11915 SW SUMMER CREST DRIVE-1 0 I i=s
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639401
71
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D ete Requested- _ /0 c�� A.M. i� -M. MST:
Location:_LJ!1 ti BLIP:
Tenant: _ � te /� 39 aI PLM:
Suite: _Bldg: _ NEC:p
_ v �` 1
Contractor: Phone:
Owner: _ Phone. � _ e�62 ELC: I
YIn n_ _ ELR:
SIT: _
BUILDING BLDG(con't) MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In DJG Sprinkler
Foundation Insulation Sewerfw—
Bsmt
Hood/Duct Reconnect Vault
Damp Drywall Storni W Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm C�m
.y"ouild Dr Heat Pump low Volt
Approved mud Approved Approved Approved
Appr/Sdwlk Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
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orrequired before nexttinspection C I l Jnable to inspect
: Date: l�` ! 'S'/ �i� / Page_. of
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CITY OF
TIGARD
DEVELOPMENT SERVICES N.A-IMSTNIS r'E`RMTT
13125 SW HBO BlVd., 1'IQard,OR 97223 (503)639.410-1 rl�:RM T T #. ° • ' Pl_'•h197...-00p_
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lyric r?r I41717W. ;ALT t';KapSPC:-,E DISPOSALS— 0 l"0_8T!,F.. HOMF F11r3ACEF3. 0
WASr11 NG MACH. .�iv _,c*1!0PNcy GRP. -R3 r-1 00r, DPATNIS, 0
Q( PACKT'1_.i?W F�Gf V4vITR!�, 0( �
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r!r'TFF. . . . . . . . . 0 WATE HEPTERF. . . . . . 1 GATCN AAgTMS. . . . . . . .. �+
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NKS. , . . . . . . ; 0 UPINAI_ES. . . . . . . . . . . .. GarOSE TRAPS. . . . . . . s 0
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'-is perW i= issued subject is the. r••vJlrti^^ rortai^e'! to N,F 19:1 -'r' , Tr'),npct i.orr _..
pard Municipal Cod@, State of Dee, rpeciall lodes arc al: Phe'• u; i,eal Tnrnr�rt i nn
T aplicable laws. All Moro soil] be done in ;,'-• -ranee wit's
asrcved plans. T'•ie pe"eit will expire 41� work is not st,, tPd
;thin 11N days ce iivianc'e, er if work is impended for tory
tiro l8l days,
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TY OF TIGARD Plumbing Application Recd By�J���
125 SIN HALL BLVD. Comrnercial and Residential °ale c p�s
GARD, OR 97223 Cale to CST
03) 639-41 r71 Pnrm l s el n11-7 `C7�J9
Print or Type Related S"s� i
Incomplete or illzgible applications will not be accepted called
Name f CevelopmenliProlect FIXTURES (individual) QTY PRICc AMT
Sink 900
Job
t
Address •;'eet Address Suite rub
1t T 9 00
�� 1 St.kN4MA"Cn'c flab or uoiShower',.amb 900 4
di Ig s wl tslate /,/�[n '.p 'ihower Only 9.00
4� C Water Closet
9.00
Wme l r�. Dishwasher ~�,l J��j ) �Y1e 900
Owner &fading Address 5wte Garbage Disp01a1 900 JI
ffif/L,� S.0It+ ercSt Wasning Machine 9 00 i
�.(rSlaie Lp Phoneain Floor Cr2" 900
r c# g7Xz3 51�—S�i1Z 3- sok
Name V 900
I OCCUpant Mamng Address Suite Water Heater J 9 u0
Laundry Room Tray 9.00
citVIState Zip Phone Unnal I 9_J0
Name c�. ' -- 01her Fixtures 15oec,ty) _- 9.00
_�J��fj, xQ►i/1✓� 9.00
Contractor MaAdOress Suite _ 9.00 I
JZhn 5 fW 601 _
9.00
Pnor to issuance city/ late Zip Phone
30plicant must 014 q7,92 7 3;1 _ 9.00
1 provide an Oregon Const.Cont. Roard Lic 0 Exp 0,7
a a 9.00
contractors 02- _7_73C-1 � 97 8.00
license Plumbing/Lic.s Exp.Date Sewer- Ist 100' 30.00
information -26Z 6i-"g 6—.Tc)�Q 7 Sewer-each adCition,at im, 25.00 1
for CC� C::T 3usiness Tax or Metro s exp.Date
database). Wafer Service-tst tQ0' a 30.00
Name later Service-each admaonai 200' 2500
' Storm d Rain Crain- I st n0 3000
Architect _in
Or Maahng Address I Sure Storm d Rain Crain-each additional 100' 25,00 I
Mobile Home Space 25.00
Enginver CiyrSlale Zip Phone Cammeraal Barx Pow Prevention Cevics or Anti- 25,00-
I
3 00 �^
I- Po11Wnn CJevice
_esCribe-.vorx New Addition Alteration .D Recair c -Residential 9ac0ow''evention ev+ce' I !S 30
b ee 3cne Residential,C Non-residentiat J I any Trap or Nas;,t Nct Cor nec ed fo a Fixture I T 00
adcr onal nescnotion of wcnk Cairm basin i 900
1
-nsb or Exis;inq c umoing •10.00
_ perihr
;xisnnq use 31 Soeaalty Requested Inspections 40.00
oechr
wlC:ng or prOpeRy Rain Crain sinTe'amiy cweuing I 30)0
ocosed use of Grease Traps — 9130
:u1ming or prooerty____
( J QUANTITY TOTAL i
-:a ,ov caoninq movirg or replaanq any fixtures ves r No sort eirc v nl4f=wry^ s-ecu""f C.+uanity-otar ii t
It yes see back of toRrtt _ 'SUBTOTAL
"eret)y acknowledge that I'Nave read;hit application.that the-nformalion _
given,s-orrect that I am ne owner or authonted agent of*ne owner and S%SURCHARGE `
I :rat olars submitted are - :CIMChance with Oregon State laws. +
Signature of OwneriAgent pate PLAN REVIEW 25%OF SUBTOTAL f
7 aaavna k n t°n ra ttr wsi a 3
TOTAL
'ontact Perso71141IL4
Phone z S;
� 'Minimum permit tra ,525 -51%surcnarge except Residential i3ncklow
cw L 3V Prevention Cevica. ^kch•_S1 S-5%surcharge
i:'.dsts'olmsoo doc 9:98
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AS APPROPRIATE TQ PROJEC-T:
LFixtures to be capped, moved or replaced { Qty
Sink
Lavatory
Tub or Tub/Shower Combination _
�r Shower Only
Water Closet
Dishwasher
Garbage Disposal
{ Washing IViachine
Floor Drain 2"
4"
Water Heater
Caundry Room Tray
Urinal
Other Fixtures (Specify) _
::OMMENTS REGARDING Ac _.
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