11546 SW LAKEVIEW TERRACE I
r s yid.
H
`3
`I
i
e
4
I
i
i
I
HMI MSIAM9 MS 9f7STT —"
ri
CITY OF TIGARD
IJEVE-"JPMENT SERVICES PERMIT
P ' . . . . FERMI r r
T ##. . . . . . . : PI_.M 37-OSE,
13125 SW Hall Blvd., T'gard,OR 97223 (503)639.4171 DA rE ISSUED: 07/00/'J7
PARCEL: 1S133D- -05300
51TE ADDRESS. . . . 11546 SW 1_AKk V IEW TERR
SUBDIVISION. . . . : VILI-qGE AT SUM-";' LAI,t PARK ;a ZONING: R--4. 5
BLOCK.. . . . . . . . . . . LOT. . . . . . . . . . . !92 JURISDICTION: TIC,
CI-ASS OF WORK. . :ALT GARBAGE D I SPOSAI.S. : 0 MOB I L'= HOME ;PACES. : 0
TYPE OF USE. . . . :5F WASHING MACH. . . . . . : 0 FACKFLUw PREVNTRS. . :
OCCUPANCY GRP. . :R 1-LOUR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . : 0
STORIES. . . . . . . . WATER HEATERS. . . . . . 0 CATCH '3AS :NS. . . . . . . . 0
FIXTURES- - ------ ---- LAUNDRY TRAYS. . . . . : 0 SF RHIN 5RATNS. . . . . . 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . : 0 GREAEE TRAPS. . . . . . . 0
LAVATORIES. . . . : 0 OTHER FIXTURE('. . . . : 0
TUBISHOWERS. . . ; 0 SEWER LINE (ft ) . . . 0
WAYER CLOSE. rS. : 0 WATE1. LINE (ft ) . . . : 0
nr_SHWASHERS. . . . 0 RAIN DRAIN (t- ! . . . : 0
Remar : Installation of v,esi.dential back Flow pr•eventi.on ,:invite.
Owner- : ------ _.____.___._..-____-- FEES
DOUGLAS JACKSON type amol_tnt by date r -'-Pt
1I.546 SW LAKEVIEW PRMT t 15. 00 DRA O7/O2/97 97-296884
TIGWRI) OR 9722-3 SPCT r 0.. 75 DRA 07/08/97 `37 -�*=`36-B84
Phone #:
NATURAI.. TOUCH I_.ANDSCAP T NG i Nr,
2. 5 BENTS RD NE
AURORA OR 97O02
Phone #: 503-678-1328 $ 1.`_-i. 75 TOTAL
Rey #. . : 6811
REDUI RED INSPECTIONS --This permit is issued subject to the regulations contained in .tie PP/Backflow 1--ev —___---_
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final. lnspec• ion
applicable '.aws. All work will be done in accordance with Ea.a.31_.• ra4A Ga 4,a
approved plans. This permit ,ill expire if work i; not started
wzthtn 180 days of issuanc_•, or if wore is suspended for more
than 180 days. ATTENTICA: Oregon law requires you to follow rules
adopted by the Oregon utility Notification Center. Those rules are
set forth in OAR :-0001-0010 thrc-igh OAR 95r'-(1901-0080. You may
obtain copies cf mese rules or direct questions to WC by calling
IssP_ted E.; t4 Y1
- Permittee Signatl-We - 2�"�_✓ ..
+++++4++++++++++++++++++++++++4-1" ++++i++++++++4-++•+++++++•+++++-++++++++++++++++
Call 639- 4175 by x..:00 p. in. for an inspect ion needed the next bi-t iness day
++4••++++++++++++ I +'+'+'t-'+-+r+ I ++++4 F+++++++++'-++++4•++++-t-++4•++4.4-+++++++4•+++++++4•++++
.-Y OF TIGARD Plumbing Application Recd By
.125 SW.HALL BLVD, Commercial and Residentia,' OatsRac'a y
Cate to P E.
;ARD, OR 97223 oats to DST
3) 639-4171 Pemut s Pit 11 7 7&
Print or Type ketated FOA s
Incompl, r illegible applications will not be accepted calla_
Name of DevelopnnentlP•opct - F.IXILREB;,QndlWdual), rOKA
Job 5 !L) L A U- Strut 9.00
".;,sat Address scats Lavatory 9'00
Address Tub a TuW-:.uwer Comb. 9.00
Bldg r G_tyisizfe Zip Shower J" 9.00
Names ! L•�'•f 0 Cl ) '. -1) Waterdlosst 9.00
07u ! t /9 I<Sor C)bhwseher 9.00
Owner Address Suds - ear""X0'"1 9.00
1{ �Gv 4 AkeVir w Washing Machla 9.00
Clty/State Zip a PhorM Floor Drain Y 9.00
! J,4 rt b r s 21 !2 q `, 3• 9,00
NanM
4- 9.00
occupant 1-u"V Address Swe Weer Mester _- 9.00
un
_ Ladry Roam Tray 9.00 j
Gty/State Zip Phone u1mal 9.00
-Name Otfw Flxuxs (Spa cfy) 9.00
JVI I tA1/ , -!uuL �q N Qs(qP t 9.00
ntrector Mailing Address suite 9.00
21;1-s g r�11, i .•1 9.00
for to issuance Gty/State Zip S Phone - 9.00
r
rppllgnt must ,�v�. �''1 �)L?c�%-1 9.00
provide all Oregon Goost.Cont.Board Lic.0 Exp.Dat
contractors 6, - i �, {� (�, 9.00
Ikarus Plumbing Lic,a EAp.OAts Sewer-1 at 1 ocr 30.00
nformattm Sewer-each additional 100' ---- 25.00
for COT CO Business Tax or Metro a Exp.Date Water Service 1st 100' 30.00
tatabase). _ _
Narrre Water Service-each additional 200' 25.00
,�rc h itect Storm 6 Rain Drain•1 st 100' _ 30.00
or Mali,;Address Suft- Storm d Rain Drain-000 additional 10d 25.00
Mobile Moms Spada 25.00
=ngineer C.lty/Stai�- ZipI Phone Commercial Back Flow Prevermon Device or 4ntl-_ 25.00
Pollution Dsvke _
scnbe work New O Addition O Alteration O ilepair O Residential Backflow Prevention Device* 15.00 r_
5e done: Residential O Non-residential O _ Any rrap or Waste Not Connected to a Fixture 9.00
dditional des tsiptlon of work -
Catch Basin 9.00
Insp.of Existing Plumbing 40.00
pr0ir
sting use of-- -- Specialty Requested inspections 40.00
_ _ DwMr
yiug or Property - -.- Rain Drain,single family dwelling 3000
.iassed use of Grease Traps - 9.00 --
•iding or property_ -
_ _ QUANTITY TOTAL
re you capping, moving or replacing any futures? Yet[] No C Irormeerte a mer dl.grarn u rcaurM 10usnry tow is >9
11!13"beck of form) _ _ - 'SUBTOTAL
hereby acknowledge that I have read this application,that the information
even is cored,that I am'he wvner or authorized agent of the owner.and .SURCHARGE
-at plans submitted are m :ompliance with Oregon State Laws."(7-7zt';,,,
t OwnerfA crit l s ) Date PLAN REVIEW 25%OF SUBTOTAL/9 / / Reound only d ftrhrn Cry taw u>9Z r� /L t G/ % TOTAL /
5�
j7pet Person Nan* P l ---
•Muilmum permit fe#is$25•5%surcharge.except Residential Baddlow
"revention Device. Mhicn is V5•5%surcharge
- -- --_--J Llplmapp doc 12/96 (dst)
'LEASE CQM LETS AS APPROPRIATE TO PROJECT:
rFixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Dispo!,4
Washing Machine
Floor Drain 2"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Speciry) _
COMMENTS REGARDING ABOVE:
Pplmapp.doc 12.!945 (ds:)
1
CITY OV nGARD BUILDING INSPECTION DIVISION
24-Hmir Inspection Lina 6394175 Business Phone: 639-4171
Date Requested. "-LD'" cl 7 A.M. �i� Y.M. MST:
Location: (-e—, BUP:
Tenant:_ Suite: Bldg: MEC:
Contrak eor:_ i Phone: PLM: 1J
Owner: o
���• � ELC:
- --u -- — ELR:
Srr: _
BUILDING BLDG(can't) LUMBING ?— MECHAI-4ICAL —ELECTRICAL SITE
Site Post/Bcam Post/Betun Cover/Service Sewer/Stortn
Footing koof UndFUSlab Rough to Ceiling Water Line
Slab Framing Top Chit Gas Line Rough-in Ura Sprinkler
Foundation Insulation Sewer Ilacx'JI)uct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C IJG Slab
Sheat/Sheath fire Spklr/Alm Crawl/Found ih Heat Pump Low Volt '
Approved
proved Approved Approved r ed
Appr/Sdwlk Not Approved oved No A ovcd Not Approved o pproved
FINAL FiN`At` FINAL FINAL
O Call for r D R tion fee o S_ _ required before next inspection O linable to inspect
Inspector: fate: 7 Page_ of