The URL can be used to link to this page

13820 SW BOXELDER STREET 1 co N U �n Q X tri r d ra h r.� ca H � I 1 1 i "-13820 SW BOXELDER STREET � � CITY OF TIGARD DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 CERTIFICATE OF [ICCUPP,WY PERMIT #. . . . . . . : ME3,T97-00C .. kIARCEL t 25104Cq-01220 )ITE AD[)REa'.'.'i. . . t 1380 SW La[7XEl.pER f37 �UBDIVIGION. . . . z HIL.l-SHIRE FSTATES "" zC1NINC z R•-7 PD . . . . . . . . . . t L(.)T. . . . . . . . . . . . . 801,2 JURISDICTION tTI0 'LA81; OF" WORK. :NEW I YVIE OF USE. . . z SF IYPE OF CONST F7 z 5N )CLOPANCY GRP. t R3 � 1CCUPANCY LOAD 8.P- e n a t k s z Pith t 'wner t , ,E:OF-F B0UR(3EOI':_, '9351 SW BAKER RCS .HERWOOE, OR 97140 hone #t 682--8777 ontractor: -.- 0PTHWEtiST DREAM HOMES 9.31.31 SW BAKER ROAD HERWOOD OR 97140 horse #t 682 -8777 ep #. . 1 000869 his Certificate 91-ants occupaanc:Y of the above refer—iced building ar pot-tion hereof avid C- .nfir-ms that the building has been inepec_ted for c:ompliaance with he State of regon Sprcianit,y Codes for the gr01.1p; occkTar.r.-y, acrid ,..iae- ,.indAr jhic.•h the re er,enc_•ed permit w,as issued. / 1 'IJILDIN(3 1NSPE[";1'OR ___... ..._._ _. . __ .... . ._ _UILSING3 OFFICIAL. POST IN CONSPICUnl1L, PLACE L q,IF CITY OF TIGA91) BUILDING INSPECTION DIVISION 4-Hour Inspection Line: 6394175 Business Phmie: 6394171 Date Requested: 19—q _ AM*. M. _ P. MST:c(00 Location: A I �L� � 42— BUP: Tenant: Suite---- Bldg: NEC: Contractor: one: 7- 3�45.`Z PLM: Owner:` UL 4Z.- Phone: -- ELC: ------- ELR: SIT: BUILDING LDG n'tl PLUMBING AL ELECTRICAL SITE Site Post/lieam Post/Bearn Cover/Service Sewer/Storm Footing Roof UndFI/Slab Rough-In Ceiling Water Line Slab Framing Top(hit Gas Line Rough-In UG Sprinkler Foundation Insulation Sewer flood/Duct Reconnect Vault Bsmt Ihunp Ihywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Thain -A/C UG Slab Sitear/Sheath Fire Spklr/Alm Crawl/Found Ih Beat Pump Low Volt _ my Approved ,roc Approved Approved Appr/Sdwlk uved Not Approved Not A ved Not Approved Not Approved AL ' FINAL FINAL FINAL. i D Call for reinsvection 0 Reinspection fee of S_ Qrequired two-fore next inspection O l Inable to inspect Inspector:— — -. _-- — Ntr.: //� — Page•--_ of_---— Remarks : Path I Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, pl,.ase have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of work. No plumbing inspections will be authorized until this completed form is received. AN INK SIGNATURE IS REQUIRED ON THIS FORM OWNFP : PLUMBING CONTRACTOR: GEOFF BOURGEOIS WOLCOTT PLUMBING CONT. INC 29351 SW BAKER RD P 0 BOX 2007 SHERWOOD OR 97140 GRESHAM OR 97030 682-8777 Pho•ie # : Reg # . . : 23847 Signature of Authorized Piurnber Please return this completed form to the address above. ATTN: Building Dept. If you have any questions, phase call 639-4171 , ext. 11310 AN INK SIGNATURE IS REQUIRED ON THIS FORM ')WNEP : ELECTRICAL CONTRACTOR: GEOFF BOURGEOIS BEAR ELECTRIC 29351 SW BAILER RD PO BOX 389 28085 BUTTEVILLE RD NE SHERWOOD OR 97140 DONALD OR 97020 Phone # : 682-8777 Phone # : FAX-687- 1108 Req # . . : 000209 X �G S Y- -- Signature 0 Supervising Electrician Please return this completed form to the address above. 3/G S ATTN: Building Dept. If you have any questions, please call 639-4171 , ext. #310 .,treet Address Mailing Address WOLCOTT 2050 N.W. Burnside P.O.box 2007 Gresham,Oregon Gresharn, ')R 97030 PLUMBING (503'.667-1781 Fax(503)067-9891 CONTRACTORS. INC. CCB 23847 August 20, 1997 Attn: Bldg Dept. City of Tigard 13125 SW Hall Blvd. Tigard OR 97223 Re: 13820 SW Boxelder- Permit Ntimber MST970060 It was brought to our attention that the plumbing Rough-In inspection at the above named house was never approved. All of the issues that resulted in the failure at the first inspection were resolved and the waste and water were both tested per UPC requirements. We believe that the plumbing system installed is both legal and demonstrates quality workmanship. Please sign off the plumbing Rough-In inspection as Wolcott Plumbing, Contractors, Inc. will accept responsibility for any failures in the plumbing system. Thank you, Guy Wolcott, Jr. Plumbing • Site Utilities • Excavation I CITY DEVELOPMENT SERVICES MASTFR PERMIT 1 13125 SW Hall Blvd,, Tigard,OR 97223 (503)639.4171 F'R RI+ITT #. . . . . . . : III-3T97-0060 DAl F=: TEi OF D: 03/P'0/97 PARCEL.: c'Fi31 04CD-0i c'Qr0 ! TF` A0DRF=SS. . . 1358c-111 9W BOXF=:I...OF_R F3 f IF�DIVTF3T0N. . , . e HII_.F_.SHTRF F_fil-ATF, ZONING: R-7 �:'F) 0l M. . . . . . . . . . . I_OT. . . . . . . . . . . . . ..ui1 marks: Path 1 ------------------------------------------------------------ BUILDING -------------- -------------------•----------------------------- REISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...; 0 sf REQUIRED SETBACKS---- REQUIRED----------- - CLASS OF WORH.:NEW HEIGHT........: 26 FIRST....: 1.349 sf GARAGE.,...: 745 if LEFT..,,,,,,,,; 20 SMOKE DETECTOS: Y T- PF OF USE_:SF FLOOR LOAD....: 40 SECOND. . ; 1255 sf FRONT.........; 20 PARKING SPACES: 1 TYPE OF CON9T.:5N DWELLING UNITS; 1 FINBSMENT: 0 if RIGHT.........; 26 OCCUPANCY GRP.:R' BDRM: 4 BATH: 3 TOTAL-------: 2604 sf VALUF..1: 189364 REAR..........; 21 -------------------------•--------------••------------------------ PI_l1MBING -----------------------------•- SINKS.........: 1 WATER CLOSETS.: 3 WASHING MACH..: 1 LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 0 TRAPS.........: 0 LAVATORIES....: 5 DISHWASHERS...: I FLOOR DRAINS..; 0 SEWER LINE ft: 0 SF RAIN DRAINS: 1 CATCH BASINS..: 0 TUB/SHOWERS...: 3 GARRAGF DISP..: 1 WATER HEATERS.: 1 WATER LINE ft: 100 BCKFLW PREVNTR: 1 GREASE TRAPS..: 0 ---------------------------------------------------------------- MECHANICAL ------------ OTHER FIXTURES: 0 F'UEL TYPES----------- FURN l 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1 /GAS/ / / FURN i=IW ..; 1 UNIT HEATERS..; 0 HOODS.........: 1 OTHER UNITS...i 1 MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....; 0 GAS OUTLETS...: 1 -•---------------------------------------•---------------------- ELECTRICAL --RFSIDFNTlA1. 11NTT--- ---SERVICE/FEEDER---- --TFM0 ERVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS-- 1000 SF OR LESS: 1 0 - 200 amp..: 0 0 - 2" amp.. : 0 W/SVC, OR FDR..: 0 PU09/IRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 500SF.: 5 201 - 400 amp..: 0 201 - 400 ago..: 0 lst W/0 SVC/FDA: 0 SIGN+OUT LIN IT: 0 PER HFHJR......: 0 LIMITED ENERGY.: 0 '+01 - bw aan.. : 0 401 - 600 amANE o..: 0 EA ADD[ BR Cl" 0 SIGNAL/PL...: 0 IN PLANT......: 0 MANE HM/SVC/FDR: 0 6b; - 1000 amp.: 0 601*amps-1000 v: 0 MINOR LABEL -10: 0 10Pc4 amp/volt,: 0 --- -------------------------------- RAN REVIEW SECTIIMI -- - - --- --------------- Reronnert only.: 0 )=4 RES UNITS..: SVC/FDR)=2.25 A.: ) 600 V NLWINAL: CLS AREA/SPC OCC: ------------------------'----- -------------- -- ELECTRICAL - RESTRICTED E+06i, A. SF RESIDENTIAL--------------------------- B. COWRCIN.---------------------------------------------------------------------------- AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO I STEREO.; FIRF ALARM...... INTERCOM/PAGING: OUTDOOR I_NDSC LT; BURGLAR ALPRM..: 0TH: :: M BOILER.........: HVAC.......,...: I_ANDSCAPE/IRRIu: PROTECTTVE SIGNL: GARAGF OPENER..: CLOCK..........: INS1RI,"TPTION: MEDICAL........; OTHR: .. 14VAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL_ k SYSTEMS: 0 Owner: -------------------------------------Contractor: - -- ---- TOTAL FEES:$ 4687.70 GFOFF BOURGEOIS NORTHWEST DREAM HOMES - -- -- '9351 SW BAKER RD 293551 SW RAKFR ROAD ;HERWOOD OR 97140 SHERWOOD OR 97140 Dhone 0: 682-8777 Phone is 682-8777 IWl Req N..: 86979 'his perelt is issued sub iect to the rq uiations cortained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other, applicable laws. All work will he done in accordance with aparnved plans. This permit will expire if wori, is not started within 180 Jays of issuance, or if worts is suspended for mnre than IAA dans. __ ----- - - - -----------._..--------------------- REQUIRED INSPECTIONS ------.. ---------- rosion Contnl Pnst/Beam Mechan Electrical Servi Gas Line inso Water Line Insp Building Final ,rading Inspecti Crawl Drain Electrical Rough Gas Fireplace Appri9dw1k Insp _ noting Inso PLM/Underfloor Framing Insp Insulation Insp Electrical Final _ oundation Insp Mechanical Insp Shear Wal lisp Gyp Board Insp Mechanical Final •ost/Bea• Struct Plumb Top Out f j#a \Rain drain, Insp plumb Final ;•n• i 1-+ i nriat i ir.,(P ; �,,6 �' �� T55i.re,d Fly: �i r fr ; i 'iPPrtion -- 639, 4175 CITY C F TIGARD SEWER CONNECTION DEVELOPMENT SERVICES PERMIT PERMIT #. . . . . . . : SWR97-0069 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: 03/20/97 PARCE1_- 2S'.04 7l)--01200 SITE. A 1.)D R E)S. . . : 1.3820 SW PDXEL-DER ST RUBD J V T F)I ON.. . . . : H I LL_SF1 I RE ESTATES ZONING: R-7 PD RI 0 C W,. . . . . . . . . . LOT. . . . . . . . . . . . . ..012 TFNANT NAME. :BOURGEOIS, GEOFF USA NO. . . . . . . . . . i FIXTURE UNITS. . . : 0 ri. A!7)F") OF:' W(IRK. . . :NEW DWEIA-ING UNITS. . : I TYPE OF' USE. . . . . :SF NO. OF BUILDINGS: I TNSTALL TYPE. . . -BUSWP IMPERV SURFACE: 0 s f Remarks : Path I Owner-1 FEES GEOFF BOURGEOIS type amol.Ant by (late recpt 2,9351. SW BAKFR RD PRMT $ 2200- 00 B 03/20/97 97-29201,4 T 1\1!-`3P $ 3`i. 00 R 03/20/97 97-292014 SHERwnon OR 97140 Phone #: 682-8777 Contractat-: CONTRACTOR N('T ON FILE 17,1-1 o n e # $ 00 TOTAL. RFQ1UIRED INSPECTIONS iF.js Applicant agrees to comply with all the rules and regulations Sewer Inspect ion the Unified Sewage Agency. The perett expires 180 days from date issued. The total amount paid will be forfeited if the -sit expires, The Agenry does not guarantee the accuracy of the l,le sewer laterali, if the sewer is not located at the measurement _- -nn, the installer shall prospect 3 feet in all directions from _P distance given. If not so located, the installer shall purchase "Tap and Side Sewer" Permit and the Agen, I I a lat%ral. r.7, 1-M i t t p p q i r ri,:) si-iPci By Call for inspection 639-.-4175 Plan ' Y OF TIGARD Residential BuildingPermit Application Rec*dBerK#4 P P Rec d By 25 SW MALL BLVD. New Construction Additions or Alterations Date Recd ,ARC, OR 972:3 :angle Family Detached or Attached Duplex) Date to P e iO3-639-3171 Oata to OST •G SOJ 684-7297 Permit 0K117 - Print or Type caned — 11 7 � v g00(S Incomplete or illegible applications w.;; -.ot be accepted -- Name of/Prbiect Job ice, �� 4.2 _ Address Site Acore's .9 Architect Marling d e}s 7vl. NamrSta ip Phone Owner Mailing d re a % Ina .Q /state Lip Phone Enqineer Mailing Agdr ,(,/"V,'+VVW t-5 'Itylstate 2io Phone General —_ Describe work �ir,r m- Addition O Atbrabon O epa,r O intractor Mailing Address to be don, Additional—Description of'Nork: City/state Zip �^ Phone I regon,Con , Cont.Board L c A I EX0 Date ach Copy of (•r - Current COT Business Tax or Metro+► P. ate PROJECT � - Licenses 4 --- VALUATION Name vlechanical ,`/� � L, j1NEW CONSTRUCT/ N ONLY: Sub- Mailing Addrp} Sq Ft..House: Sq. Ft. ar ge 1 Vd' v� ntractor « l C4YIS t ic Phone Comer t YES NO Flag Lot YES ��.�� !I >� (check one) (check one) 1/ Oregon yon t�Cont._Boaro Lc.0 Ex .Dace Restricted Audic/Stereo _ Burglar acn copy or (, !� r^ Ji! r�J /�" Energy System Alarm Current COT Business Tax or Metro K xp. ate Installation i _,cense' Garage Door HVAC Name Opener Systems 'lumbing �f�. ;check an that I Other Pp Y) S ib- +''ling Address �W;, the electrical subcontractor wire for all YES NO ntractor % :n, �Dc1,T restricted energy installations? C,ry,S to Z.o ?hone Has the Subaivision Plat recorded NIA YES NO 9 e,� r/ re on Const Cont- Boaro L,c a p Daj Reissue of MS': Ch Copy of �` I Solar Ccmpliance _urrent Plumbing Lie.t (Calculation Attached) icenees I ;� , t r �7 I 1 hearby acknowledge that I have read this application, that the COT gusiness Tax or f�l tri} x to information given is correct, that I am the owner or authonzed I agent of the owrer, and that plans submitted are in compliance I N me with Ore on a laws ectrit:al r ' - Sig a er A e t 0at iub ailing Acdress 1�. Conta rson N e one'# ntractor �� 11;f., C.ry,S Zip Phone FOR OFFICE USE ONLY: t< /� l o�,e 'i Plat W Ma 1.0: hCopy of Oregon Const. Cont Board L c M Ex .x Date l ,c r• � ..irrent E'ecincal L.c 0 Se ba s Zola: Solar xp. ate �`. L senses � '. I - _� t " Engineering Approval. P e Hing Approval: TIF COT 8u:;,ness Tax or Metro to E o ate p.doc (dst) 1,97 r � P2rm1 A"QUnLQ n ILn Amount Aunt. PI aq-I .5?-ue NIST Permit (BUILD) 658, Plumb. Permit (PLUMB) Z5, Mech. Permit (MECH) _ ELC/ELR Permit (ELPRMT) Z S, 27_1 State Tax (TAX) 60. Bldg 32, 90 Plumb. Mech 73S ELC/ELR: 13, Plan Check NIST: (BU°PLN) 417. �� , so, �✓ �_ Plumb: (PLMPL.N) Mech: (MECPLN) CDC Review (LANDUS) -Ilt2, Z 0 Sewer Connection (SWUSA) Z��, 2260. Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) tv b� Residential TIF (TIF.-R) ,S All /57/0, Mass Transit TIF (TIF-MT) 12o, _ 20, Water Quality (WQUAL) w Water Quantity (WQUANI� Erosion Control Permit (ERPPM-F) � ,!v4. Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) Fire Life Safety (FLS) _ TOTALS: ZZ,1O 2,56) i7v 1 Sf3C0.00C CSO 1 97 Box B. continued Box B: Measure change ;n eievztion from front property line to finished floor elevation. If the lot sloces up from the front !cc line to the foundation, the tiQure is positive. If the 'ot slopes down mom the front lot line to the foundation, the figure is negative. ft 3. Measure distance from finished floor eievation to the affected peak/eave. ;( + It 4_ If the roof line runs 'North-South, deduct three feet. If the roof line runs fast-West; -; deduct nothing,. D. Subtract one foot for each foot of difference in elevation from the front property line to the rear property line, if the lot slopes up from the front to the rear. If the lot has no slope or slopes up from the rear to the front, deduct nothing. _Zy 3 ft 6. Total Figure for box B: -7 -2 ft �,J Box G Distance to the shade reduction line. Box C- 1. :1. N*.asum the distance from the North property line to the foundation near the iJ ft affeard peak/eave. - 2. Meas,r,t tree distance from the foundation to the affected peak or eave. + 3. Total figure for box C: z, _ ft It is mast useful to draw a vertical fine to represent d+e appmpriaoe fgue(found in box'A'and a horizontal Gne to represent the appropriate in m found in bot-C'. The inoersecuon of the Yen"and honzonW Pws determines the value found in box 'O'. The value in bort 'O"O"ild be c r"pared to the value in box "8'; if the value in box'8'is less than or equal to the value found in beet 'O', then the buffo.-g is in ci�mpfiance w%Lh the solar balancx code if you have any quemons. please conca its at 619-4171, x304 or at the Community De+ek Amen t Canter. MAMMUM PERMMED SHADE POINT HEIGHT (In Feet) Cmunce to North-smth lot dimension rn feea s1ade 100+ 95 90 85 80 75 70 65 60 55 50 45 40 redumon rine from northern Ent 5nr fin fee- _ 70 40 40 41 42 43 44 63 ti 36 38 39 40 Al 42 43 50 6 36 36 37 38 39 40 41 42 5.3 34 34 35 36 37 30 12 32 32 33 34 35 36 37 38 39 40 3 30 30 31 32 33 34 35 36 37 33 39 '0 _ 23 Z3 29 30 31 32 33 34 35 36 37 39 '-5 26 27 28 29 30 31 32 33 34 35 36 A 24 24 24 25 25 27 28 29 30 32 33 3.4 S 22 2-7 22 23 24 2S 25 27 28 29 30 31 32 :0 z 1 20 20 21 2-1 23 24 25 26 27 28 29 30 15 1 18 18 19 20 21 22 23 24 25 26 27 28 10 1 16 '6 17 18 19 20 21 _'2 23 24 25 26 I_ 5 1 14 14 15 16 17 18 19 20 21 22' 23 24 Box D. Maximum allowed shade po int height: _ feet 4 h�`drxsinanMvCrrtrra�so4ar cho Revised =176in6 Solar Balance Point Standard Worksheet -address Box A calculations: (North-South dimension for the lot. Box A. This dimension is determined by finding the midpoint of the North lot line and drawing an intersecting line perpendicular to that point. `M First, determine which property line is the North lot line. The North !ct line is the line with the smailest angle from a line drawn east-west and intersecting the northern most point of die lot. N \\ North-South Dimension for Lot: Measure the distance from the midpoint of the North lot line to the South lot line along the described line, i feet 1 N \ <�'TKu+�a�owq� `•� r Box B calcidations: Shade point height for your residence. Box B: 1. G'erermine whether measurements will be based on the peak or ea"_ cf your structure. The orientation of the ridge is also important_ Which describe, your residency? 1 a: If the roof line runs North-South, measurements will (circle one) be based on the teak of the roof. T o o r C 13 1 c 15: If tt.e roof line runs cast-West and the roof pitch IS less tnan 5,12. measuremerts will �_-e 'ased cn "-e ease. 1 c- If tf;e rcof lire nuns East-.vest and the roof pitch is 5i12 cr steeper, measurements will be based on the O"i= peak. 503-225-0933 MASCORD DESIGN ASSOC Eta P01 MAR 03 'S^ 16:38 ��D 4- �� -c f/ono • 2212G1 BY : r N W. DREAM HOMES s CITY OF TIGA7ap _ �; HILLSHIRE ("Ab I - C' z� 6 lot 12 ( 9,IBJ SQ. FT.) XN \ 1 \ se I , \ ae, GARAGE 1 o ri t h 6* x . 4 'J• 1 •; xAr + z MAIN FLOOREll i y n von ►�Oy ORIGIN ` M 1 Q o � h 03/03/97 MPR 'w W6('LYp Delm Aswcu'FS,hC 0 Y06AMI40 WArAt@L ,i M i SOLE C '10YVICA*r OF fly D WI TO vVWv " 112 CVWTCP(NOWOMO AM'Rt ..fD QM'1t�tj NO MF011Y OM'14aR W+'rOfut1w RLQ YCMCiTw". CITY OF TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT 13125 SW Hall Blvd., Tigard,OR 97223 (50.9)639.4171 PERMIT #. . . . . . . : PLM97-0332 DATE ISSUED: 08/ 14/97 PARCEL: ._S 104CD-012'00 SITE ADDRESS. . . : 138: 0 SW PDXEI_DER ST SUBDIVISION. . . . : H I LLSH I RE ESTATES ZONING: R-7 PID BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :012 JURISDICTION: TIG CLASS OF WORK. . :ADD GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1 OCCUPANCY GRF,. . :R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 F I XT LIRES---------•------ 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 WATER LINE (ft ) . . . : 0 I)I5HWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks : !)dd one ( 1. ) residential backflow prevention device. Owner,: _______._________-____-___.____.__-•---------.-.---_.__-_____-- FEES -- -- --------- - GEOFF BOURGEOIS type amo -tnt by date recpt 1382:0 SW BOXELDER FERMI $ 15. 00 GEO 08/14/97 97-298282 TICARD OR 97223 5-PICT $ 0. 75 GEO 08/ 14/77 97-.298282 Phone #: ANCTIL PLUMBING INC 16900 SW MERL...0 RD BEAVERTON OR 97008 Phone #: 503-642-73:3 $ 15. 75 TOTAL Reu #. . : 000,-41 - - - ---- - REOU I RED INSPECTIONS --- -This permit is issued subject to the regulations contained in the Water Line Insp Tigard Municipal Code, Stete of Ore. Specialty Codes and all other Ro l_igh-i n I n s p applicable lass. All Murk will he done in arcordance with Mi sc. Inspection approved plans. This permit will expire if work is not started RFI/Backflow Pr-ev _ _—^— within IPO days of issuanre, or if Mark is suspended for more Final Inspection _ than 180 nays. ATTENTION: ►lregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-8010 through OAR 952-9001-0080. You may obtain copies of these rules or d,rect questions to OI.AiC by calling �503�24h-1987. 1 ss�:ed Py : F'er-mittee Signat!ire -!_ _._....._ ++4++++++++++++++4+++++++++++++++++++++++++++++++++++++-f-++++++++++++++++ F+++++ Call 639-4175 by 6:00 p. m. fat- an inspection needed the next hi-rsiness day +++++++++++++++++++++++++ti ++++++++•++++++++++++++++++++-++++++++•F+++t+++++- +++++ ,ITY OF TIGARD Plumbing Application Rwc'dBy 13125 SW HALL BLVD. Commercial and Residential omit Recd "iGARD, OR 97223 0610 to P E._ 503) 639-4171 oats to osr Permits Print or Type Related SWR s Incomplete or illegible applications will not be accepted salted Nems of Developmen/Prolttt FU(TURM,QlrllvIdual) ori tP E/,�AM7a Job 5M9.00 Address Su"t Address Sutw L'va1Of�' —' i "Z� �2 G '50 '6,,,< C- 1- r C f•- Tub or Tub/Shower Comb. 9.00 Bldg P city/Stale Zip Shower Only -- 9.00 /<C, Water Closet 0.00 Dlmnwaaher 9.00 Owner Ma&9 Address Str►ry Garbage Dlapo6af 9.00 Ciry/Sute Washftp Maclhirw roo Phar» Flow Dream r _ 9.00 Name 3' 9.00 4' 9.00 Occupant Ma&v Address Suite Water Heater 9.00 La m"Room Tray 9.00 City/State Zip Phone Umal ----- I _ _ 9.00 Namur Other rLdw,6(Speahy) 9.00 / I//7l! 9.00 ontractor Ma'WV Address Suite rkX to WwAnce Clly/stafe Zip Phots _ _- 9.00 aPPlt' . Ant �V !�4 c. 6 G ((Z-� provide all Oregon Conal.Cont.Board L,c.s FF,,e� 19 9.00 contractors Ikxnse PMa 7"Lie Sewer-to tO0' 9.00 Informadw . (' C .) r^b -- 30.00 k i Sewer-each additional t 00' for COT COT Busww Tax or Metros Exp.pate 23.00 database). 1) r3 // / -% Water 5w"rwca-1st 100' 30.00 Name Water SavKA-each WdMonal 200' 25-00 ArchitectStaxm ti Ran O!en-1st 100 �� 00 —� or AMaing address ,a,ite Storm!t,Win Oran-each aditonal 100 29.00 _ Mo[>tla Hartle SRacs� 23.00 -_ Engineer City/State Zip Phone coneneroai sada Flow PrOvwht,on Oev ce or Antl- 23.00 Pollution Devin Describe worts New O Addition O Alferatkxr O Repair O Resadermal Backitnw provwntlrn D,,nee' 15.00 o be done: Residential C Non residentlal Q Any Trap or Waste Nod ConneueC to a Fixnue .additlenal description of;-w --- 900 titch Basin 9.00 VAC - r r Insp.of Ebsong Phxnbing — 4000 xtsting use of Speaauy Request" Inspections 40.00 ,ddWq or prop" pefft _' Ran Drain,single hmaty dwebV ---— 30.04 .xseo use of Grease Traps —-- —' - 9.00 Kling or property_ QUANTITY TOTAL e you rapping. moving or replacing any fixtures? Yes L7 lwrrmm or rote&pam a recused if 9uWWy Total is ,9 f yes+M beck of form) 'SUBTOTAL ^ereby acknowledge that I havh,rear:this application that the"ZM- a n ,"n is correct•that I am the ow,er or authorized agent of the owner. and 5%SURCHARGE at clans submitted are in complpa on State Laws. _ mature o OwvneNAgent ^ Date PLAN REVIEW ZS% OF SUBTOTAL , rofy is,9 C t TOTAL 'ntaet Ptrson Name Vphone r �� 'Minimum / � `� �7 pe*rnit fees523- S%sucharge.esaept Resdentfal�drfbw // /3(, Prevention Device,which is$15•3%umchsrye 1:1p1dnapp.doc 12/96 (dst) 'I FASE COMPLETE 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" 3" 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) •OMMENTS REGARDING ABOVE: AUG t 1 1991 COMMUNITY DEVELUNMENIL: phnapT,.loc IJ% (dst)