Permit •`„_ OF T I A R D ..
C ITY G
% ■� i � , DEVELOPMENT F �Ef�Mi ' T U # PERh1 F!Lr�i9Fs O34'i
13125 S Hail d, Tigard, OR 9 223 (503) 639 - 4171 •
. DATE ISSUED: 09/22/98
PARCEL.: 1 S 135CC-00200
SITE ADDRESS... 0 10250 , SW TIGARD ST .
SUBDIVISION. e ..: ZONING: R-4.5' '
BLOCK LOT....... : JURISDICTION: TIG _ ' •
CLASS OF WORK.. :ALT GARBAGE DISPOSALS.0 0 MOBILE HOME SPACES.. :. 0
TYPE OF USE .-SF . WASHING MACH......: 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP. :R3 FLOOR DRAINS....... 0 TRAPS..... 6....... 0 ' •
STORIES... o .... 0 . WATER. HEATERS.....: 1 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 0 WATER LINE (ft) ...: 0 .
DISHWASHERS,,....: 0 RAIN DRAIN (ft)...: 0. '
Remarks: Jackson - like kind water heater
Owner: 7:--- -- - - - - - -- - - - -- FEES - - -- - --
- 'SIMONE JACKSON type amount by date recpt
10250 SW TIGARD ST PRMT $ . 25.00 JSD. 09/22/98 98- 309400
' TIGARD ST: 97223 -0000 5PCT $ 1.25 JSD' 09/22/98 98-- 305400
Phone #t: 684 -6876' '
- Contractor--- ------------------------- - - - - -- .
COLUMBIA HEATING' NG' &• COOLING INC
PO BOX 230397 ,
8900 SW BURNHAM ST STE E -110 '
'TIGARD OR 97281 -0397 •- -. - -•- . --• -
Phone, '# 0; 624 -2704 , $ 26. 25 TOTAL '
Reg #k..0 006007
, REQUIRED INSPECTIONS -----7---
. This permit is issued subject to the regulations contained in the Misc. Inspection • _
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.pernit will expire if work is, not started _
within 180 days .of issuance, or if Work is suspended for °ore -- _ ' ____ _
than 180 days. - RTTENTION: Oregon law requires you to follow rules _ • . _
adopted•by the Oregon Utility Notification Center. .Those rules are .
• set forth in ORR 952 - 0901 -4010 through ORR 952 -0001 -0080. You nay _ _
obtain copies of these rules or direct questions to CIJNC by calling .
(503)246-1987. ' • .
IPA
Issued B, '/ Permittee Si nat� A l'aL,
_ _.. - .
+'+ 1-+ •1 � ++ I-+ �•�- 1--h +-I •• F+- F+'-r-+- F++,- F•- 1••+- 1-- 1• �- M- F+- F• i- +••F� + +- F.++- !- +-F +-F + +�--I- +-t +-� • •F + + +-F+• + + +. +-•I-- F• + +- 'r +•f•, Fi- .
Call' 639- +175 by 7:O0 p.m. for an inspection needed t e next business day
++++++++•+•++- h+++ + + + + + + + + + ++ + + + + + + ++ ++• + + + + + + + ++ • h•++- r- + + + +-r- + + + + + + + + + + + + + + ++ + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd Q9 9
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # / 5g o
Related SWR #
Called /, iZ.
• Name of Development/Project 'FIXTURES (individual) QTY., `PRICE;. AMT
Job 6 1 fPnn e 0- 0.ckspn Sink 9.00
Address Street Address Suite Lavatory 9.00
/019 1(n 5/ ggotrel 54-_ Tub or Tub /Shower Comb. 9.00
Bldg # • Ci y/S ate Zip Shower Only 9.00
Nme
. r e OR_ q a OZ Water Closet 9.00 •
c�J l) on e J QckscJ7 Dishwasher 9.00
Owner Mailing Address .� �LL Suite • Garbage Disposal 9.00
/09.1 Ow / aard 5f' Washing Machine 9.00
City/State l Zip Phone
-Aa r / 0 In q 7o T 6 (f,/ kg7 /_ Floor Drain/Floor Sink 2" 9.00
Na ¢ � l � 3" 9.00
W41 E, 4" 9.Q0 .
Occupant Mailing Address Suite Water Heater • 0 conversion r like kind 9.00
Gas piping requires a separate mechanical permit. q.
City /State Zip Phone Laundry Room Tray 9.00
•
Urinal 9.00
me
I al bi ' . 'Qa1- l Other Fixtures (Specify) 9.00
Contractor Mailina Address Se 9.00
- Pa 80X30.39 17 9.00
Prior to permit State Zip Phone Sewer - 1st 100' 30.00
issuance, a copy / I a . rd d2. q7 , 3 6 t;;( 1 2o�
Sewer - each additional 100' 25.00
of all licenses are Ordghn Conet. Cont. Board Lic.# Exp. Date
required if '7 la ? 7 /v g -9 � Water Service - 1st 100' 30.00
expired in COT Plumping Lic. # Exp. Date Water Service - each additional 200' 25.00
database �3 /9, / /a 3I' 7 Storm & Rain Drain - 1st 100' 30.00
• Name - . Storm & Rain Drain - each additional 100' 25.00
Architect - Mobile Home Space 25.00 •
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- • 25.00
Pollution Device . •
Engineer City /State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to.be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work:
". has w 1 e Y I I r � ,� Insp. of Existing Plumbing hOr
W ■ -14 c .5 & d e healer -1D 1D nl �i) Specially Requested Inspections 40.00 •
G V per /hr
Rain Drain, single family dwelling 30.00 •
Are you capping, moving or replacing any fixtures?
Yes O No O Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL
. fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. •SUBTOTAL
I hereby acknowledge that I have read this application, that the information . . •/C6
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE •
that plans ubmitted are in pliance with Oregon State Laws. • /•25
Sign. t14 Owner /A.: i Date "PLAN REVIEW 25% OF SUBTOTAL
o ��1 l / 1 n (/ q Required only if fixture qty. total is > 9
! / . 1�_ `•i (�[� -�'7 TOTAL .
n
o . c • erson Name Phone .962a2.-
')\ ". 6I"' •Minimum permit tee is $25 + 5% surcharge, except Residential Backflow
G (. /� 11 /O j � p�� Prevention Device, which is $15 + 5% surcharge
•
• "All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:tdststplumapp.doc 712/98
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New
Moved Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater 1
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:ldstslplumapp.doc 7/7/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Q //l
-( 72 9:k te Requested �0 ' /� - AM PM BLD
Location /10, 5Z SSG( / ,it Gl./1 o( (4 Suite MEC
Contact Person S Ph Oe 0 Y ` 15E9
Contractor G � Ph �7 (7 SWR
BUILDING Tenant/Owner r1 / ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear `^,� r
Framing �� Y , `s �, L - Og� 0
Insulation /
Drywall Nailing " "l,\ 4/
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
P FAIL
PLUMBING
Post t� seam
Under Slab
Top Out
Water Service
Sanitary Sewer
- rains
PAS ti 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 Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 1 ` Inspector \ Ext� l
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.