10272 SW MEADOW STREET-1 1S MOV3W M8 UZU
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10272 SW MEADOW ST ,'�
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 839-4171
SUP
Date RequestedWAAjk� AM f'iVl OLD _
Location Suite MEC
Contact Person � d Ph C7 PLM
Contractor_ Q Ph _ $%VR _
BUILDING TerianUOwner ��� ELC
Retaining Wall EL 11
Footing ACCe3s:
Foundation PS
Ftg Drain SON
Crawl Drain Ir spectign Notes:
Slabs SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _.
Firewall
Fire Sprinkler - ---
Fire Alarm
Susp'd Ceiling _ -
Roof
Misc: oe
Final —
PASS PART FAIL - --
Pos!& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Fin
PART FAIL
MECHANICAL
PoFt&Beam
Rough In
Gas Line
Smoke Dampers
Fina, - --- -
PASS PART FAIL
ELECTRICAL
IL Service
Rough In
N UG/Slab
Low Voltage —
Fire Alarm
� Final
PASS PART FAIL -
W SITE
J Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$— required before next inspec,,,on. Pay at City Hall, 13125 SW;'el Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: Unable to Ina,� _ [ ] pact-no arx ss
ADA
Other ch!Sidewalk Dtite �1 ;vispectorApproExt%
Other -f----
Final
PASS PART FAIL Dd RIOT REMOVE thh, Inspection record from the Job sit*.
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM1999-00267
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.41 1 NVPARCEL:
E ISSUED:
SITE ADDRESS: 10272 SW MEADOW ST 1S135CC-01600
SUBDIVISION: THE MEADOW O� ZONING: R-4.5
BLOCK: LOT: 009 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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 300 ft
Remarks: Installation of 300 feet of storm& rain drain line.
FEES
Owner: Type By Date Amount Receipt
FAUGEROUX, LUC MARC+ JULIE A PRMT DEB 8/17/99 $102.00 99-317727
10272 SW MEADOW ST 5PCT DEB 8/17/99 $5.10 99-317727
TIGARD, OR 97223 --
Total $107.10
Pho;-T 1:
ContrF^tor:
OWNER
REQUIRED INSPECTIONS
Rain Drain Insp
Phone 1: Final Inspection
Reg#:
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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 plans.
LU LU 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 Oregon Utility
Notification Center. Those rules are set ioith in OAR 952-00el-0010 through OAR 952-0001-0080.
Y7edBy: as
Wain copies of these rules or direct questions to OUi`IC by Galli (503) 246-1987.
IsL Permlt! Signature: V Ale�L
�L�4Call(503)A-41 by 7:00 P.M.for an Inspect Ion needed the ess day
CITY OF TIGARD Plumbing Permit Application Pian C.. :_ _
13125 SW HALL BLVD. Commercial and Residential Recd B
TIGARD,'OR 97223 Dale Recd
(503) 639-4171 Date to P.E. --
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Pearce 7
Related SWR e _
Called—
No
alledWNo a of Development/Project —, f,aXMRES 1114 Y1dU-
;��t„ QTY.= PRICE] AMT
JobSink 11.50
Address Street Address Suite Lavatory 11.50
to-LIC L Tub or Tub/Shower Comb. 11.50
Bldg a Cit /S fe Zip Shower Only 1 11.50
A0, U3
Nem n� Water Closet 11.50
V` °l1� Dishwasher 11.50
Owner Mailing ddress Suite Garbage Disposal 11.50
13M 11
Washing Machine 11.50
/State ZI Phone Floor Drain/Fioor Sink 2" 11.50
16 A40 4 :; la, aft4t
Name 3" 11.50
4" - 11.50
Occupant Melling Address Suite Water Hester O conversion O like kind 11.50
Gas piping requires a separate mechanical permit. _
City/State Zip Phone Launuiry Room Tray 11.50
Urinal 11.50
Name„ 1 , �, Other Fixtures(Specify) _ 15.00
Contractor Mailing Ade,ess Suite
Prior to permit City/State Zip Phone Sewer-1 at 100' 38.00
Issuance,a copy Sewer-each additional 100'^ 32.00
of all licenses are Oregon Const.Cont.9oam Lic.e Exp.Dale
required If Water Service-tat 100' 38.00
expired In COT Plumbing Lic.a Exp.Date Water Service-each additional 200' 32.00
database ^� Storm d Rain Drain-tat 100' 38.00 ra
Name Storm&Rein Drain-each additional 100' 32.00 "-
Architect Mobile Home Space 32.00
or Mailing Address Suitt+ Commercial Back Flow Prevention Dtivice or Antl- 32.00
Pollution Device
Engineer CRy/State Zip Phone Residential Backflow Prevention Device* 18.00
(Irrigation timing devices require a separate
Describe work to be done: restricted encpermit.)
New O Repair O Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 11.50
Residential *-I'Commercial O Catch Basin 11.50
Additional description of work:
�� � ^ � Insp.of Existing Plumbing 50.00
NX A (r1 A GP, :i 1plLM rthr
Are you capping,moving or replacing any fixtu ? Specially Requested Inspections 50.30
Yes O No ty _ per/hr00
d Rain Drain,single/amity dwelling � 45.00
If yes,see back of form to indicate work performed by Grease Traps 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD REgI1L'r IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that 1 have read thlr application,that the Information Isometric or riser diagram Is required s Ouanifty Total Is >9
J given i correct,that Iam the owner or authorized agent of the owner,and "SUBTOTAL
that I submitted are In compliance with Oregon Stale Laws.
V, Signa of OwDate 6%SURCHARGE
J Contac mmee�?�__. Phone **PLAN REVIEW 25%OF SUBTOTAL F
RequW only If fixture qty.total Is>9
TOTAL
'Minimum permit fee is$50+5%surcharge,except Resldential Backflow,
Prevention Device,which Is$25+5%surcharge
**All Nov;Cnmmerciat Buildings require plans with Isometric or riser diagram
and ptenr,review
I Wst9Vorm#4pkxnepp dm 6/2/99
• -w
PLEASE COMPLETE:
Fixture Type alu.g.i.iftKyby Work Pe` ormed
New Moved Replaced Removed/Capped
Sink —
Lavatory _ ,e
Tub or Tub/Shower Combinatiolfk A.`• ••
Shower Only
Water Closet _
Dishwasher '
Garbage Disposal '
Washing Machine r -� • —
Floor Drain/Floor Sink 2"
391
Water Heater
Laundry Room Tray _
Urinal
Other Fixtures (Specify)
COWENTS REGARDING ABOVE:
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