11970 SW LINCOLN AVENUE-2 0
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24-Hour Inspection Linn: 639-4175 Business Line: 639-4171
BLIP
Date Requested t U v1 --AM— PN] _ — BLD
Location �� U , L J 3 -a2 L/':f Suite — _— MEC _
Contact Person
Contractor 'h SWR
BUILDING— _ Tenant/Owner _ ELC
Retaining Wall _ - ELR
Footing —
Access.
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Nntes: -
Slab _ d'
Post&Beam SIT
Ext Sheath/Shear
!,rt Sheath/Shear
Framing
Insrl,ation � --
—�--
� _1
nr�w311 N ilinq
Flrrv,all —
F;re Sprinkla
Fire Alarm
Susp'd Ceiling
Root
Misc:
Final --
BI4 - RT FAIL --- - -- - ---------- --�.. _--�- _
PLUS,
Post& Beam _
Under Slab
lop Out
Water
nitary Sew
Rain ff-r-JITlTr-
AM PART FAIL
MECHANICAL
Post& Bear i ------- -
Rough In
Gas Line - -
Smoke Dampers
Final -- -- - —�
PASS PART FAIL
ELECTRICAL --- - --- -- ---_ -- _- -
Service �—
- -- - -
Rough In - -
UG/Slab
Low Voltage �-
Fire Alarm
Final ---- --- ---- ---_
PASS PART FAIL ---- --------------__._—.----
SITE ----- --- --- _
Backfill/GradingSanitary Sewer
Sewer
Storm Drain [ ] Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SVV Hall Blvd
Catch Basin
I' re Supply Line I J Please call for reinspection RE: Unable to inspect-no access
ADA
V 11 . .-
Approach/Sidewalk
Other Date 1 —_ Inspector _ Ext _ f
Final
PASS -PART----FAIL- J DO NOT REMOVE this inspection record from the job Ate.
r
\ CITY OF TIGARD _ PLUMBING PERMIT
DEVEL.OPMEN"r SERVICES PERMIY#: PLM2001-00146
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/10!01
SITE ADDRESS: 1 19'0 SW LINCOLN AVE PARCEL: 2S102AB-01000
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEN-.). ZONING: R-7
BLOCK: LOT: 065 JURISDICTION: TIG
CLASS OF WORK: REP 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: 20 ft
WATER CLOSETS: WATER LINE: ft
DISoWASHERS: RAIN DRAIN: ft
Remarks: R'ipair of approximately 20 feet of sanitary sewer line.
FOES
Owner: - -- -
Type By Date Amount Receipt
BARBER, RAYMOND C AND PRMT CTR 4/10/01 $72.50 27200100000
NORMA A 5PCT CTR 4/10/01 $5.80 27200100000
11970 SW LINCOLN AVE
TIGARD, OR 9722.3 Total _ $78.30
Phone 1:
Contractor:
TRI MOUNTAIN EXCAVATING INC
21605 NE i 0TH AVE
RIDGEFIELD, WA 98642 REQUIRED INSPECTIONS
Phone 1: 360-887-4144 Sewer Inspection
Reg #: LIC 146353 Final Inspection
This permit is issued subject to the regulation,-, 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
This permit will expire if work i; not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION Oregon lay, requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You nray obtain copies of these rules or rjirect questions to OUNC by calling (503) 246-1987.
Issued By: �,'_ �.Y c (r )1. ,� LPermittee Signature:
Call (503) 639-4175 by 7.00 P.M. for an inspection needed thi;; business day
L�
Plumbing Permit Application
Datcrcccivcd: ��/ Permit no.:AH;jZ/'
City Of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tig4rd,OR 97223
City of Tigard Pho-le: (503) 639-4171 I'rojecUappl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: R ,;eipt no.:
Land use approval: —-----. _�— Case file no.: Payment type:
1
U 1 &r 2 family dwelling or accessory U Commercial/inths.tiuial U Multi-family U Tenant improvement
J Nrw comsuurti.in A Addition/alter ition/replacement U Food service U Othrr
SITF INFORMATION 1:1-:e t
Job address: Description _ Qty. hec(ea.) 'Total
Bldg no.: Suite no.: New I-and 2-family dwellings only:
--- (includes 10011.loreachntilityconnection)
/ Tax map/tax lot/account no.: _ SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath -- ---
Project name: _ SFR(3)bath
City/county: 7r f;,
ZIP: 0-72- Each additional hath/kitchen i
Description and location of work on premises: e Slteutilities:
Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/french drain
Footing drain(no. lin.ft.)
1 Manufactured home utilities
Business name: ' /lit-070,v., ti�.r 1=.i' w✓F- t'+ Manholes
Address:?,0 Gt,.vC Rain drain connector
City: �. Strte"V$- ZIP: C `� Sanitary sewer(no.lin.ft.)
Phone 360_ Fax: I E-mail: Stoma sewer(no.lin.ft.)
. Plumb.bus.re no: Water service(no.lir ft.) _
CCB no.: '�' g' Fixture or Item: 1
City/metro lic.no.: J _
Contractor's representative signature,: �s Absorption valve
Back flow reventer
Print name: G �r, —C _((_ Date:0`/ /0 aaaj Backwater valve _
Will RILE 0 Basip-Aavatory _
Name: Clothes washer -
- Dishwasher _
Address: Dunking fountain(s)
�^
City: State: ZIP: Ejectors/sum
Phone: Fax: �1: ttetil Expansion tank _
Fixture/sewer cap i
Floor drains/floor sinks/hub
Name(print): ,i(/pd'µ,aGarbag
01 e disposal
Mailing address: /Iq 70 S LV, (-r 40141
Hose Bibb _
City: State:LJ6- I ZIP: — Ice maker �V
Phone:---7V3 4 ZQ-0 1 E-mail: Interceptor/grease trap__
Owner installation/residential maintenance only: The actual installation Primer(s)
evill be inade by me or the maintenance and repair made by my regular Roof drain(commercial)
emplo/ec on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature:__ Date; L Sump
Tubs/shower/shower pan
Urinal _
Name: — Water clo-.et _ —
Address: Water heater
City: — State: _ ZIP: _ Other:
Phone: Fax: E-mail: Total
Not all Jurisdictiom accept credit cards,pieaae call Jurisdiction for more information. Notice:This permit application
Minimum fee................$
O visa U MaatetCard expires if a permit is not obtained Plan review(al _ %) $ _
Cuda card number'----- —1—J— within 180 days after it has been Stale surcharge(R%) ....$ _
Nome of cardholder an shown on credit card Expires
------ — accepted as complete. TOTAL .......................$
Cardholder signature Amount 440.4616(6 W*OM)
1
0
PLUMBING PERMIT FEES:
--� W PRICE TOTAL Now 1 and 2-famlly dwellings\only:
FIXTURES (Individual) _ QTY ea _AMOUNT (Includes all plumbing flature�In 1,410E 'TOTAL
Sink 16.60 the dwelling and the firsl100 K, Q (ea) AMOUNT
l avalo �— 16.60 for each utility 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 V —16.60 -- —
SUBT TAL _
Urinal -16.60 __ _— 8%STATE SURC ARGE _
Dishwasher 1 .60 F1 AN REVIEW 25%OF SURTOTAL
Garbage Disposal -lu 30 _—_ -00%AL
Laundry Tray 1660
Washing Machine 16 bJ
Floor Drain/Floor Sink 2" 16.60 —
3" -- -16.60 - PLEASE COMPLETE:
4" 16.60
Water Heater O conversion O like kind 16.60 — Quantity b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved ReplacedRem��edr
permit. _ — -- _— pecl-
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 — Lavato
F'ose Bibs — — 16.60 -- Tui a wer —�
Corr inationlon
Roof Drains 16.60 Shower Only
— --
Drinking Fountain 16.80 Water Closet —.
Other Fixtures(Specify) 1660 Urinal
_ Dishwasher
Garbage Disposal _
Laundry
Ws Ing Machine
Floc `rain/Sind 2
Sewer-1 st 100' 55.00 31•
Sewer-each additional 100' 46.40 4" _
Water Service-1st 100' 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixture
_ — (specify) _
Storm R Rain Drain-1st 100' 55.00
Storm 8 Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 --------
Residential Backflow Prevention Device' 27.55 — --
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Reguesled Inspectionsper/hr _ COMMLNTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60 _ —.—_—
QUANTITY TOTAL —�— _--- - _—
Isometric or riser diagram is required If — T
Quantity Total Is >9 ------ --
`SUBTOTAL ---— - ----------- —-- ——
8%STATE SURCHARGE --- --- - -- —
"PLAN REVIEW 25%OF SUBTOTAL
Required only If fixture qty total Is>9
TOTAL a
Minimum permit fee is$72 50•8%state surcharge,except Residential Backflow
Prevention Device,which is$30 25+a%state surct.erie.
"*All New Commercial Buildings require plans with Isimetrlc or riser diagram and
plan review
1:\dsts\forms\plrn-fees.doc 10/10/00