11810 SW SUMMER CREST DRIVE S
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11810 SW Summer Crest Dr
CITY OF T`GARD B JILDING NSPECTION DIVISION Ms•r
24-Hour Inspection Line: 6:,9•4175 Business Line. 639-4171 BLIP
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Date Requested _ AM_ _---PM BLD
Location_ l � �7�-'1'22.1 i-� Suite _ MEC
_
Contact Person Ph PLM y(;:,�.'� - - —
Cortractor- -t �„�.� Ph �I/ l�y 7 SWR
BUILDING Tenant/Owner _ ELC _ —
Retaining WallELR
Footing A cess =���� �_ ✓�r/t�" ' A4 FPS
Foundation -
Ftg Drain — — SGN —
Cre-d Drain Inspection Notes: SIT
f - ;
slap ' , 1 +
Post&Beam
Ext Sheath/Shear L ----
Int,;heath/Shear
Framing �' I Q— _ �-�CIr��.. .a CSI'd
Insulation
Drywall Nailing ---- -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling --
Roof --
Misc:
Final
PASS PART FAIL
PLUMBING —
Post& Beam
Under Slab
Top Out ---
Water Service
San l!ary Sewer
Rain Drains _ - ----- -
fi
p -' PART FAIL
r,kANICAI_
Post 8 Beam -
Rough In
Gas Line ---- _----!
Smoke Dampers
Final _
PASS PART FAIL - _-
ELECTRICAL
Service ----
Rough In �T
UG/Slab - ---
Low Voltage
Fire Alarm - ----- - -_ - - _ --_ - -
Final
PASS PART
SITE _
Backfill/Grading
Sanitary Sewer
Storm Drain I ]►leinapection fab of s _ _— required before next inspection. Pay at City HAI! 13125 SW Hall Blvd
Catch Basin Please call for reinspection RE: _ ( J Unable to Inspect-no access
Fire Supply Une I J
ADA _
P,pproach/Sidewalk Date
_ Inspector- sI
4 Ext
Other Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITYOF TIG /1, R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: P 00402
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 8/22 4/014/01
PARCEL: 1 S 134CD-07900
SITE ADDRESS: 11810 )W SUMMER CREST DR
SUBDIVISION: BURLWOOD NO 4 ZONING: R-k 5
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORE'.: OTR GARBAGE DISPOSALS- MOBILE HOME SPACES:
TYPE CF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATEP.S: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: Sr' RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES.
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device__
_ FEES
Owner: —
'Type By Date Amount Receipt
BOER NEW PRMT CSR 8/24/01 — $36.25 27200100000
11810 SW SUMMER CREST DR
TlGARf), OR 97223 5Pr,T CfR 8/24/01 $2.90 27200100000
-
Total $39.15
Phone 1:
Contractor:
C NNER
REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone 1: Final Inspection
Reg #:
This permit is issued subject to the regL lations contained in the Tigard Municipal Codc, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started with 80 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
Notificatior! CeWer. hose rules are set forth n 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: � i' .,? _ Perrnittee S gnature: -
Call (503) 639-4175 by 7:00 P M. for an inspection needed the next Business day
Permit#: ' -►i ='—
oF o n /
Address: / 1 �5
r 6r
s
Issue(by: Ai
_ ���� -!' Date:
F7003
Statement: Information Notice to Property owners
About Construction Responsibilities
Note: Oregon Law, ONS 701.055(4), requires residential construction permit appli-
cants who art, not registered with the Construction Contractors Board to sign lite
following statement before a buildingl>crmit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt,front registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
IVI 1. 1 own, reside in, or will reside in the completed structure.
1 2. I understand thus I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3A. My general contractor is
l_1 (Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must he
registered with the Construction Contractors Board.
OR
.111 1 w be my own general contractor.
Ute' If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractor
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners alltit Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) Dat
(White copy to issuing agenc.v permit file,
pink copy to applicant)
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VAPLUXER �0.-;-�FtiONWJIHiL+��t: �.
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Plumbing Permit Application
Date received: l '// r/ Permitna: LIYtW/
City of Tigard Sewer permit BuilAing permit no.:
Address: 13125 SSV I iall Blvd,Tigard,OR 97223 —
City of Tigard Phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: i _ Case file no.: Payment type:
❑ I & 2 family dwelling or acer-ssory U Commercial/industrial U Multi-family U Tenant improvement
J U Addition/altcrition/replacement U Food service U Other: _
11 %[TV NVOItMATIOort
Job address: t IIQ,1,� ' „„ ! 1 t__T 1)escri tion —_ (jt . Fee(ea.) 'total
Bldg.no.: Suite lo.: Ne" I-and 2-family d"ellings only:
(includes 100 fi.foreach ulilil y connection)
Tax map/tax lot/account no.: _ SFR (1)ba!h
Lot; Block: Subdivision: SFR(2)bath
Project name: SFR(3)bath
City/county: '7;aia,�J ZIP Each additional bath/kitchen
Description and to t' n of work on prem..•;s:_ _ SlIeutilities:
Catch basin/area drain
"6i6iEiia
Drywells/leach line/trench drain
Footing drain(no.lin.ft.)
1 ' Manufacturer home utilities
Business nameManholes
Address: Rain drain connector
City: State: ZIP: Sanitary sewer(no.lin.ft.)
Phone: Fax: I E-mail: Storm sewer(no.lin.ft.)
CCB no.: Ph ith.bus.reg.no: Water service(no. lin.ft.)
City/metro lic.no.: - fixture or Item:
Ahsor[rtion valve �
Contractor's representative signature: Back flow preventer
Print name: Date: Backwater valve
Basins/lavatory
Name: )ri Clothes washer
Dishwasher
Address: rz I� Drinking fountain(s)City: tI Q' ! �— State:7'� F.jectors/sump _ —
Phone: .� Fax: E mail: Expansion tank _
Fixtwr/sewer cap _
Floor drains/floor sinks/hub
Name(print): Bol— l_-�_ 1ti.) Garbage distiosall
Mailing address: I 5. r.0t'IrAi (�1 Hose bihh
_City;_-"� State: ZIP: Q�_ Ice maker
Plr ne: V Fax: E-mail Intet.e tur/grease trap
Owner installation/residential maintenance only: The actual installation Primcr(s)
will be mode by me he main tena)tc an repair made by my regular Roof drain(commercial)
employee nn the p petty I n pas 'r R apter 447. Sink(s),basinlsl, rvs(s)
Owner's si natu Dale / Sum
Tubs/shower/shower an
Urinal
Name: /;4� 1� _ Water closet
Address Water heater
City: ----- I',i,tir^ ZIPS — _ Other;
Phone: Fax: I E-mi,.: Total
Minimum fee................$ r. •
Not all Jurledlctions accept cmdlt cards.please cell iudsclicllon foe more Information. Notice:This permit application
Uvisa UMasterCard Plan review(at — 96) $
expires if a permit is not obtained --�" --
Credh card number _�__`_ within 180 days after it has been State.surcharge(8%)....$
Name of shown on credit care accepted its complete.
TOTAL .......................$
Cardholder itnaiure Anw J 440-4616!hA%Yt't"!
PLUMBING PERMITFEES:
PRICE TOTAL Now 1 and 2-family dwellings only:
FIXTURES individual QTY ea AMOUNT (includes all plumbing fixtures in PRICE: TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utlllty connection
ry One(1)bath $249.20
Tub or Tub/Shower Comb. 16.60 Two 2)bath - $350.00
Shower Only 16.60 Three(3)bath $399.00 -
Water Closet 16.60 - SUBTOTAL
Urinai 16.60 8%STATE SURCHARGE
Dishwashnr 16.60 PLAN REVIEW 25%OF SUBTOTAL -
Garbage Disposal 16.60 _ TOTAL_
Laundry Tray 16.60
vva,.``Ing Machine 16.60
Floor Drain/Floor Sink t" 16.60
PLEASE COMPLETE:
3• 16.60
4" 16.60
Water Heater O conversion O like kind 16.60 _ t]uantit b Work Performed io_
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced R -" vedl
ermit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lave►o
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains - 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures(Specify) 16.60
Dishwasher
Garbage Disposal
Laundry Room Tray _
Washin Machine
Floor Drain/Sink: 2"
Sewer-1 at 100' 55.00 -' 3"
Sewer-each additional 100. 46.40 4" _
Water Service-1st 100' 55.00 Water Healer _
WaterSerelc.e-each additional 200' 46.40 Other Fixtures
(specify)
Storm F,Rain Drain-1it 100' 55.00
Stone b.Rain Drain-each additional TOO'--. 46.40 - -
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device- 27.55
Catch Basin 16.60
Inspection of Existing Plumbing of Specially 72.50
Requested Inspectionsper/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 05.25
Grease Traps 16.60 ---- _--•- - --
QUANTITY TOTAL --
Isometric or riser diagram Is required if -
Quantity Total Is >9 -----�
"SUBTOTAL ----- -- ----
8%STATE SURCHARGE - ---- -
"PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture qty total Is>9
TOTAL
"Minimum pe-mit fee Is$72,50,6%state surcharge,except Residential ackflow
Prevention Device,which Is$36 25-8%state surcharge.
"All New Commercial Buildings require plans wMh Isometric or riser diagram and
plan review
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