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11860 SW CARMEN ST
CITY Cad TIGAi�D _ ELEGiRICALPERMtf
PERMIT#: ELC2003-00609
DEVELOPMENT SERVICES DATE ISSUED: 10/2/03
13125 SW Hall Blvd., Ticiard, OR 97223 (303) 639-4171 PARCEL: 2S103BD-02500
SITE ADDRESS: 11860 SW CARMEN ST
SUBDIVISION: CARMEN PARK ZONING: R 4.5
BLOCK: LOT: 006 JURISDICTION: TIG
Project Description: Install(2)branch circuits. Wire AC an f derior outlet.
RESIDENTIAL UNIT TEMP SRVC/FLS ERS MISCELLANEOUS
1000
1000 SF OR LESS: — —~! 0 200 amp: PUMP/IRRIGATION--
P CH
UMP/IRRIGATION:PCH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HfAl SVCI FDR: 601+amps - 1000 vnits: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: W/SERVICE"OR FEEDER: PER INSPECTION:
201 400 arnp: 1st WIO SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp. _ _ PLAN REVIEW SECTION
10004 amp/volt: _ J >=4 RFS UNITS: >600 VOLT NOMINAL:
Reconnect on_I�r —_"_ SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC: _
Owner: Contractor:
WAYNE,ROSALIE WEST SIDE ELECTRIC CO INC
WAYNE, ROSALIE E 1834 SE 8tH AVE
11860 SW CARMEN PORTLAND,OR 97214
TIGARD,OR 97223
Phone: 503-590-3031 Phone; 231-1548
Reg #: LIC 13306
-- --- SLIP 2663S
FEES _ _ ELE 26-135c
Description Date Amount Required Inspections
[FLPRIVIT)ILC Permit 102 u3 $53.50 -["I AX]8916 State Tax 10/2/03 $4.28 Rough-in
Elect'I Final
Total $57.78
This Permit is Issued subjpct to the regrdations oontained in the Tigard Municipal Code, State of OR.Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to fo'!ow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)24645699 or
1-800-332-2344
Issued BY Permit Signature.--
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not it ended for sale, lease, or rent.
OWNER'S SIGNATURE: _ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: —�_ DATE:--
LICENSE
ATE: _LICENSE NO: —�--� ---—- ---— — ----- -- ----—
Call 639-4175 by 7:00pm for an inspection the next bus'ness day
v
i
clue 11 03 U1 : %'p Duf'f ,t Mo-i-cep 503 G35 05t7 p. :
Electrical Permit A.p>��cationKxCCi" /
�', Pa.",N,:Z �=
City of Tigard I'lantrng App ,tire s.so-
rzrlcmy --- rerrru(Nn.. _ -
11125 SW 11211 Blvd. Plan Rivrcw 011ier
'rigged,Oftwn 97223
Phofx: 503.639-4171 Fax: 503-598-1960 1'oe(itcvw w Land Ose
l aetc/Ffy- _ C`w%r No
o
Infe",,ot: www.ci.tisard 01.11i (oroxt - iu*s. snr�;pr 2 Imo. _
24-hour Inspection Request: 903.619.4175 N.rncrt++rdrod _ (c„pr�envtnul Ywfnr+nat ow.
_ TYPE OF WORK --- PIAN REVIEW(Please check ail that apply)-__.^-.__ .-
1•rrwcon�tructinn J
-_� Sctvicc over 125 amps• y n t Wilily
1.4 th.arlily
. _ UGrt1AlAt1(ln
callrrttn:,-, ❑Ilaranl.ao.ImaNr,n I
dditlfm/alteratim Vrc to"ment Oer:
r' _ _�th—•_-__ ❑$crvrut over 310 arrpt ralntp of Q HudWn`over I0,000 souarc IRi,
CATEGG•._ OF CC1NtiTRIJ('TION —^. 1 6c 2 I'awrily dwellings four or mule oexrlcnfiul unit,in
1 eYt 2-Family dwelling C'omnimciaVlndustrial _ n System over bw tions nominal vete svucrurc
Yfuilding over thrrc ttorrti 1+uv)crs,400 pro"a rrw»r.
AcccNso Butldln adult]-Family UCCwp,urtIced ovar991--A Matr,racturedxauclurcsorKVparlk
D Master DWI(lrr Other: til!rmitAiEroing pian other_ _
_
JOSS177 INFt)RMATIOK and LtK.tTIUN Srbeeil-_•_aets of puss with any of the obwve.
The robotic arr wet■pplierblc to lem 1�ry cowrtr.Marw seevicc.
lob site addrers: jigA lj r.J C 4�y--•.- - ._ _ ._..__F_Ft;`SfHF UY1LTu _ __
Number of incwectitorn per permit allowed
PrV
Gct Narnc- �'CS-n — Ihae Iton fy rw(cs.) Total�_ _ SNew rewtioWhopk or m.11"Andy per
Coss sL`tPt/i)ifrCtiOn to job Rite: dwrflirn.■soli.Inelodes attached carat e,
$errtte IwtMtletf'
10001 h,nr latx _ .. 145.15 a
1-:ach amitnonsl 500.3.i't.orwLn”MOW 3340 �
--- 1�1N iimhedtime&,reswkm4l _ >IIh 1
Subdivision; _. t...,reA marry,nen rn nrmut --T;66- __ 2
Tax tma /parcel 0: _�. LAOntwwroctwed bane.ur modutar dwelling - -
p ,ION Or WrJRZK MNMC antVnr(KMr_
✓mss ',ie�+cn.r fetden-IOHall.enw•
sheratienof Ithwalinw:
I00!lop3-or Ism; - _ NO.10 2
to 400 wn
W It ambo•.w 600 a� .t__ _ 160.ti0
PRt).t')E OWIVP.R _ IkNA1V7 401&myslyPafn'P - ----- --- 2Ifi.M1 V)
Name:
Address: Temporar]■er-ic#sorfredtr..inslsllation•
----.. •••__e�- - -- --,y Yterati000,wr".1e,raliont
Ci /Statc/ZI "il L r•f c c 2 Z i 200 amps or lir.
Phonic: - t7 J lea.: xoi ampr tn+oo uwpe_� icto.w z
PLICANT CON 1 A<.`I PIF))-SON 401 b M10 am - _----_ _ t)1.7} 2
- � .... .� GrawgM wimifx-oar,aheralwrn,gr
_Add1•ess: p'' . g� 1�]lS r_.-.- - ofirNam! \/,),e S - A.fee rXr branch Liw%
tww1,purchase oft1- --
__ .er•'w.�w fttde/rCC_�each}nwwir t•intl 4.65 !
Cil /StutivZip: �C -—
too Cnr branch Crrcwilt wnir.w ptuchaw of
+ervim or(r,*r 111 ISr�C hr.nrh cncuil I6.E:+ rte[ 1 2
Phone'7 "L -. Fax: Fachrkhrww,l IN,. ,h r.uam _ 645
h_taall: � �_�•� lvC+/ H./ Miae(tikrvkrwrrrw+Ae+nrrinc�it'dy
faeh pump w iniprion e,mk
_ CON' A4I'OR.
.t J,, �. - Fach nen w nullnr , S\I0
Jf)�1 4�0. - .�.W.���..._--_- ... efCn.l cwavil(x)M ro hmRtt ek�t;y pot"Cl. ..
_5UMness Name' en�aggn,a exltrN etc _.,– Pam�.. 2
Addramg_
t /Stal:/7 1 - Fpfb additional rat 1, aver flog alb"Able in wnx or the above:
-�__ p Pur.rhrw Mao—(rein 1�)..._� b2.SU
Phonic: a><: In 1rtwt tea: _T
__ I
�_
CCIR Lie,0: n I.ic. : Z E ied es
tPermtt Fe "
Supervising cleetticla — --- _ subtotal S �.,.
si nature r turcd.– ..t r c �-� PI"Rrvicw(25"Pe of Tamit Per) s
Print Nrme: �.•tL_. # _ Sta[e Surchatge�.of Pt�nnt Pee f t _
TOTAL MRM" F'Fl. s —�57 —
Autholrn. d Nuticet U6per,nil applicatroa eaplrea if a pePMlil it nowwMahsed wrlb{w
Sigrlrofllrt: _ Dntc _•• 180 days aAer it An betty octepted u crrwplits-
-Fre awbbdolory set Icy TriCrrrnty St ilding Indworp Scrvice Hoare.
._ — (P'htaie pentt na;r+e) _
I r-orjmi\MCp-,nitAppdoc 0IM3
2 'd LL90-9EL f F.OS) -03 01 jaoa 1 A ap t g Isam W2* :GD EO 20 200
\ CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00506
13125 SW Hall Blvd., Tigard, OR 97'123 (503) 639-417DATE ISSUED: 9/24/03
SITE ADDRESS: 11860 SW CARMEN ST
PARCEL: 2S 10313D-02500
SUBDIVISION: CARMEN PARK ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
Cl ASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE C7 USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS- TRAPS-
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURFS LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 01-HER FIXTURES:
TUB/SHOWERS: SEWER LINE: 115 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 1151f of line work to connect existing house to street lateral.
Septic tank must be pumped and filled or removed. Reimbursement paid 8/26/03
Owner: FEES
-- Description Date Amount
RHONE, HENRY JR —
WAYNE, ROSALIE E IPLUMB] Permit Fec 9/24/03 $101.00
11860 SW CARMEN JAX] 9%State Tax 9/24/03 W8.08
TIGARD, OR 97223 _ Total $109.08 _ J
Phone .
Contractor:
APOLLO DRAIN + ROUTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone : 239-8801 Sewer Inspection
Misc. Inspection
Reg#: MFT 00003082 Final Inspection
LIC 00049418
PLM 26..533PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other 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
,u, more than 180 clays. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By:, �� Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. fcr an inspection needed the next business day
Building Fixtures
PlucnbinLy Permit Application Receive
� Plumbing
a Permit N5��
tdov mo b
Planning Approval Sewer
City of Tigard Date/Fjy: Permit No:
13125 "r.'V Hall Blvd. Plar.Review Ot,ler
Tigard,Oregon 97213 Date/Bv: Permit No.:
Phone: 503-639-4171 Fax: 503-598-19x0 Post-review Land Use
Dare/By: Case No.•
Internet: www.ci.tigard.or.us Contacts.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method- / Su lemental Information.
4
- s drrlb3
y�C j1tJ ;F oei or'M P chPcklisf
r. cllli l--
New construction Demolition Descri tion Qty. F'ee(ea.) Toi.1 1
Addition/alteration/re lacement Other:
SFR�bath 249.20
1 &2-Familydwellin Commercial/Inaustrial SFP. 2 bath 350.00
_Accessory Building Multi-Family SFR 3 bath 399.00 _
❑ Master Builder ❑Other: Each additional bath/kitchen 45.00
A;? a,+•;_. d i t_ON __ Fite sprinkler-sq.ft.: PaeEl
2
Job site address: L� �1 '
Suite#: Bld ./A t.#: Catch basin/area drain _ 16.60
Dr ell/leach line/trench drain 16.60
Project Name: Footing drain no.linear ft. _Pae 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 416.60
16.60
Rain drain connector Sanita sewer no.linear ft Subdivision: Lot#: Storm sewer no.linear ft.Water service no. linear ft.Tar ma / arcel #: Absorr+r alve Backflow reventer Backwater valve .
Clothes washer 16.60
— _---- —------ -- — Dishwasher 16.60
Drinking fountain 1 16.60
Ejectors/sum 16.60
�- i _
Name: - i L Expansion tank 16.60
Address:
1 I Fixture/sewer cap 16.60
Cit /State/Zip: Floor drain/floor sink/hub 16.60
-
Garbage disposal 16.60 _
Ph n j 46 -' Fax: _ Hose bib 16.60
Ice maker 16.60
Name: Interce tor' rease trap 16.60
Address: th� Medical as-value: S _ Pae 2
--- -- Primer 16.60
City/State/Zip: Roof drain comtnercia� 16.60
Phone: F:1X: Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16.60
-- ,— --- _ -x. Urinal 16.60
Water closet 16.60
Busif:,,ss Name: Water heater 16.60
Address: 2-'2X A dr, Other:
City/State/Zi t Other
Phone: r - 4qej I Fax: ;
CCB Lic. #: ggtl 1- Plumb. Lic.#: 2G S3 subtotal S
_ _ Minimum Permit Fee$72.50 S
Authorized Residential Backtlov:Minimum Fee$36.25 jol
Signature: " ._ Dete: j�Zej Plan Re,,lew_154'0 of Perntit Fee S
�`� State Surcharge(8,1u of Permit Fee $ U
—_
(Please pn i name)' ---- TOTAL PFILMIT FEE S _
Nottct. This permit application expires if a permit Is not Owned within All new commercial buildings require 2 sets of plans with isometric or
180 days after It has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service Board.
i.\Dsts\Permit Forts'NlmPermitApp doc 01,03
a R
Plumbing Permit Application- City of Tigard
Page 2 - Supplemental Information
Fee Sc_hedale: _M _ _Residential Fire Sup ression Sstems:
4i
_St�eUtilttres Fec( ` Total Square Footage, Permit.Fee,
Footing drain- I" 100' 55.00 0 to 2 000 $115.00 —
Footing drain-each additional 100' 46.40 2,001 to 3,600 _ $160.00 _
3,601 to 7,200 _ _ $220.00
Sewer- 1st 100' 55.00 7,201 and greater $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' 55.00 Medical Gas Systems:
Water Service-each additional 100' 46.40
Storm&Rain Drain-Ist 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100,00 or fraction thereof,to and
including$10,000.00.
Commciciel Back Flow Prevcntion Device765.25
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25 and including$25 000.00.
Rain Thain,single family dwelling $25,00100 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 fur
each additional$100.00 or fraction thereof,to
Inspection of',listing plumbing or and includin $50,000.00.
s eciall re uested ins ections- er hour $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures! If
"yes",please indicate work performed by fixture. Failure to
accuratph'report fixtures could result in increased sewer fees*.
---_--- - -- —�_14uui,f',v`S tore Work!'ctfurma Comments regarding fixture work:
FlxturrType: ,' f�i•placl�'
Hove,, , ibitin Ca ed
DaptisLrytFont
Bath -Tub/Shcwer
-Jacuzzi/Whirlpool —
Car Wash -Each Stall _
-Drive Thru
Cus idor,hVater Aspirator
Dishwasher -Commercial
-Domestic
Drinking Fountain
Eye Wash — ---------
Floor Drain/sink .2" _
-Y — - -
-4„
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage -Domestic
Disposal -Commercial increase of sewer EDUs,a sewer permit will be issued and
-Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refrf .Drains plumbing permit can be issued.
Oil Separator Gas Station
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
-Bradley
-Commercial
Service
Swimming Pool Filter
Washer-Clothes
Water Extractor
Water Closet-Toilet
Urinal
Other Fixtures:
i:\Dsts\PerniitForms\PlmPeffrutAppPg2doc 01103
CITYOF G I G A R® MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00584
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417 i DATE ISSUED: 10/1/03
PARCEL: 2S1036D-02500
SITE ADDRESS: 11860 SW CARMEN ST
SUBDIVISION: CARMEN PARK ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: _ B_ OILERS/COMPRESSORS _ HOODS:
FUEL TYPES 0 3 HP: 1 DOMES. INCIN:
LPG p 3 15 HP: COMML. INCIN:
"VIA", INPUT: BTU 15 - 30 HP:
FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 #- HP: WOODSTOVES:
FURN < 100K BTU: 1 A;R HANDLING UNITS CLO DRYERS:
FURN —100K BTU: <= 10000 cfm: - OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: In,i, 11 hmwce and AC.
Owner: FEES
RHONE, HENRY JR Description Date Amount
WAYNE, ROSALIE E —
11860 SW CARMEN IMEC'H] Permit Fee 10/1/03 $72.50
TIGARD, OR 97223 ITnx] RQ;,StateT'ax 10/1/03 $5.80
Phone: __ Total $78.30
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND,OR 97202 REQUIRED INSPECTIONS
Phone: 503-234-7331 Heating Unt Insp
Cooling Unt Insp 4`
P.eg #: LIC 1441 Final Inspection
This permit is issued subject to the regulation, contained in Vie Tigard Municipal Code, State of Ore.
Specialty Codes and al! other applicable laws All work will be done in accordance with approved
plans. Th s permit will expire if work is riot started within 180 days of issuance, or if work is suspended
for more t-ian 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through CAR
952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246-6699.
Issued By: Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
opt -cit - oma 0f : 2crp
02
FOR OFFICE VSFONLY
]OU'f.'Acal Permit APP *cation >ee,veeMechanl
e.,
- - natdB l� 0 6 PerrNt No.: ''-Lv
Planning Approval fludding
City of Tigard nate — Permit o.: _
13125 SW Hall Blvd. Plan Revicw her
Tigard.Oregon 97223 DW l = Permit No.:other
_
Phone: 503-639.4171 Fax; 503-598.1960 ;'mt•Rcview Cana Us
UattJHCast:Na..
:
Internet: www.ci.tigard.orms crmuct JZT, : Ste Page 2 for
24-hour Inspection Request: 503-639-4175 N■inc/Metliod _ Su nlentanttd Information,
TYPE ON WORK " "( iiCOMMERCIAL•FEE*rS0IEDU1,F-i USE,CIFECKLIST
New construction nemulit►an Mmhanical permit fees*are based on the total value of the work
F�Addlat:etttcnt Other: performed. Indicate the untie(rounded to the nearest dollar)nl'ali
ition/alterHLiott/rc.. - — - mechanical materials,equipment,labor,overhead and profit
CATEGORY OFC RUCTJON
1 ramil dwelling (Commercial/industrial value; S, • See]'age 2 for Fee 5rhrdule
�— RESIDENI'IAT.E Ut:'MEN7'/SYSTE S'FEE'HCHYDULE
_Accessory 13uildit�_ Multi-Famit� — Dip Alou t Fee ett. Total
Mastcr Builder ❑o6ur. —�- _ �
((Caton Conlin
:.' JUII SITE INFORMATION and LOCATION Furnarc-add-on stir cmidltioning•• _ 14.00
,lab site v: Duct addfCs � Du heat wum _ 14.00 —
Suitc#' _ Bldg./Apt.#: a14.(x1
nk _
Pro'cet Name: H dronic hot water cyalcm 14.00
- Residential boiler
Cross street//Direct to job site: for radiator or hyi'runlc a cm 14.00
Unit heaters(fuel,not electric)
in wall,in-duct,suspended,etc. 14.00
Flue/vcnl for any•of tl>ove 10.00
Subdivision;
j,pt�/;
Repair unite 12.13 •
Other Fuel A illonem _
Tax me / nivel f1: Water heater ^ 10.00
t7 i`y • ES O 1Wb Y 'r�?'l '�l' Gas fimplace _ 10.00
Flue vent(water 1"tcr/gas fir Isco _ 10.00 _
�� 1_�� ---—_ Log Iter s�_R 10.00
—---- - —
-Wood/Pellet stove 10.00
WoodMcplace/insert 10.00
Chinutey/liner/flue/vc_nt 111.00 —
opFk• :bwNER Nth'! T.-] 3t"A. t Other: _ 10.00
19IflC: b s. 1. ; V — _Enylronmcntal Exhaust A Venalation _ —
_ Kange hood/other kitchen equipment TO.UU
Address: 010 ) - Clothes dryer exhaust ' 10.011
City/, tC/Z'-1 _ Single ductexhaust —" -
p i j �Q Fax: (bathrooms,toiler compartments,
P c. C CONTACY PERSON utilil rooms 6.90
Attidt:rawl space fans 1000
---� �- Uthcr. 10.00 _
Address: I �------��---- _ ` Fuel i'It Ina_"_
'"((5.40 for flrat 4,St.110 oath addWonal
Phalle: Fax: _ Fumace etc. _
Vias heat pump
E-i118i1: '77_ WaIVsu3lxndcd/unit heater
ONTRM _
_ t: OW *C'..' t; _ ti't! Water heater «`
Business Name: c.�(�t; �i �� . -, _ h'ircplace
Address: y41' `') �`� �J�-•:n'�i Range .. —
City/State/7_i 4• i 1C C��� '1.1 h «; a�B►Cha errs-8�tsL_ _ -'•
PiloQC'07.� rttx; 1�2c-17 - Other - ea _MechaoiTaal
-
CCB Lic. #: ` ` `_ __
—�-- � ral Permit trees• _ _
Authorized / I _Subtotal; S _
Sitp+atutc, �/-� Date: Minimum Pcmtn Fee S72.50 S
Plan Review f'ee(25%of Permit Fec S _
—-- - — _—State Surchar 8%of Permit Ncc $
(Plcase pent name) 'TOTAL PF.ltMIT FELT S
Notice: This permit application ecptres If a permit iv not obtained within "Fat mothodolM set by Tti-Couoly imodiog industry Service hoard.
180 day, after 11 hat heen accepted at complete. **Site plan required for exterior A .'unlls.
i"ut\Permit Fomts\MecPermitApp doc 01/03
Oct-01 -03 01 : 21P
rte-.
P . 03
�90
L
aiQCc�"icnl
rRoNr
CS.CCX) 7—
MAKE
�fRGoC35 N7T� � A�C
fit
r�lorzr.
503 - 23q- 733/
<Ax
CITY OF TIGARC 24-hour
BUILDING Inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171 —_--
BUP
Received -_ Date RequesteAM— PM_—___ BUP
Location _ �~ Suite MEC
Contact Person __—_ —___- Ph O & - PLM 5 -
Contractor -__-- --- — Ph SWR
BUILDING Tenant/Owner _- _- - ELC
Footing ELC
Foundation Access:
Fty Drain ELR
Crawl Drain ----
Slab Insper-!ioes / r SIT - -_ ---_
Post&Beam - fr �'
Shear Anchors --
Ext Sheath/Shear
Int Sheath/Shear
Framing ---- -- — ------ -- —
Insulation
Drywall Nailing -- - - -----
Firewall
Fire Sprinkler — ----- —
Fire Alarm
Susp'd Ceiling - '— -- -"—_----�
Hoof
Other: - ------ -- - — -
Final
PASS PART FAIL
IN ---- ------- -_—
Post 8 Beam
Under Slab - -- —
In
Water /
Water In
2 - -------- - -
anitary Seer ��vv
---
Catch Basin/Manhole
Storm Drain --
Shower Pan
Other: -- - - - -- — -- - -
FipW- ---
4PCHANICAL
PART_ FAIL
-- --- ---- _--- -- -� -
Post&Beam
Rough-In -- - -- -- - ------------ _ —.-
Gas Line
Smoke Dampers - --- --- - -- - ---- - -- - ----- - - -- -
Final
PASS PART FAIL - -_---'
ELECTRICAL
Service — -
Rough-In --- ------ ---- —-- - ----- - -
UG/Slab
Low Voltage —
Fire Alarm
Final Reinspection fee of$ —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
[l Please call for reinspection RE:— --. —_ Unable tc,inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date _ Inspector Ext
Other:
Final J— D6 NOT REMOVE this Inspection record from the job site.
PASS P"�RT FAIL
Scheduled.,, Date
Work Order# j
i
River City Environmental, Inc. Complete Industrial
P O. Box 503-252-6144 Waste Removal
Portland, Oregon Septic Tank Cleaning
97294 l 1 �, U j 1 UV Sump j
Y 1 Line Cleaning
w nSite Information,
Description Units Amount
—T - --
Instructions: Driver Notes — — --
River City Environmental, Inc. is in no way responsible for damage to the septic tank or lids on the system.
Terms: Net 10 days. 1.5% per month will be charged on peat due accounts. (16% per annum).
Terms and Conditions
The customer agrees to pay all Invoices arising out of pumping services,and any other special services herein within 10 days
i
The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered,over and above th'a
normal servicing schedale,on behalf of the customer j
The c-.stomer agrees to assume responsibility damage to customer's real or personal property arising from pumping services which take pace
ustomer's premises,where the drivers and vehicles of River City Environmental have been instructed to enter
,'his includes,but Is not limited to driveways,trees,power lines or poles and building structures.
If River City Environmental,Inc finds It necessary to add liquid to the tank on jobsite,customer will be charged for the additional gallonage resulting
from these condidtions.
I
Customer agrees to reimburse River City Environmental,Inc.for all reasonable attorney's fees court costs and other expense Incurred by said
company to enforce collection or to serve their rights under this agreement.
Customer agrees to the above conditions. Redeemable in Multnornah County
Work Authorized bjJ ! Date
r..
Driver Signature Date / / , Time
---- ---
CATY OF TIGARD 24-Hour
BUILDING Inspection Linc- (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
B U P —_.-
Received __ Date Requested a - - AM PM __.. BUP
Location �1, -�!� �-��_Suite____ _____-___ __ MEC
Contact Person -- Ph (-----.) — -. -----__ . —--- PLM - — �—
Contractor ___ Ph ( _—.—) --._--_ __—_- SWR
BUILDING' Tenant/Owner �_- _ � ------- - ELCl��
Footing S _ -�C 3 ELC —
Foundation Access:
Fig Drain 'S, �\ y N c� �) , EI-R
Crawl Drain
Slab Inspectior, Notes: _ SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear — -- - ---
Int Sheath/Shear
Framing ------ -- ---
Insulation
Drywall Nailing - - - -- --. . - ------ ---
Firewall
Fire Sprinkler ----
Fire Alarm
Susp'd Ceiling — - -- ---
Root - - ------- - --
Other:__ --_— -- -- .. --- -- -- -----
Final
PASS PART FAIL ------�.---- — -_- - - ---
PLUMBING T--—- - --- -_ --
Post&Beare
Under Slab -- — -----`
Rough-In
Water Service - - ---
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other: —
Final
PASS PART FAIL
MECHANICAL --
Post&Beam
Rough-In
Gas Line A
Smoke Dampers
rig
ART FAIL
ne
EL RIC L.
Service
Rough-In ' -
UG/Slab
Low Voltage
rrm
L-� Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: _ Unable to inspect-no access
Fire Supply Line l /
ADA Date
I 1/ � _� Inspe+ r
Approach/Sidewalk
Other:
Final - DO NOT REMOVE this Inspection record from the Job slab.
PASS PART FAIL