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125%5 SW BROO:,SIDE AVENUE
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour[nspxtion Line: 6394173 Business Phone: 6394171
Date Requested: >0 A.M M. MST:
Location:_ L 5 74; �t� BUP:
Tenant:— Suite: Bldg:
Contractor:
--Phone: 'c;LPLM: D10
Owner: ' �� Phone: `
ELL:
ELR:
SIT:
BUILDING BLDG(con't) LUMBtNG MECHANICAL ELECTRICAL SITE
Site Post/Beam o .Post/Beam Cover/Service Sewer/Stone
Footing Roof UndFUSlab Rough-In Ceiling Water Line
Slab Framing Top Out '
Line Rough-In UG Sprinkler
Foundation Insulation Sewer 'Ilaod/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheadi Fire Spklr/Alm Crawl/Found Dr IIcat Pump Low Volt
Approvedprov Approved Approved Approved
Appr/Sdwlk Not Appro^edo proved Not Approved Not Approved Not.Approved
FINAL FINAL FINAL FINAL FINAL
IVC
0 Call for reiinn�spec einspection fee of S r uire/d �ffor next inspection 0 Unable to inspect
Inspector: ' � �/�� Date: v "'
—V _ ----- Page —of
CITY CSF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-41il PERMIT *1. . . . . . . : PILM98-0043.
DATE' ISSUED: 02/17/138
f-,ARCEL: 2S102BC-00103
SITF ADDRESS 12575 SW BROG".'_'_DE AVE'
SUBDIVISION_ . : WALNUT ACRES ZONING: R-4. 5
BLOC!',. . . . . . . . . . . LOT. . . . . . . . . . . . . :002 JURISDICTION: TIG
-------------------------------------------------------------------------------------
CLASS OF WORN. . : REP GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GFRP. - :M FLOOR DRqINP. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES---_--__---__-- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : it
SINKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . .
( LAVATORIES. . . . : 'A OTHER FIXTURES. . . . : 13
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 100
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 121
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Replacement of less than 100 feet of sewer, line.
Owner: FEES
G'--ORGE VATERNICK type amol-int by date recpt
12575 SW BROOKSIDF PRMT $ 30. 00 DRA 02.'/17/98 98--303298
TIGARD OR 9722 ' 5PCT s 1. 50 DRP. 02/ 17/99 98-303298
Phone #:
Contt-actov------------ ------------------------
RESCUE ROOTER
PO BOX 1728
WIL.SONVILLE OR 97070 ----------------------------I-------
Phone #: 68b-9050 $ 31. 50 TOTAL
Req #. . : 000446
REQUIRED INSPECTIONS
This permit is issued subject to the requ)ations contained in the Sewer Inspection
Tigard Municipai Code, State of Ore. Specialty CoOps and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This permit will expi v if work is not started
within 188 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Granon Utilitv Notification Center. Those rules are
set forth in OAR 952-MI-010 through OAR 952AWI-0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246-19P7.
Issi.ted Permittee Si gnat 1-tre:,,
4.................................................................
Call 639-4175 by 7-00 p. m. for- an inspection needed the next bi-isiness day
++++++++-v.......4...............4-+4++++++++4..........4...............4++-+... ....+
i
ITY OF TIGARD Plumbing Application Recd By
M25 SW HALL BLVD. Cemmercial and Residertiai Date Recd /
Tlr,",RD, OR 97223 Date to P E. �—
fx,03) 639-4171 pc!nDate!oDST
Print or Type Related SWR
Incomplete or illegible applications will not be accepted Called
Name of Development;Proy�ct —� ` On back Indicate Work Performed by fixture.
Job — FIXTURES (Individual) QTY PRIDE AMT
Address treet Address /) , Suite Smk �— - 9.00
SIV" { ✓Cc \ t Lavatory — -- 900
Bldq t, City/State r� Zip --- 9.00
r /� �)�q Tub or Tub/Shower Comb.
NNeemme Shower Only 9.00
0 p �C _ f?�j 1' Water Closet —906—
Owner
00Owner Mailing dress uite Dishwasher
9.00
i )S tv 6/10-1/`-S16141 Garbage Disposal 9.00
City/State ZIP I Phone
r c/rc3 �3 39 y(aly washing Machine 9.00
e e � Floor Drain 2" 9.00
SLI Vf eV Ali— 3" — 9.00
Occupant Mailin ddress / Suite 4" — 9.00
ty/Stat
e (,IQ 1 — Water Heater O conversion O like kind 9.00
T�p Phone
ClG( '- 7��t 5 1 6�L r Laundry Room Tray 900
e l• Urinal 9.00
Other Fixtures(Specify) -- — 900
Contractor 11' ddress Suite — �• 9.00
Pnor to permit Clty/ tate zi , Phone _ -- _ —_ 9.00
issuance.a copy S�,�tv�� � i'[Sx) I-�j7 )(,P"ru(bl 9.G0
of all licenses are Oregon Const.Cont.Board Lic.0 E.•p.Dote 900
required if --- —
Cawer-1st 100' 306-0 c
expired in COT Plumbing Lic.N Exp.Date
database Sewer-each additional 100' 25.00
_ _ _
Name Water Service- �1 100' 30.00
rchitect water Service=emit additional 200' 25.00
or Mailing Address Suite Storm&Rain Drain- 1st 100' 30.00
Storm&Rain Drain-each additional 100' 2500
Engineer City/Slate Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New O Addition U Alteration O Repair O Pollution Device
to be done: Residential O Non-residential O Residential Backflow Prevention Device' 15.00 —7
Additional descnph:n of work: Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9 00
Insp of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspec-tions 4000
buildir g or property,__ _ per/hr
Rain Drain,single family dwelling 3000
Proposed use o1 Grease Traps i 9 00
building or property _
QUANTITY TOTAL
I hereby acknowledge that I have read this application.that the information Isometric or nser diagram is requited :Ouandy Total 0 >3
given is co.rect.that I am the owner or authorized agent of the owner.and -----t— �]
`SUBTOT411
7 (1
that planssubmitted are in compliance witO Oregon State Laws.
Signature of �r�qr/A nt Date- — 5% SURCHARGE
X", PLAN REVIE.:?5%OF SUBTOTAL
Contact P no H ms Phone Required on d nztu•e qc tool�s> _
TOTAL <
'Mln:mum pennit fee is$25+5%surcharge.except Residential Backflow
Pravenli,)n Device,which is$15+5%surcharge
i'dets'.'Imano doc&V;
PLEASE COMPLETE
Fixture Type ----Quantity by Work Performed _
New Moved Replaced Removed/Capped
Sink - —_--
Lavatory_ — —
Tub or Tub!Sho_wer Combination -- —
Shower Only -- -
Water Closet — -
Dishwasher_- --
Garbage Disposal
Washing Machine _
Floor Drain —
Water Heater _— — ---
Laundry_Room Tray_ _ --
Urinal
Other Fixt,irl;•s (Specify) �� -- ---
COMMENTS REGARDING ABOVE: