11565 SW FONNER STREET i
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11565 SW Fonner Street
CITY OF TIGARD BUILDING INSPFCTIOA DIVISION
7.4-Hour Inspection Line: 639-41175 Business Line: 639-4174, MST
BUF
Date Requested ('01 ,-AM--_--PM —_` BID !—
Location_ 15 S_51,, Suite
— — _ MEC
Contact Person _ Ph _ PLM Ze6l dv LW�.'
Contractor_ Ph SWR
BUILDING Tenant/Owner ELC _
Retaining Wall ELR
Foundation Access' GfCj W _ ` c�+.
FPS _
Ftg Drain
Crawl Drain Inspection Notes. SGN
Slab / i h /i h e i s G 6,r le-
Post& Beam — SIT
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation -- - - - -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Root -
Misc: -.- - ---
Final ----- ----------
PASS PART FA;i-
(VILUMBINa5 -_-_—
Post& Beam —
Under Slab
Top Out
Water Service -
rn ary ewer --
ins I
T'ASS PART FAIL
ANICAL _ __._---
Post& Beam -- ------ ------
Rough In
Gas Line - _ ---- ------
Smoke
---Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL - --
Service
Baugh In ---
UG/Slab _
Low Voltage —+ -
Fire Alarm
Final
PASS PART FAIL
TI-TE
Backfill/Grading -- - —
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ rec,uired before next inspection. Pay at City Hal!, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( J Please call for reinspection BE: _- [ j Unable to inspect-no access
ADA
opperoach/Sidewalk Date ML� Inspector �I / L� 1�: , Ext
Final
PASS PART FAIL DO NOT REWOVE this inspection record from the job site.
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00157
13125 SW Hall Blvd , Tigai d, OR 97.223 (503) 639-4171 DATE ISSUED: 4/17/01
SITE ADDRESS: 11565 SW FONNER ST PARCEL: 2S103BD-04401
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS. TRAPS:
STORIES: WATER HEATERS: CA1 CH BASINS:
FIXTURES —_ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Instailatior of less (han 100'of water line service for relocation of water meter._
----- FEES
Owner: _ - — —
-- Type By Date Amount Receipt
SMITH, WILLIAM L
MARGARF_T O PRMT CTR 4/17/01 $72.50 27200100000
11565 SW FONNER 5PCT CTR 4/17/01 $5.80 27200100000
TIGARD, OR 97223 I Total $78.30
Phone 1: —T---
Contractor:
EAST WEST PLUMBING INC
6536 NE 63RD
PORTLAND, OR 97218
REQUIRED INSPECTIONS
Phone 1: FAX 590-6220 Water Line Insp
Reg #: LIC 102521 Final Inspection
PI-M 26-532PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OF;.
Specialty Codes and all other applicable laws. All work will be d ne 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 requires you to follow rules adopted by the Orepri Utility
Notificati)n Center. Those rules are set forth in OAR 952-0001-0010 thro�.tgh OAR 952-0011-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1981.
Azz""?
Issued By: -��. / Permittee Signature:
Call(903)3's.,-4175 by 7:00 P.M. for an inspection needed the ext business day
r
Plumbing Permit Application_
City
Date received: �/74.1 PermitA 4
C>tty Of Tigard Sewer permit no.: Building permit no.:
Address: i x125 SW Hall Blvd,Tigard,OR 97223
City ofTigard phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503)598-1960 Date issued: By Receipt no.:
Land use approval: _ Case file no.: Payment type:
1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenani improvement
U New construction U Addition/alter tion/replacenient U Food service IJ Oihrr _
.1011 SITE,INFORMATION I+E1 SkIIEDULE(for special Information use�,checkllso
Job address: 7 7,w, ` Description Qly. Fee(ea.) Total
Bldg. no.: Suite no.: New 1-and 2-famlly dwellings only:
'fax map/tax lot/account no.: (Includes 100 ft.for each utility connection)
SPR(1)bath
Lot: Block__ Subdivision: —_ SFR(2)bath -
Project name: p SIR(3)bath -
City/county:_ t ZIP: Each additional bath/kitchen
Description and location of work on premises: Siteutilitles:
_V1t,L1h .U \�.-;,. J..)Ams .-. 6lmU,,— Catch basin/area drain
Est.date of completion/inspectior.: Drywells/leach line/trench drain
Footing drein(no.lin.ft.)
Manufactured home utilities
Business name: ( /� ,1 ;�� '��. �'� , vt� __._ Manholes
Address: ,O w 'L Rain drain connector r
City: L* Stateo-fz I ZIP: Sanitary sewer(no.lin.ft.) /x
Phone: I E-mail: Storm sewer(no.lin.ft.)
CCB no.: l h 2�Z\ Plumb. bus.reg.no: Z� -S��Z
Water service(no.lin.ft.)
City/metro lic.no.: 7' Fixture or ltetn:
Contractor's representative signature: _ Absorption valve
Print name:" f *� , Back flow preventer
Backwater valve.
Basins/lavatory
Name:
-� 61�� Clothes washer
f�h.1�- lU��ca•
Address: Dishwasher
-t V Dripking fountain(s)
City: _ State: ZIP: Ejectors,'sump _
Phone: ` -U j Fax: Email: Expansion tank
Fixture/sewer cap
Name(print): Floor drains/floot sinks/hub —-- ---
Mailing ada"ess: '.v C,' —� Garbage disposal
Hose hibb _
_City: jState ZIP: Z 7 Ice maker
Phone: Z -Z(l Fax: S E-mail: Intercc rgr/grease_tra _
Owner instal lation/resi ential maintenance only: The actual installation Primer(.;) _
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's A nature: _ Dale: Sump _
Tubs/shower/shower pan _
Urinal
Name: — Water closet _
Address __ Water heater
City: - State: ZIP: Other: --
Phone: _ _ Fax: E-mail: Total w
Not all jurisdictions accent credit cards•please call jurisdiction for more information. Notice:This permit application Minimum fee................$
,
U Visespircs if a permit is not obtained Villa U Mwu!rCard Plan review(at _ %) $
Credit card number: —_-- — —/L within IRO days after it has been State surcharge(8%)....$
Expires Nome of cardholder as shown or n. i�ird accepted as complete. TOTAL .......................$ �g• O
S
Cardholder slitnarure — Amount
_ 44046Iti(NONCOM)
■
PLUMBING PERMIT FEES:
PRICE TOTAL Now 1 and 2-family dwellings only:
FIXTURES_Lirrdlvldual _ QTY (oa) I AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 tho dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory - 16.60 for each utillty connection)
_ One 1 bath _ _ _ $249.20
Tub or T,b/Shower Comb 16.60 Two 2 bath $350.00
'Shower Only 16.60 Three_(?) bath $399.00
Water Closet 16.60 _ SUBTOTAL
U inal - 1660 8%STATE SURCHARGE _
D,shwasher - 16.60 PLAN REVIEW 25%OF SUBTOTAL _
__ - --- -- TOTAL
Gar-bage Disposal 16.60 - --- - ---
Laundry Tray 16.60
Washing Machine - 16.60
Floor Drain/Floor Sink z" - 16.60 - PLEASE COMPLETE.
3"--- - 16.60
4" ---- 16.60
i--_ - - --- Quant!y b LWork Performed
Water Heater O conversion O like kind 16.66
Gas piping requires a separate mechanical Fixture Type: New Mov rd RepL'tced Remcved/
permit,.____ _ --_ -_ _ __gapped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer i 4640 -
_--. Tub or Tub/Shower
Hose Bibs 16.50 Combination
Roof Cralns 16.6( Shower Only
- -
Drinking Fountain 16.60 Water Closet -
Urinal
Other Fixtures(Specify) - 16.67
Cishwasher
Garbage Disposal -_
-
Laundry Room Tri _
- -- - Washing Machine _
Flo_or_Drain/Sink: 2"
Sower-1st 100' 55.00 3"
Sewer-each additional 100' 46.40 4" -
Water Service-1st 100' 55.00 Water Heater - --
Water Service-eac i additional 200' 46.40 Other Fixtures
S ecif
Storm&Rain Drain-1st 100' 55.00 -
Slorm&Rain Drain each additional tU0' 46.40 ----
Commercial Back Flow Prevention Device 46.40 - - -
Residential Backflow Prevention Device' 27.55 - -
Calrh Basin 16.60 -
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections _ er/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 6525
Grease.Traps 1660 --- -• ----
QUANTITY TOTAL _
Isometric or ilser diagram Is requited if
OuantNy Total Is ,9 -
'SUBTOTAL -
9%STATE SURCHARGE - -- -
"PLAN REVIEW 25%OF SUBTOTAL
Re aired only d fixture yly total is- 9
TOTAL a
"Minlmum permit fee is$72 50+B%state swuharge,except Residential Backflow
Prevention Device,which is$36 25-8%state surcharge
"All New Commercial Buildings inquire plans with isometrk,or riser diagram and
plan review
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