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Soe ciilty Codes ai�i all Neil .F_nat,� ,.Inc r ecti.on — -_ • Epp ; i'Cable - 'Laws. gill - D - iath 67111 be t'.'uilr it c'ico,d:11E' 5 iif!t i _ _ _ _ 3Ai• owed ple;ss, 'This ; 32i'eeit 011 ri!t3t'E' if worii i5 PiGt started �._ _, -_�__ . _._..._.__._ 'Sabin 1801 days of ise:ic,GCF- • ri''ii' Fctk •i'i' 51i5fiEGi'Et5 fop` fare ____. Thai. 1 days, • C3.3E�i3ION: ',,rrPotl I requires VC•,:. tb f 1Iia3 cul - - -- ado t,id.by the, Dt "Est,OP-bti'ity-i�ii GfECatitoii G2flte!'d 3 i�1 iidm2 rPS ii - 2 , _ ..__,_ , ' , ; :et• foi� t, 3n"Drii' 952° 2A-..- '2}100 the ii�;ili MR 352 "Zin1 07,80. • You aar ° .: . _ � _ . ' .obtain' Ccrpiz5 ,,o f- fists;? ?�J1es O 'heat Olies.t.iob , to 6 by.'C'al- 11'11g ' �.-__._. -i , • i521,3i •Pzica- 1t3'i. - . I . • d ., - ',., _. -_..._ _ •' � _ , __ __ - _ _ - �f "s e. s -I 77: d - 'C'3 v _ ®' 4. I 4 - 0 , ); s-i =' i ii? _ t '+,' •:} f i dl is E- 1; ;' ' r' - � / / - t 4 ' l - ). r-r r i - .4.4 I'. ... ... •' • + • t . i -• � - !_ „ t•• i -. -i ••4.4 : " � . .. 1 T ;1 -} -r a-.s_'}...}-F C 1' . 6:3 -- 4_ 7 '-r • bl.d , (�- °01;1” fit, 1n .i fr , c3i; i.:''r3VL'}.-.•• : -9 Y, , ; J_G t �•IES- ii e:',X h t;'13 ^4 i ? ?c., C.i' 4U' . F I' 1 ' • ..7...1- ° _,-.1 —+ . ..: -- / - 4...�.: .. 1 -'� ' -. '!:^ ; -- .�.. -•1•` ' ' i . < L J__ .J.__ .• ,I ' _. . :1 1 ° -' {} .{. _ f r k i' 1 z h I r: i, l t"i ti a I .}'.._.. h t' ! F 9 =i r 1• • TY OF T1CAR0 '':, Pl Application Recd Sy _!; • .;•. Date Rec ;125 SW HALL BLVD. Commercial and Residential GARD, OR 97223 sat to P E. 03) 639 -4171 care to DST Print or Type Permit s /Vara`yo , Related SWR s ` Incomplete or illegible applications will not be accepted called 1 3 4 . - . ' Name of Cev lopmenuproiect � FIXTURES (Individual) QTY PRICE' ' Job ACC \P5 U r- -� Sink AAATM .¢: ,: . Address S :reetAddres S u ,, Lavatory 9.00 • 1 13. S'►�v • °ek i J i r ruo or TuorSnower Camp. ' lag s CityiSt Zip 9.00 �� '(--). ; Shower Only 9.00 �-� '�- •• 1 3 a ra 0� c h R Water Clos "!' { Name r Z 1 ( T . ��� 1 ^ Disnwasner 9.00 • ,; ;, .,' htadin 1 1 9.00 : :. ?r .15,14 _, Owner �j /, Ad I L �,,,�, �� S uite Garoage Disposal ^ a C kA A s t i ` e 1, `n (E. r4. Wasning Macnine 9.00 _ : j x::. i,....ryiSlate l2l (nl1 G� Prone 9.00 %;, {; lainZ �1 rk 1 ! ��� �r Floor ()rain Z- 9 .,...4.,: 3• 9.00 9.00 Occupant M Address - p Suite Water Heater 9.00 l • i Laundry Room Tray 9.00 CityrState Zip Phone Urinal I 9.00 ..•- .:. 1 Name Other Fixtures (Specify) 9.00 Chre/. (1 r /(c /(f�lP I n1 r Ilty� 1` . 9.00 contractor Med A ddress Si4e _� - 75, kR .Sy) -YSihTr'r 9.00 'nor to issuance CiryrState • Zip Phone 8.00 applicant must ^ ' ."}°•'� N,?1�/4 6R 1 - 7667 r1 j � �- -CC( \41 � 9. provide all regon onst. Cont. Boip. Date ' contractors (0-7-3 � ard Lc.s Ex 9.00 license Plu s 7 7 7 li / 9.00 in cerise n r V Exp. Odle Sewer • 1st 100' Sewer • eacn additional 100' for COT COT Business Tax o etro Exp. Date 25.00 • database). hC1( 3g' 9/ I /L Water Service - 1st 100' 30.00 • Name / '.`rater Service - each addittonat 200' 25.00 Architect Storm 3 Raln Crain • 1st 100' '.,„, 30.00 . r s �Ira d : - Or Mailing Address I Suite Storm & Rain Crain • each additional 100' ` 25.00 {1t _ Mobile Home Space Engineer Cityrstate Zip I Phone I 25.00 . I Commeraal Bat( Flow Prevention device or Anti- 25.00 Pollution Device a Re Alteration Addition scroe .vcrx New ,? .') 3 u O Ra • • ! •c c c gone: Residential O Non -residential 3 p stdential Bacxlow sreventton Devu:e' � 1 15.00 I cr :oral description of wont Any Trap or Waste Vct Connected to a Fixture I 9.00 Catch Sasin I 9.00 I r • insp. of Existing = umoing I 40.00 I , . : • :: rg use of Specially Requested Inspections per:hr Derihr ;^: • 40.00 :,rig or property I "'� I ' • Rain Cram. sing:e !amity dwelling I 30.J0 I . :cased use of icing or property Grease 7racs I I 9.00 QUANTITY TOTAL t you capping . moving or replacing any fixtures? Yes r' No ^ Name= x riser :: 1 +s > i ' yes see back of formI - '3 recurred i - uanrty � Cta °racy autnowiedge that l nave read this a 'SUBTOTAL I DPiication, that the information :n is correct, that I am :he owner or authonzed agent of :ne owner. and 1 . -; r• .t clans suomittee are n compliance with Cregon State Laws. 5 %S URCHARGE I ;nature of Owner(Agent I Date PLAN REVIEW 25% OF SUBTOTAL I " "' aeeured onry f irl cry miens > 9 •.;i ce •. . • ;re (tact Person Name i TOTAL ' �� • / I Phone • • lam• • �. 'Minimum permit fee is 525 • 5% surcharge. except Restdenual Backflow •, -.. c. •. Prevention Device. with is 515 5% surcharge �:• � i :'asts'.atmapp.cac 8196 • I : _ C•' • T. A APP• •PRIAT T• P: • T: ; to be capped...moved or replaced I Qty Sink , , I Lavatory Tub or Tub /Shower Combination Shower Only � Water Closet Dishwasher Garbage Disposal � Washing Machine Floor Drain 2" I 3" \A'ater Heater 1 . _aundry Room Tray Urinal Oter Fixtures (Specify) - I )MMENTS REGARDING ABOVE: • • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 r BUP t �� 30 Date Requested ' 1V� 7EI'� .g AM PM BLD Location 15153 dWK.. r -Ai/Yl Suite MEC Contact Person V CAA / Ph - J' 1 3 - ?653 PLM ° 1 0 130 Contractor v r� C A c eud � GliANbCI�, 511 53 SWR BUILDING Tenant/Owner f/ ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler _ �j p/� Fire Alarm / � � Susp'd Ceiling � Roof Misc: Final P T FAIL UMBIN ' Post & Beam Under Slab Top Out Water Service Sanitary Sewe rains f PART FAIL ANICAL 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 Hail, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date ( 27 1 / Inspector 1 � Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .