTU_RES _ L.AUNDRY TRAYS: SF RAIN DRAINS:
SINKS: _ URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 45 ft
DISHWASHERS: R 41N DRAIN: ft
Remarks- Ri..piace 45'of water service line.
FEES _
Owner: -
--- '— Type By Date Amount Receipt
JOSH BEAN PRMT CTR 12/27/01 $72.50 27200100000
11400 SW FONNER ST 5PCT CTR 12/27/01 $5.80 27200100000
TIGARD, OR 97223 —
Total_ $78.30
Phone 1: 503-849-5972 `
Contractor:
YORE PLACE PLUMBING
608 E 2ND ST
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone 1: 503-5.54.8113 Water Service Insp
Reg #: LIC 149496 Final Inspection
PI-M 36-92PB
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 clone in accordance with approved
This permit will expire if work is not started within 180 days of issuance, or if work is suspender! for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregoo Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: Permittee Signature:���, _t
Call (503) 639-4175 by 7:00 P.M. for an inspection needed 'he next business day
Plumbing Permit Application
Date received: 17 d/
City of Tigard Sewer permit no.: Building permit no
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: r:xpire date: ,^
City ofTigard Phone: (503) 639-4171 B Recei t to..
Fax: (503) 598-1960 Date issued: I Y��Gt�
Case file no,: Payment type:
Land use approval: -
U t'onuncrcial/industrial
O Multi-Family U Tenant improvement
U I &2 family dwellin}t or artxssory
U Atidition/alteration/renlacement LI Food wivice U Other:
0 New consuurunn
t
t)cscri
lion Qt Fee(ca-) hntal
lob address: �''JZ� N -- New 1 and 2-family dwmllin{s unit"
Bldg.no. Suite no.: (include~tOO A.fur•a'c•h ul ility connrc:iuu)
Tax map/lax lot/account no.: SlAt(I)bath -.— —
�t; Block: Subdivision: SFR(2)bath
SFR(3)bath ---
Project name: Each additional batIVI(P.Chen —
Cit /county: ZIP: _-
tiiteutilities:
Description and location of work on premises: catch basin/arca drain
Drywells/leach iine/trench drain
Est.date of comple on/inspection: Footing drain(no.
t Manufactured home utilities _
Business name: I /: ,Lf7C'� /J L -
_ Rain drain connector
Addresa: Sanita sc.wer(no. in.ft.)_
State:c� D' --
City: L,�/� : _ Storm sewer(no,lin.ft.) _
Phone:,_po /� Fax: Email: fit.r'<<i!o' • ��,a�er service(no.lin.ft. s
CCB no.: Plumb.bus.reg.no' • Flxturc or Item:
City/metrolic.no.: ti i Abso tion valve _
Contractor's repmsenlativ signature: 'i Back flow preventer _
Print name:-1&4u1 i>1 �-�" yt.t/����� ate' -P Backwater valve
JIM Basins/lavato _Clothes washer
Name: -- Dishwns her _
Address: _ - - Drinking fountain(s) _
---- State: - ZII':
t'i i y Ejectors/sump -
I'hond Ex ansion tank
FixturelWWI •ca
I looi drainslloor
Name(print): OS�� ��F��—_ - Garbage dis sal
Mailing address: - Hose bibb
City: State: ZIP Ice maker
�r
Phone: 5 Fax: E-mail: Inicrcc t r/grease trap
Owner installation/residenual maintenance only: he actual installation Pnmer(s)
will be made by me or the maintenance and repair made by my regular 5—f drain(commercial)
employee on die property I own as per ORS Chapter 447. mp___) av5( )
Owner's signature: KIM -- — _
Tubslshower/shower par
-
Name: _____—_ --- Water closet _•-_
Address: __ Water heater
--- — State: ZIP• Other: --
City: — Email: Total
Phone: ax:F -.
—._. Minimum fee................$ ?� .�•t�
CN,,,all luri„di uu aceto credit cards.rteae call Jurtadktion for mtxe itJarrtutlan Notice: I his permit application Plan re`;c% (at _ %) $
U,
a U Ma.terCttrd expires if n permit is not obtained State surcharge(896)....$ •—
Credit cans number: .__—_ _ 1--L— within 180 days after t has h^-en
ERplrea accepted as completeTOTAL ... ...................$ ���•..�.d:.L..-
Name nr csrdhnldrr ar shown on credit c $
___ I40J616(NOOH'OMI
_-�- aiputwe Amount
PLUMBING PERMIT FEES:
PRICE TOTAL LNewi 2-family dwellings onFIXTURES (individual) QTYa AMOUNT all plumbing fixtures iPRICE TOTAL
16 SO gand the first100 ft. QTY (ea) AMOUNT
Sink -------- tility connection)Lavato 16.60 th 5249.20
rY 5350.00
I ub or Tub/Shower Comb. 16.60 th16.60 Treeath
Shower Only
Water Closet 16.60 - �SULzTOTAL
Urinal - 16.60 8'/.STATE SURCHARGE -
16.60 PLAN REVIEW 25%OF SUBTOTAL
Dishwasher - __ TOTAI-
Garbage Disposal 16.60
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" - 16.60 PLEASE COMPLETE:
3" 16.60
4•• 16.60 ----- Quantic b Work Performed
Water Heater O conversion O like kind 16.60 Fixture T New Moved Replaced Removed/
Gas piping requires L separate mechanical
Type: Ca ed
ermil. 46.40 Sink -
MFG Holne New Water Service - Lavato -
MFG Home New San/Storm Sewer 46.40 Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Onl
16.60 Water Closet
prinking Fountain- Urinal
Other Fixtures(Specify) 16.60 Dishwasher
------- Garba a Dis csal
Laundry Room Tra
_ -- Washin Machine
_
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3"
46.40 4"
Sewer-each additional 100' -- Water Heater
Water Service-1st 100' 55.00 --
.5 Ulher Fixtures
Watrlr Service aach additional 200' 46.40 S ed
Scorn&Reln Drain•1s1 100 55.00 -
Stoim&Rain Di sin-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55 -
- 18.80
Catch Basin _
Ins,�oction of Existing Plumbing or Specially 8e�1hr _ COMMENTS REGARDING ABOVE:
Re uesled InjLecticmfi 65.25 ---
Rain Drain,single family dwelling _
Grease Treps - 18.80
U1,lANTITY TOTAL
Isomet,ic or riser diagram Is required d -
Ou-n-Wy Total Is ,9 __ ----- --
"SUBTOTAL
80A STATE S1IRCHARGE
••PLAN REVIEW 251/6 OF SUBTOTAL
Re uired onl If t!'2e 1 tutal Is>o - -----
TOTAL $
*Minimum permit fee Is$72 50Stale surResidential sacs finw
prevention Device.which is$ae 25 4 8%slate surchart7n
"All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
I:\dsl;\fonns\pim-fees.doc 12/26/01