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CITYOFTIGARD
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�' 1 3125'SW Hall Blvd.; Tigard, OR, 97223. (503) ;639.41 ` DATE I r i E u o IZI u I .! c1 T
' SITE ;a DDfRESS. = ; 42ZI66 'SW K' LNG ARTHUR , ##fs .. ,
SUBDIVISION. . 'ZONING ; r .
BLf.JC;K. .... I J'fr . < . . SURI SDI CTION; , .
CLASS O t•,1ORK. •; ALT. GARBASE, ,;.i1 Pf'SF-LS> ,r 0 110B I L. E „I•.Ifi..FE- !3I-1, -4 So 0
, ,.TYPE= OF,,,USE. .. :SF( ' WASIviI'NG MACH. - _ '. .. B-1iCKFL.OW IDR. ',r-NrTR.S. e ; IZl'
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STORI : . '', 1'L R HEATERS..' Y r „ AC 9
ES. . o � .:.. a 0 vti 1 !"� I-� � _ :.. „ �� CATCH BASINS-. . �, z ''li,. •
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CINIKS.. , o . u „ , ID. " LIP. LE:. .. - - _ . ' e FiRL RSE TRAPS. . . o „ 0
V i_:A�A'TCJ ?I ES. 0 OTHER F 1X'TI,]I ?L_„ y.F 0
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WATER CLOSETS. ' • P
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t_ O F . , E . : : SW- .i ARTHUR- 1 4 - E 0RMT._ -�`_ I_5.I00_.JSD ' 1 7 1 . : 1 , . / 2 5 / 5 7 RII�NG. CI Y '.
i'.IY•dG c]:TY, OR 972,:!4 5 PCT 1 _3 JSD 03125/97 I-' (NG islT'
23172 S 'I STAFFO RD. , . . . . ., .
T'LlF1LAl TN OR 97062 -- -- - . - - -- - -- - - - -- -- - = - - - _ _ __.._
Phone '#° 507-638-6 671 $ 26.2 .5 TOTAL . . ,
Rej 4.. . 4267]. ' . i .
, REQUIRED INSPECTIONS -- -- - - - - --
This perait is issued 'slibject to tkie regulations contained, in the Rough-in Insp ____ -- -•--
Tioard,;'rlun; Cipal Code: State OT: Ore.. Spe_;•altu Code_ and, _',lI other p'LM'Unue Y' 1", 1 G10Y' ._...__�__ ....___. - 1
applicable laws. Pll work vii II b d ne it accord-ante with T op..-od_l'C 1_ nsp, — ______ __ _ •
approved plans, This pereit will. expire i'f.- I- ork•is' not star=ted Final' inspect ion �....___..
within 180 days ..of iSS=ance. or It work is suspended for more than l8 ,tea } °s - - --- --- - - -.— __._ _
P e Y" lri 'I. t la e e s 4 .. U Tl p 'i; x_41., }°' " - .�-�/\ ' ---- - -_.__ _. -- ----.__. __-- - -- —,_—
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Ca l' forr~ in s•pr-rct ,, i-D.n - .J'� -417�r .
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• CITY OF TIGARD Plumbing Application Ree'd B iD .6Qr-
13125 SW HALL BLVD. Commercial and Residential Date Recd
Date to P.E.
TIGARD, OR 97223 Date to 10r -5 7
(503) 6394171 Pem,it ,cl)j..ing7_ 0a- -
�f
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (Individual) ., f QTY PRICE .AM'
Job Sink 9.00
S treet Address Lavatory 9.00
Suite
Address tt '' Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
ci 7 22-4 Water Closet 9.00 f r
Name ■
CC I \ . , --n J.eiq,� Dishwater 9.00
Owner Mailing Adcress ' A / Suite Garbage Disposal 9.00
i2ctt6 11, e�/f6f.t /3 Washing Machine 9.00
City /State . ' Zip Phone Floor Drain 2" 9.00
K L7 (-':+. e(722'1 620 620 "&f� 'Lc 3° 9.00
Name
4" 9.00
Occupant Mailing Adcress Suite Water Heater 9.00
Laundry Room Tray 9.00
City /State Zip Phone Urinal 9.00
Name Other Fixtures (Specify) 9.00
Ch r Ls l (---, n --a /" f v :/1 6 i V 5 9.00
Contractor Mailing Address Suite 9.00
21 L 5 i" -ftc pit 9.00
City /State Ph�
t'//a,. I, 4.....).7 1 Zip 7G 6.L 6 J4 _46 21( I 9.00
Oregon Cont. Cont. Board Lic.# Exp. Date 9.00
Attach Copy of Ll 70 9.00
Current Plumbing Lic. # Exp. Date Sewer - 1st 100" 9.00
Licenses L( 2 6 7 ( Sewer - each additional 100' 30.00
COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 25.00
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Name Water Service - each additional 200' 30.00
Architect Storm & Rain Drain - 1st 100' 25.00
Of Mailing Adcress Suite Storm & Rain Drain - each additional 100' 30.00
Mobile Home Space . 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Describe work New 0 Addition 0 Alteration 0 Repair O Residential Backflow Prevention Device' 15.00
to be done: Residential 0 Non - residential 0 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
Existing use of Specially Requested Inspections 40.00
hr
building or property 30
Rain Drain, single family dwelling 30.. 00 0
Proposed use of Grease Traps 9.00
building or property
QUANTITY TOTAL �]�± /
Are you caooing any fixtures? Yes o No Isometric or riser diagram is required if Quanity Total is > 9 _ .7S.c:f .7 Aikl
I hereby acknowledge that I have read this application, that the information *SUBTOTAL -
given is correct. that I am the owner or authorized agent of the owner, and 5 SURCHARGE
that plan miffed are in compliance with Oregon State Laws. 1,a
Sign of wn /A Date 5 PLAN REVIEW 25% OF SUBTOTAL
/ ~�� Required only if fixture qty. total is > 9
Contact Person Name Phone TOTA
v - =
W C., �� SC . !n c 7 0 "7 • Minimum permit fee is $25 + 5% surcharge. except Residen Backflow
i:ldstskpfmapp.doc 8/96 Prevention Device, which is $15 + 5% surcharge
RECEIVED
APR 141997
COMMUNU DEVELOP MO1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location / oZ O a 1 14 �J�� Suite MEC
Contact Person I Ph PLM 7 -Z l Y'
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation /1 /' n Witt tt A� ���/ j/ � 1 �. FPS
Ftg Drain ��lL� ,xr. f C/ 'v'vi CJ�(J
Crawl Drain — -- SGN
Slab yNot-Requested SIT
Post & Beam 'Found During Research _
Ext Sheath /Shear No_Insnection(s) . In File _ -.
Int Sheath /Shear Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm f c /�
Susp'd Ceiling 7V- (�( / �`—
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Fi
PART FAIL
MECHANICAL
Post & Beam
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 /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 DM
Other Date Inspector ���2 Ext"
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.