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Permit IF' A CITY OF TIGARD `. 01 0fl6� 1' DEVELOPMENT SERVI PERMIT LU # WING PERh1 F'LM97 -0388 E 13125 DATE ISSUED: 09 /29/97 PARCEL: 2S109BA -06900 SITE ADDRESS...: 13874 SW LEAH TERR SUBDIVISION HILLSHIRE SUMMIT #2 ZONING: R -7 PD BLOCK • LOT :055 JURISDICTION: TIG CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0 TYPE OF USE -SF WASHING MACH 0 BACKFLOW PREVNTRS..: 1 OCCUPANCY GRP..:R3 FLOOR DRAINS : 0 TRAPS ° 0 STORIES • 0 WATER HEATERS • 0 CATCH BASINS : 0 FIXTURES LAUNDRY TRAYS - 0 SF RAIN DRAINS • 0 SINKS 0 URINALS • 0 GREASE TRAPS • 0 LAVATORIES • 0 OTHER FIXTURES....: 0 TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0 WATER CLOSETS.: 0 WATER LINE (ft)...: 0 DISHWASHERS 0 RAIN DRAIN (ft)...: 0 Remarks: Install residential backflow prevention device Owner: FEES JOHN NAEGELI type amount by date recpt 13874 SW LEAH TERR PRMT $ 15.00 JSD 09/29/97 97- 299620 TIGARD OR 97224 5PCT $ 0.75 JSD 09,/29/97 97- 299620 Phone #: 590 -0396 Contractor OWNER Phone #: $ 15.75 TOTAL Reg f..: 999999 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the RP /Backflow Prey Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection applicable laws. All work will be done in accordance with approved plans. 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 forth in OAR 952 -0001 -0010 through OAR 952-0001-0880. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-1987. Issued By: 4111011111111117 t Permittee Signatur + + + + + + + + + + + + + + + + ++ ++,++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ CITY _,r TIGARD Plumbing Application Recd By 131.25 SW HALL BLVD. Commercial and Residential Date Recd 1 i - 'TIGARD, OR 97223 Date to P.E. Date to DS (503) 639 -4171 Permit # I t-114 L7.- Print or Type Related SWR # - Incomplete or illegible applications will not be accepted Called ...ear_ Name of Development/Project Job dal- t. kr V. s � S I t-L i r t cL FIXTURES . (Individual) -;; ° ; - Y QTY PRICE - AMTA Address Street Address Suite Sink 9.00 I '3 Fi 1 1 .S to 1.--e-a3 TA Lavatory 9.00 Bldg # City /State Zip Tub or Tub/Shower Comb. 9.00 Shower Only 9.00 Name '3"-- e (.s to � - _ i Water Closet 9.00 Owner Mailing Address J Suite Dishwasher 9.00 i 3es 7 9, S U 1.--e--t,-(6,- Garbage Disposal 9.00 City /State Zip . r Washing Machine 9.00 1 '1- et X-2 .5 '-0 57, � I Name Floor Drain 2' 3' 9.00 9.00 Occupant Mailing Address p Suite 4• 9.00 G �'�� Water Heater 0 conversion 0 like kind 9.00 City /State Zip Phone Laundry Room Tray 9.00 Name Urinal 9.00 ©L..,5-9 --(j--' Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 (Prior to issuance City /State Zip Phone 9.00 applicant must 9.00 provide all Oregon Const. Cont. Board Lic.# Exp. Date 9.00 contractors 9.00 license Plumbing Lic. # Exp. Date . r- 1st 100" 30.00 information if expired Sewer - each additional 100' 25.00 - in COT COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00 database). Water Service - each additional 200' • 25.00 Name , Storm & Rain Drain - 1st 100' 30.00 Architect Storm & Rain Drain - each additional 100' 25.00 Or Mailing Address Suite Mobile Home Space 25.00 Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device Describe work New ® Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00 to be done: Residential 0 Non - residential O Any Trap or Waste Not Connected to a Fixture 9.00 Additional description of work Catch Basin 9.00 Insp. of Existing Plumbing 40.00 per/hr Specially Requested Inspections 40.00 Existing use of • per/hr building or property R-"e-`' '`` 4- 'A' t:r` Rain Drain, single family dwelling 30.00 ' Grease Traps 9.00 Proposed use of . building or property QUANTITY TOTAL Are you capping , moving or replacing any fixtures? Yes 0 No Isometric or riser diagram is required if Quanity Total is > 9 (If yes see back of form) 'SUBTOTAL i • / I hereby acknowledge that I have read this application, that the information 5% SURCHARGE t q-5 given is correct, that I am the owner or authorized agent of the owner, and that plans submitted are in compliance with Oregon State Laws. PLAN REVIEW 25% OF SUBTOTAL Si ature of Owner /Agent Data Required only if fixture qty. total is ? 9 �� , . 9� c� ' C TOTAL - Con ct Person Name P 'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow I Q , -. C 616 _0,.q e, Prevention Device, which is $15 + 5% surcharge 1:ldststplmapp.doc 5/97 PLEASE COMPLETE AS APPROPRIATE TO PROJECT: Fixtures to be capped, moved or replaced Qty Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain 2" 3" 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I:{dsts1p1mapp.doc 5/97 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested AM PM BLD Location /3,7V ,5) Suite MEC Contact Person / Ph PLM 97 o3 Contractor Z f � / S Ph 6„2 V 7V,_3 SWR BUILDING' 'N, Tenant/Owner ,_je 2)/di'LQ A/a-e ELC Retaining Wall _ _ _'d3�� ELR Footing Foundation AC NOT R E Q UESTED FPS Ftg Drain —, FOUND RESEARCH SGN Slab Crawl Drain In; l NO IN FILE ' Post & Beam SIT Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm T . -( / Susp'd Ceiling • Roof I Misc: .; - .. Final , /r.•�`= PASS PART FAIL PLUMBING Post & Beam Under Slab - Top Out Water Service Sanitary Sewer Rain Drains Finat� s PASS' PART FAIL MECHANICAL ° & ; ; Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICALH;'a Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE : Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date 4 I y ' 1 1 r .) Inspector ". Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site