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13640 SW FERN STREET W CD cn m ;o z X m m r �x 11 ■ 13640 SW FERN STREET _ CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business line: 639-4171 Gate Requested AM PM BLD I ocation r �� Suite MEC Contact Gerson Y _ _ Ph PLM ' 4�1 2-- Contractor Contractor _ Ph SVGh BUILDING -- Tenant/Owner _ ELC - -- _ Retaining' 'all - ELR Footing Access. Foundation FPS Fig Drain Crawl Drain Inspection Notes: SGN Slab Post& Beam �.. - - - -------- ---- — -------- SIT - Ext Sheath/Shear Int Sheath/Shear Framing Insulation --- -- -- ---- �- Drywall Nailing Firewall -- Fire Spr,,,kler Fire Alarm _--------------- _ _ �__ ------------------ ... -�— Susp'd Ceiling Roof Final —_--- PART FAIL LUMBI Post&Beam -- —--- --- Under Slab Top Oui (✓ - Water Service Sanitary E-wer - --- Rain Drains PART FAIL. CHANICAL ---_ --- �-� _--- Post& Rrani ------------ ---- - Rough In Gas Line ---- — Smoke Pampers Final - - ---------- PASS PART FAIL. ELECTRICAL.Service Rough Rough In -- ------- --------------- --- UG/Slab Low Voltage - ---- ----_.----- - Fire Alarm Final PASS PART FAIL SITE _ -- Backfill/Grading Sanitary Sewer Storm Drain i ) Reinspectinn fee of$—_ Irquired before next inspe inu Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( Please call for reinspection RE: [ J Unable to inspect-no access Fire Supply Line --------- ,.- ADA Approach/Sidewalk Z�Zdvl�w� Other —! Date - Inspector _ _ ,— —_` Ext Final PASS PA':T FAIL DO NOT REMOVE this inspecttun record ;rom the job site. invoice .,,4 (311FFS nrric mmuclz.. IN(.',* Narne Date Address I Phoie. City Initial On Acct. State iik Zip Code Price Amount J 7 ---------------NO--T—RESPONSIBLE--FOR LANDSCAPING A service charge of 1.5% per Month will be charged on all past due accounts Total! Not responsible for attorney's fees. Approval By Customer Signature ,Ihankyou P.O E30X 1244. - Canby, OR 97013 (503) 263-2087 or (503) 632-6138 C'-B# , . CITY OF TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMI-i #. . . . . . . : PLM98-0301.' DATE ISSUED: 09/01 /98 PARCEL: 251.04BP-02200 SITE ADDRESS. . . : 13640 SW FERN ST SUBDIVISION. . . . : HANDY ACRES ZONING: R--7 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :028 JURISDICTION: URB ----------------------------------------------------------------------------------------- CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE:. . , . :ST"' WASHING MACH. . . . . . : 0 BACKFLCJW PREVNTRS. . : 0 OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . .. . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WA*TER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 FIXTURES-__-----__---___.- LAUNDRY TRAYS. . . . . - 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . „ . izi GREASE TRAPS. . . . . . . . 0 LAVATORIES. . . . : 0 OTHER FIX'TURE9. . . .. : 0 TUR/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : C?00 WATER CLOSETS. .- 0 WATER LINE (ft ) . . . - 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks: Disconnect from septic and connecting to sewer. USA sewer, permit it 1. 1'! 381 Owner: FEES ---------.---_ BOYCE, THOMAS & CAROL type affloUnt by dote reept '13640 SW FERN ST PRM7 $ 55. Q10 B 09/01/98 98-30A767 TIGARD OR 97223 5 P C,T $ 2. 7c P 0`3/01./'38 98--308767 Phone #: Contractor---------------------.__—_--_--._ E=D ontractor-------------------------------- ED WYANT EXCAVATING INC PO BOX 1242 SHERWOOD OR 97140 ------------------------------------------ Phone #: 625-9294 $ 57. 75 TOTAL Req 111263 REDUIRED INSPECTIONS This permit is issued subject to tiie regulations contained in the Sewer-, Inspection Tigard Municipal Code, State o' Ore. Specialty Codes and all other Final Inspection applicable haws. All work will be done in accordance vith approved plans. This permit will xpire if work is not started within IS@ days of issuance, or if work is suspended for more than 1BO days. ATTENTION: Oregon law requires you to follow rules adopted by the Regon Utility Notification Center. Those rules are set forth in OAR 952-MI-0010 through OAR 952-MI-MO. You may obtain copies of these rules or direct questions to OUN[ by calling Tissued BYIL---— P,et-mittL.e giunati-trp : i 6-- -k +++4-++++'4"V .....................4........4•................4 *++++4+4-+++.+.4.+4 Call 639-4175 by 7:00 p. m. for an inspection needed the next bi..tsiness day ............A......................................J.......................... CITY OF TIGARD Plumbing Permit Application Plan Che 13125 SW HALL BLVD. Commercial and Residential Recd By TIGARD, OR 97223 Date Recd - (501) 639-4171 Date to P.E. - )q k) FPrint or Type Dale to D$T Incomplete or illegible applications will not be accepted Related SWR# Called Name of Development/ reject FIXTURES (individual) QTl(,'. PRICE: .AMT Job (F- Sink —�. 9.00 Address Street Ad ress Suite Lavatory _ 9.00 Tub or Tub/Shower Comb. —� 900 Bldg# Clty'State Zipfjlrr a!� %') 1 Shower Only 9.00 Na 1� 1 I Water Clcset 9.00 lltawa-0- a Dishwasher 9.00 Owner Mailing Address t Suite Garbage Disposal 9.00 L'L1:G I) ��'�' -Washing Machine 9.00 C lSLrie — �. Floor Drain/Floor Sink 2" _ 9.00 Nam 1 1 3" 9.00 f ��n I►l — _ 4" 9.00 Occupant Mailing Address Suite Water Heater O conversion O like kind 9.00 —_ Gas piping requires a separate mechanical permit City/State Zip Phone Laundry Room Tray 9.00 Urinal 9.00 Name -- Other Fixtures(Specify) 900 1 ,4 C-- — - Contractor Mailing Addresd Sue - 9.00 r I t'' ). t z-`f 2- 9.00 Prior to permit City/State Zip Phone Sewer-1sl 100'— Issuance,a copy '_,,z c -XV 0 !r- rt 7 r-r�- -1);'')`> -- Sewer-each additional 100'— l 25.00 of all licenses are Oregon Const.Cont.Board Lic.# Exp.Date 1< --. ref uired if /,/ Z 6.S Water Service-1st 100' 30.00 expired in COT Plumbing Lic.# Exp.Dale Water Service-each additional 200' 25.00 database _ Storm 6 Rain Drain-1st 100' 30.00 �J Name J Storm&Rain Drain-each additional 100' 25.00 Architect _ Mobile Home Space ~ 25.00 or Mailing Address Suite Commercial Back Flow Prevention Device or.Auti 2500 _ Pollution Device Engineer City/State Zip Phone Residential Backflow Prevention Device" 15.00 _ (Irrigation timing devices require a separate scribe work beto be done: restricted energy permit.)_ _ New O Repair O Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture^ 9.00 Residential * Commercial O _ Catch Basin 9.00 Additional description of work: Insp of Existing Plumbing 40.00 Specially Requested Inspections 40.00 ----per/hr Are you capping,moving or replacing any fixtures? — Rain Drain,single family dwelling — 30.00 Grease?raps 9 Yes O No O . If yes,see back of form to indicate work performed by -- QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric orriser diagram Isrequired ItQuantity Total Is >9 _WORK COULD RESULT IN INCREASED SEWER FEES. "SUBTOTAL I hereby acknowledge that I have read this application,that the inform"':-, _ given Is correct,Thal I am the owner or authorized agent of the owner,and 5%SURCHARGE that tans submiltsd ate in com liance with Ore on State Laws. _P _ —_L �— _ _ Signature of owner/Agent Date "'('LAN REVIEW 25%OF SUBTOTAL only it rrxture qty Iota(is>9 J (, Contact Person N� TOTAL '7 Phone ( U ,r 'Minimupermit foe is 525+5%surcharge,except Residential Backflow �' (�� 07 d1� ��_ �t1`i T i" m"Prevention Device,which is$15+5%surcharge I "All New Commercial Buildings require plans with Isometric or riser diagram and plan review I tdgt,r;, ,ora doc 701118 X / PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed/Capped Sink L a_vatory fub or Tub/Shower Combination _ Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain/Floor Sink 2" _ 311 _ 4" Water Heater Laundry_Ro_o_m_ Tray Urinal � — Other Fixtures (Specify) — — COMMENTS REGARDING ABOVE: I WgWplumepp dm 7/7198 sewer agte SANITARY* n], ) Uf agency +N. First Ave.,Suite270, Hillsboro, Or.,97124 SURFACE WATER J � 503 648-8621 1 'I'-( ISSUE; DATE 082598 EXPIROTION TATE. 022199 F':1:,' FXF' DATE PERMIT I1'` STRUCTURE ADEIRESS 1.;5640 PPO.IECT 9995 5TRUC11.1RE 9Tr•!E:FT SW FERN 5T LOT HL.00K TY1='E CONNECTION- EXIST OF TYPE INSTALLATION- ( 1 ) BUILDING '5FWFR ONI. Y TYPE OCCUPANCY.. ( I ) STN071 F. FAM11-Y PARC F.A. 2 S 1 M 2200 QTR. SFC MH 9U(iti t 9WNET, THOMf1S BOYL.E. ADDRESS 1.3640 SW FERN ST TRF.ATMFNT PLANT PURHAN 'TI GARD 1.1R 97223 1'HONF. 524--7344 WATER DISTRICT TTGAF,II f IXTURE EQUIVALENT DWEL r_rNcaRESI1;1F:NTIA1. UNI I$ 9E RV 11"1E L!NJI'S 0 . 0 UNITS t SERVICE UNIT4:} CONNECTION FEE'S r SURFACE WA'IE;R 1IFVFLOPMFN'1 FIFES ` EWER CONNECTION 2300 .00 WATER QUALITY 0.00 LESS CREDIT 0 .00':- WATFR QUANTITY 0.00 LESS CREDIT O.00: ERDSTON CONTROL. aUb 1 11TAL 2300400 SIM TOTAL 0100 TOTA1 2300 ,00 �1F r'I... TAME'. T HgMAS PHONE AFFILL.IA1 TON OWNER REMARKS E'.XISTING HOME: HOOKING TO TIOARCr SF WE R SE:. Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,including those regarding erosion control. A 24-hour notice Is required for erosion control Inspectinns.The Inspection request number Is 844.8444. When calling for an Inspection,pisses refer to the permit,project and lot numbers. The permit e.<pires one hundred eighty I t 802 days from the date of issuance.The Agency does not guarantee the accuracy of the location of side sewer lateral 7193 WHITE - USA, BLUE - Accounting, GREEN -Inspection, YELLOW - CUSto111P1 =� INSPECTED BY DATE (:ONIRACTOR/INST LER I IYPF (IF PIPE _ _ DIAMETER OF PIPE Inspector, Please sketch below or�attach the following information 1 Street & nearest cross street Location of structure being served 3 Route of service line from structure to property line where it connects to the service lateral . Include length & diameter of service line, depth at the structure & property line, dimensions referencing line to structure, property lines and/or corners, etc, 4 North arrow I i 1 I I i I I i i i I