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13664 SW ASHBURX LANE
(.'ITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639.4171
D �
Date Requested: M. MST:
---
Location: Bim'
Tenant: Suite: Bldg: MEC: 7,
r�
Contractor PLM: r'J
_�. +'�_= '—�/�^ Y� _Phone:
Owner: .. Mimic: ELC: _
ELR: _
SIT: _
BUILDING _ XDG(con't) �'PLLU PLUMB -- MECHANICAL ELECTRICAL SITE
Site Post/Beam cam Post/Beam Cover/Service Sewer/Storm
Footing koof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out _, tt,CR�as Line Rough-In U[G Sprinkler
Foundation Insulation Sewer /1,Fi�l/ Iiood/Duct Reconnect Vault
Bsmt Damp Drywall Storm J� ' AVA64 Furnace I'err►p Service MISC.
Masonry Ceiling Rain Drain 0 O A/C UG Slab
Shcar/Sheath Fite Spklt/Alm Crawl/Found I Icat Tropp I,ow Volt
Approved �V( Approved Approved Approve
Appr/Sdwlk Not Approved pproved Not Approved Not Approved Not Approved
FINAL p > FINAL FINAL FINAL
C]Call for reinspection D Reinspection fee of Srequired bef rc next inspection C7 Unable to inspect
of
Inspector._ 1 _.. ,--- Dater Page_
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PLUMBING PE RM T T
PERMIT #. . . . . . . : PLM'37-•030 i
DATE ISSUED: 0.7/29/97
SITE ADDRESS. . . 13664 SW AGHBURY LN PARCEL: 1 S 1.JJCD-04600
SURD T V I S I ON. . . . : COTSWAL_D MEADOWS ZONING: R--25
13L0CK. . . . . . . . . . L0T. . . . . . . . . . . . . :44 JURISDICTION: TIG
CLASS OF WORN.. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. :-0_ .
TYRE OF USE. . . . :SF WASHING MACH. . . . . . s 0 9ACF;FL0W PREVNTRS. . : 0
OCCUPANCY GRP. . :R:?, FLOOR DFAINS. . . . . . : 0 TRAPS.. . . . . . „ . , . . . . . : :T
TORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASIN;. . . . . . . : 0
F-IXTLJRES_-._ _.__..____.__.. LAUNDRY TRAYS. . . . . : 0 5F RAIN DRAINS. . . . . : 0
SINKS;. . . . . . . . . . 0 URINALS. . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
I-AVATORIES. . . . 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER L. INE (ft ) . . . : 0
WATFR CLOSETG. : 0 WATER I..INE (ft ) . . . : 10V.,
DISHWASHERS. . . . : 0 RAIN DRATN (ft ) . . . : i1
Remar•ks : Replac-e water ser,vicv piping
Owner: -____--•-_----__._.___-_ _____________ .______._______._._____ FEES _--._------_-_-..
MIKE MONJE type amol_int by date rer_pt
13664 SW GISHBURY PRMT t 30. 00 JSD 07/29/97 97-297667
TIGARD OR SPCT $ 1. 50 JSD 07/29/97 97
Phone # :
,on t Tact or--
(,ANYON PLUMBING & HEATING
4245 SW 109TH AVE
.11..(-iVLRiUN OR 97005
''h on e #: f 31. 50 TOTAL
00004 '
_._--___-_• REDIJ I RF:D INSPECTIONS
'h:s pereit is issued subject to the regulations contained in the Water- Line Ins p
Tigard Municipal Code, State of Dre. Specialty Codes and a?l other final Inspection _
applicaVe laws. All work will be done in accordance with -
approved plans. This perert will expire if work is not started -
within 180 days of issuance, or if work is suspended for lore -
than IAB days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
,et forth in OAR 452-MI-0018 through DAA 452-ONI-(080. You lay
obtain copies of these riles or direct questions to OUNC by calling --
(503)246-1497.
i
1S5,.lfPd By :. _ �- �---- Permittee Signatr.rr� � '
1 -F...�-4-+++44+-1-F....4++4+++++4......4.......... h+f.++++++-F++++++++++++++++++++++.
Cal. 1 639--417`", by 6:00 p. m. for an inspect i on needed the next bt.isiness day
++++4--F++++'4•+++++++++++++++4+++•1-+4+4•++4•++++++++++++++++++++++.+++++++++++++++++
Dat
:ITY OF TIG !RD Plumbing Application Di F;Ar
77
3125 SW WALL BLVD. Commercial and Residential °a'' "d
GARD, OR 97223 Dstei to P E.
Or,re to DST
03) 639-4171 Prrnut
Print or Type Related SWR a
Incomplete or illegible applications will not be accepted caned. _
Name of De F RE3. ndlvidwl
velopment/Propd I 0 QT"
.lot) sinkY 9.00
Address
Street Address State Uvac"ry 9.00
,
Tub or TuWShower Comb. 9.00
Bldgs Gty/State ZiShower Only — 900
Water Closet �� 9.D0 "—
Name _
�,q\\ _ Otahwsrilher 9.00
—'
—.
Owner Madinb
9 Address Sante Gars Disposal D.00
Washing Madhme o.00
City/State Zip Ph" Floor Drain 2' 9.00
3' 9.00
Name
4- — 9.00
Occupant Msi"Address Suite water Heater 9.00
Laundry Room Tray 9.00
City/State Phone Urinal� — —— 9.00
Name
Other Fixbues(Sp") 9.00
_ ---
U\INN Co Ili UAA&Ng lk_04, 9.00
Contractor ms*v ss Suite ��--' 9.110
;
L i ' t i . ), --- -- — 9.00
(Prior to issuance Gty/State Zip Phone —
appllcant n"t - ,SI I IG` 9.00 —
pmvide ad Oregon C'.onat.Cont.hoard Lia.! Exp.Date _ 9 W
conlaCom Z — , M 9.00
Acenso PManbkv Lie,0 Ftp.Date_ Sewer-1st 100' 30.00
Infonnaticxh C) ..,t 4A_ 1 C _ Sewer-each additional 1W 25.00
I'm COT COT Business Tax or Metro S Exp.Date Water Service-tst 100' �— — 30.00 _ —
database).
—�^ Name Water Service-each additional 200' 25,W
Architect Storm&Rain Drain-1st 100' — 3000
or Marang Address Suds Storm 6 Ram Otarh-each addKbnal 100' 25.50
Mobile Honk Space 25.00
:ngineer Cifyislate Zip Phone Co rrerual Baric Flow Prevention Device or Anti- 25 W
Pollution Device
&cribs wont New O Addition OA Alterabon O Repair O Residential Bactflow Prevenbon Dance' 15.00
oe done: Residential O Non-residential O Any Trap or Waste Not Conneded to a Fixthre 9 W
vdional description of work Catch Basin — 9.00
Insp.of Existing Plumbing -- — 40.00
SAA 9 v.L C , N t~ per/hr
Speoaly Requested Inspections 40.00
sting use of
Ktu,g or property S c NC �_ rrii l �(I ----- p_/hr
Rain Dram,single family dwelling 30.00
•oposed use of Grease Traps 9.00
.uikfing or property
_ QUANTITY TOTAL
are you capping. mow g or replaang arty(bourse? res p No p Isornnic or roar dugnm to reouired f Quarry Tial is >9
(Ifsee beck of donne _ 'SUBTOTAL t
hereby adunowledge that I have read thin application.that the information —_
-.ens correct,that I am the owner or authorized agent of the owner.and 5%SURCHARGE
',at olaro submitted are in compliance with Oregon State Laws.
gnaturs of OwrwHAge Date PLAN REVIEW 25%OF SUBTOTAL
Qwur"ooh if%tse my total to 1 9 _
29—TT I TOTAL
,act Person Nan is Phots
'Minimum permit fee is$25• 5%surcharge.except Residential Backflow
Prevention Device.which is$1 S.5%surcharge
l:\phapp.dtx 12/95 (dst)
'l.EASE C�MPLE?E 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"
_ 4"
Water Heater _
Laundry Roorrl fray — -
Urinal
Other Fixtures (Specify)
:OMMENTS REGARDMG ABOVE:
L: pimapp.doc 1116 (dst)
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