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10785 SW DERRY DELL COURT r I F-' U N OD Un Cn d C7J 7d K d C�] r� r c x 1 i r 1 10785 SW DERRY DELL COURT CITY CSF TIGARD ELECTRICAL DEVELOPMENT SERVICES PERMPERMIT PERMIT #: ELC97-0251 13125 SW Hall Blvd., Tigard,OR 57223 (503)639.4171 DATE I SSLIED: 04/24/97 PARCEL: 2SIO3DA-01700 ';ITF ADDRESS. . . , 1O785 SW DERRY DELL C'T 9UBD I V I S I ON. . . . :DERRY DELL. PLAT 70N I NG:R-3. 5 rAt.nr-K. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1.7 JURISDICTION: TIG Pro j ect De scr i pt ion: one branch circuit for furnace ------------------------------------------------------------------------------------------- --RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS----- -----MISCELLANEOUS---- 1.000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' L 5O0SF. . . 11 0 201 - kOO amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 I._IMITED ENERGY. . . . . : 0 401 - 6O0 amp. . . . . . . : 0 SIGNAL-/PANEL. . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 600+amps-1.000 volts. : 0 MINOR LABEL ( 1O) . . . : 0 -----SERVICE/FEEDER---- ----BRANCH CIRCUITS---_--- ---ADD' L_ INSPECTIONS-- 0 - x.'00 amp. . . . . . : 0 U/SERVICE OR Ff+EDER: 0 PER INSPECTION. . . . . : 0 201. - 4O0 amp. . . . . . : 0 ist W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0 601 -- 1000 amp. . . . . . 0 ------------------PLPN REVIEW SECTIO14-----_---___._-___ 1000+ amp/volt. . . . . : 0 )-4 RES UNITS. . . . . . . . : ) 6O0 VOLT NOMINAL... . : Reconnect only. . . . . : 0 SVC/FDR ) _ 225 AMPS. . : CLASS AREA/SPEC OCC. : --------------------------------- ---------------- _.caner: _ _______..._______--- FEES TIPTON type amount by date recpt 1.0795 SW DERRY DELI.. CT PRMT 4 35. 00 JMN 04/24/97 97-293729 TIGARD OR 972:23 SPCT $ 1. 75 JMH 04/24/97 97-293729 Phone #: Contractor: -----------------_... .._.__--.-_--_.----_--_----.-._•_.-----_..---------------- PORTi_.AND METRO AIRE $ 36. 75 TOTAL 10010 SW BEAVERTON-HILLSDALE HWY REOU I RED I NSPECT T LINS+ _._.._ BEAVERTON OR 97005 Ceilinq Cover Elect' l Final. Phone #: Wall Cover Reg #. . : 000612 Th,,', nerait is issued subject to the regulations contained it the ! I o f�rC Tigard Municipal Code, State of Ore. Specialty Codes and all other PE'rm itt a Si.gnat .ire applicable laws. All work will be done in accordance with approved plans. This pervit aill expire if work is not started within 19N dais of issuance, or if work is suspended for sore than 19@ days. 2. 0NLY ed By ----------OWNER INSTAI L.r r --------------------------___ _ The `. nstallation is being made nn prorer'.-v T own which is not intended for sale, lease, or rent . OWNER' S SIGNnTUFE: DATE: INS'T' !' ',"'TION ONLY—_---_____________________- IGNATURE OF SUPR. ELEC' N ) Tr7ENSE NO: Call for inspection - 639-4175 CITY OF TIGARD Electrical Permit Application Plan Check N- 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Rec'd_ Date to P.E. Phone(503)639-4171,x304 Print or Type Date to DST Inspection (503) 639-4175 Permit# .5 Fax(503) 684-7297 Incamplete or illegible will not be accepted Called_ �►-t 1. Job Address: 4. Complete Fee Schedule Below: Name of Development_________,_ ,__ ____T._ Number of Inspections per permit allowed - Name(or name of business)-j-1 J)to yt Service included: Items Cost Surn Address_ '1 l CA - 4a. Residential per unit CI /State/Zi To ,vr, � � 1000 sq.ft.or less $110.00 4 ry P _ _ _ _ Each additional 500 sq.it.or portion thereof _ _ $25.00 _ 1 Commercial ❑ Residential® Limited Energy $25.00 Each Manut'd Home or Modular Dwelling Service or Feeder $66.00 2 2a. Contractor installation only: (Attach copy of all current licenses) 4b.Services or Feeders Electrical Contractor Prri I , M-AP c, 1 Y,� Installation,alteration,or relocation ry 200 amps or less $60.00 2 Addr s-j�'I / '101 amps to 400 amps _ $80.00 2 CityIr,-h -State Zip_ /IO 101 amps to 600 amps $120.00 2 Phone No._ 2 �� - '1(�iZ _ _ 601 amps to 1000 amps _ $180.00 2 Job No. Over 1000 amps or volts $340.00 2 Elec.Cont. Lice. No.-- `1-3 6Exp.Date 10 �?- Reconnect only _ .. $50.00 _ 2 OR State CCB Reg. No, 1,6121 7 Exp.Date_ /u-t 7 _ 4c.Temporary Services or Feeders COT Business Tax or Metro No. i OqE _Exp.Date3-III installation,alteration,o,relocation 200 amps or less $50.00 .1 :,ignature of Supr. Elec'n,2" 201 amps to 400 amps $75.00 _ ------ 401 amps to 600 amps $100.00 _ 2 r Over 600 amps to 1000 volts, License Nr _ I _ Exp.Date see"b"above. Phone N1+ h i.L __-.. - 4d.Branch Circuits New,alteration or extension per panel 2b. For owner installations: a)The fee for branch circuits with purchase of service or Print nwnbft Namo_ _ fordo'rnv - Each branch circuit $5.00 _ 2 Address h)The fee for branch circuits City State _ Zip _ without purchase of Phone No. _ service or feeder lee. rte: First branch circuit $35.00 y�.) 2 The Installation is being made on property I own which is not Each additional branch circuit_ $5.0c 2 intended for sale,lease or rent. 4e.Miscellaneous (Service or feeder not included) Owner's Signature Each pump or irrigation circle $40.00 _ Each sign or outline lighting $40.00 3. Plan Review section (if required): Signal circult(s)or a limited energy panel,alteration or extension _ $40.00 _ Please check appropriate item and enter fee in section 58. Minor Labels(10) $100.00 _4 or more residential units In one structure 4f.Each additional Inspection over Service and feeder 225 amps or more the allowable In any of the above System over 600 volts nominal Per inspection $35.00 _ Classified area or structure containing special occupancy Per hour $55.00 as described in N E C.Chapter 5 In Plant $55.00 Submit 2 sets of plans with application where any of the above apply. 5. Fees: Not required for temporary construction services. So.Enter total of above fees $ - 5%Surcharge(.05 x total fees) $ -1.1 1- NO ICE subtotal $ - --- 5b.Enter 25%of line 5e for PERMITS 9ECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if ree_VirQgI(Sec 3) $ NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ 1 rust Amount#_ _ $ Total balance nue I DSTS,ELCN APP Rry 9/06 1 CITY O F TI G A D MECHANICAL. DEVELOPMENT SERVICES PERMIT 13125 SW Hall Blvd., Tlr,,-ard, OR 97223 (503)639-4171 I",ERMIT #. . . . . . . : MEC97-01,..Vi DATE ISSUED: 05/07/97 PARCEL: 2SI03DA-01700 SITE ADDRESS. . . : 10785 SW DERRY DELL CT SUBDIVISION. . . . : DERRY DELL PLAT 2. ZONING: R-3. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1.7 TURISDICTION: TIG CLASS OF WORK. . :ALT FLOOR FURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. — :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0 OCCUPANCY GRP. . :R3 VENTS W/O APPI—c 0 VENT SYSTEMS: 0 STORIFq. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . .. 0 FUEL 0-3 HP. . . . : 0 DOMES. INCIN: 0 :BPS 3-15 HP. . . . : 0 COMML. INCIN: 0 MAX INPUT: 0 BTIJ 15-30 HP. . . . : 0 REPAIR UNITS: 0 FIRE DAMPERS?. . : 30-50 HP. . . . - 0 WOnDSTOI-ES. . : 0 GAS PRESSURE. . . : 50+ HP. . . . : 0 CLO DRYERS. . : 0 NO. OF IJNTTc3------------ AIR HANDLING UNITS OTHER UNITS. : 0 FURN ( 100K BTU: 1 10000 cfm : 0 GAS OUTLETS. - 1. FURN )=100K BTUs 0 > 10000 cfm: 0 Remarks : nwnimr: FEES TIPTON type ammmt by date reept 10785 SW DERRY DELL. CT PRMT $ 25. 00 JD 05/07/97 97-294241 TIGARD OR 97223 5PCT $ 1. 25 JD 05/07/97 97-294241 Phone #: PRODF HEATING AND A/C 41.80 SW 192ND AVENUE ALOHAOR 97007 _.____.—_------.__.—___—__--.-----_--..____.._ Phone #: 972-8571 $ 26. 25 TOTAL Reg #. . : 007611 REOUIRED INSPECTIONS This pervit is issued subject to the regulations contained in Ue Meehan ic-al I n s p Tigard Municipal Cede, State of Ore. Soprialtv Codes and all other Final Inspection applicable laws, All work will be done in accordance with aDnrovpd clans. This p@reit will expire if work is not started ------- within IN days of issuance, or if work is suspended for sort than lot days. Permittee Si gnat 1AV1,40-1 Issued Call for inspection 639-4175 Plan Check 0 CITY OF TIGARD Mechanical Permit Application RecdBy -- - 13125 SW HALL BLVD. Commercial and Residential Date Recd 0S67-97�?- TIGARD, OR 97223 Date to P E (503) 639-4171, x304 Date to DST_ Print or Type Permit C 1197 0476 Incomplete or illegible applications will noCalled-- Name of OeveiopmenVProler;t Description — _ Table 1A Mechanical Code QTY PRICE AMT Job C�Adprer Swre6 A) Permit Fee •0- -0- 10 UO Address Bldg6 C iyrstate ip_ 1 ) Furnace to 100.000 BTU 600 i including duds$vents __ l Nems(orname of businessi 2) Furnace 100.000 BTU+ /50 Owner including duds d vents Mailing Address 3) Floor Furnace� 600 (::II - —0 Y C ( _ including vent _ cnyisute Zip Pruny Jy 41 Suspend?d heater,wall Neater 600 floor mounted neater Name(or name of twsnesal 5) Vent not inr.tuded in appliance permit 300 _ Occupant Mailing Address 3.) Boiler or comp,heat pump,air Gond 600 _ to 3 HP:absorb unit to 100K BUT" city'state Zip 7) Boder or comp,heat pump,air cond 11 00 3-15 HP.absorb unit to 500K BTU" Contractor NoTe ^ 8) Boiler or comp,heat pump,air cond 15 00 (Pnor to (�-�1,:U� �, 15-30 HP,absorb unit 5.1 mil BTU" issuance Ma. Address t, '\ 9) Boiler or comp,heat pump,air Gond 22.50 applicant -l t�� `'v�,l� `�t3 f �t� 30-50 HP,absorb unit 1-1 75mil BTU" must provide all c 151106 Zip Phone 10.) Boder or comp heat pump,air cond. 37.50 ctor A contraI L�LXCti L k,CIA?CV I�1 (,�- .��� >50 HP:absorb unit 1 75 and BTtI- license Oregon Const Cont Board Lic a Exp Orae 11 ) Air handling unit to 10,000 CFM 4 50 information " ( I� I for COT COT Business Tax or Metro Exp Doe 12.) Air handling unit 10.000 CFM -- — database) T (1 r Architect Nome < t 3► Non-portable evaporate cooler 454 Nome or Mating Address 14) Vent fan connected to a si t dud 300 Engineer City stat° ziP Pnone 15) Ventilation system not included in 4.50 _ appliance permit r)escnbe work New O Addition-6 Alteration Repair O 16) Hood served by mechanical exhaust — 450 to be done _Residential O Non-residential J Additional DescnpUon of work 17) Dumestic inc. .;rators 7 1 0 18) Commercial or mdustnal tyPr' 30 OC Incinerator Existing use of 19) Repair units 4 50 bwiding cr property---- --- �,- T 20) Woad stove 450 Proposed use of 21 ) Clothes dryer,etc. 450 building or property _-- -----` 22) inner units - 450 Type of fuel-oil O natural gal`r LPG O electric O 23 1 Gas piping one to four outlets I hereby ar�criowk-dge that I have//read this application,that the 24) More than 4-per outlets(each) 50 information given is correct,that I am the owner or authorized agent of the owner,that plans submitted are in compliance with Oregon State CITY SUBTOTAL laws Signature of Owner/Agent Date !� 'SUBTOTAL c� 5%SURCHARGE I V Co ct erson Name \ Phone C� ( 1 - PLAN REVIEW 25%OF SUBTOTAL — TOTAL rr Wstlmechpmt doc (rev 9 -- 'Minimum permit fee is S25+5%surcharge "Residential AiC requires site plan showing ptacernent of ur.1 CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Phone: 6394171 Date Re<auested: v ( j A.M. ( P.M. MST: Location:/��? �-� � ^ ,L i ., (�. $UP: Tenant: Suite:— Bldg: MEC Contractor:--- Phone: // -"C -- ScZ�� ��r'� PLM: Phone: ELC: �• — -- - ELR: SIT: BLMPING BLDG(con'[) PLUMBING MECHANICAL X6RCi'� SITE Site Post/Beam Post/Besm Post/Berun C'o` �ver erv►ce Sewer/Storni Footing Roof UndFI/Slab Rough-In Ceiling Water Line Slab warning Top Out Gas Line Rough-In UG Sprinkler Foundation Insulation Sewer I-lood/Duct Reconnect Vault Bsmt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Thain A/C UG Slab Shear/Sheath Fire Spklr/Alm Crawl/Found D- Ileat Pump Low Ved Approved Approved Approved . oproved Approved Appr/Sdwlk Not Approved Not Approved Not Approved No .rw?ed Not Approved FINAL FINAL FINAL All FINAL 01 Gr J1mac+' 1 i d Call for reinspection C1 Reins / pcctipn fee of S _required before Wert inspection CI Unable to inspect ` 1f - _ ��f Inspector: i_�f ��' Irate: �� c�` -� Page of — CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 6394175 Business Phone: 6394171 Date Requested: �7 /"a r� 19 ~/ M. ke I'.M. MST: Laation: S BUP: ^— i,entutt: Suite: Bldg: MEC: -7 `0 -sem y Contractor: Phone: , PLM: Owner:—�� • 7 _ ELC: �4'1K 'q7'� iVA -- R: _ _ srr: BUILDING BLDG(con't) PLUMBING ECNANI ELEC�ICAL SITE Site Post/Beam I'ost/13cam Cover/Service Sewer/Storm Footing Roof UndFI/Slab Ceiling Water Line Slab Framing Top Out s line Rough-In UO Sprinkler Foundation Insulation Sewer 11< tic Reconnect Vault Bamt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Thain A/C 1JG Slab Shear/Sheath Fire Spklr/Alm Crawl/Found Ih Ifeat Pump Low Volt Approved ApprovM Approved Approved App,oved Appr/Sdwlk Not Approved Not Approwd ed Not Approved Not.Approved FINAL FINAL INAL , FINAL FINAL O Call for r ' r O Rcinglm;tion fee.of S required before next inspection O Unable to inspect Page Date.�I��/`—� -----of CITU OF TIGARD BUILDING INSPECTION DIVISION 2441our Inspection Linc: 6394175 Business Phone: 639-4171 Date Requested: r .J "C A.M. �_ P.M. MST: Location: � Br rp. Tenant: Suite: BHg: ntractor: NEC,:Iv Phone- �tt�x� (i(,I � _��i(�s PLM: Owner: �� � � Phone; ��– -�-'�- ELC: BUILDING BLDG(coni) PLUMBING MECHANICAL ELECTRICAL STf. SITE Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storm Footing Roof UndFI/Slab Rough-In Ceiling Water Line Slab Framing Top Out Gas Line Rou -►� Foundation Insulation Sewer Hood/Duct Vault Sprinkler Reconnect Vault Bsmt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shear/Sheath Fire Spklr/Alm Crawl/Found lr Hwt Pump Low Volt Approved Approve Approved Approved Approved Appr/Sdwlk Not Approved -proved Not Approved Not Approved pp Not Approved FINAL FINAL F1N�. • FINAL FINAL 0 Call for Rein tion oC required before next inspection� O l Inable to inspect Inspector: �_— Date: >— Page._ of CITY OF TIGARD PLUMBING PERMIT F2MIT DEVELOPMENT SERVICES PERMIT #. . . . . . . : PLM9"/-02151 15125 SW hall Blvd. Tiqard, OR 9722.3 (503)639.4171 DATE ISSUED: 07/01/97 PARCEL: 2SI03DA-01.700 !:;ITE: ADDRE S. . . : 1078`1 aW DE_RRY DELL CT' SUBDIVI'SION. . . . : DERRY DELL PLAT 2 7.ONING: R-3. 5 BLOCI'. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1 JURISDICTION: TIG CL.ASS OF- WORT!.. . :ALT GARBAGE D I CFPOSALS. : 0 MOBILE HOME YSPACES. :_0__ TYPO: OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW P EVNTRS. . : 0 OCCUPANCY GRP. . R;3 FI_..00R DRAINS. . . . . . . 0 TRAP'S. . . . 0 STORIES. . . . . . . . . 0 WATER HEATERS. . . . . . J. CATCH BAS I '5. . . . . . . . 0 FIXTUREF3---.._......_.___-___....___._. LAL.INCRY TRAYS. . . . . : 0 SF RAIN D AINS. . . . . : 0 S I NKS. . . . . . . . . : 0 URINALS. . . . . . . . .. . . : 0 GREASE TRIPS. . . . . . . : 0 LAVATORIES. . . . : o OTHER FIXTURES. . . . : 0 1 TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0 I WATER CLOSETS. : 0 WATER LINE (tit ) . . . : 0 DISHWASHERS. . . . : iA RAIN DRAIN (ft ) . . . : 0 Remarks : Installing a water heater Owner,: - - —__.___.___.___-----___ ------_._._.___._.___._____ FEES PtICHELLE 'TIPTON type amorAnt by date — r•ecpt 10785 SW DERRY DELL_ C1 PRMT $ 25. 00 B 07/01/97 97--296645 TIGARD OR 97223 OPC'T $ 1. 25 B 07/01/97 97-29664 Phone #: Contr'•ac t o r.----___________.____._---___—___...---_-- GEORGE. mnRL_AN PLUMBING & APL I ANCES 12.9185 SW PAC I F'I C HWY CCB (EXP 6/2002) TIGARD OR 97223 Phone #: 624-6895 $ 26. 25 TOTAL Req #. . 000027 - ---- — REQUIRED INSPECTIONS This permit is issued subject io the regulations contained in the Misc. Inspection Tigard Municipal Code, State of pre. Specialty Codes and all other V i na 1 Inspectionapplicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 188 days of issuance, or if work is suspended for more than 188 days. ATTENTION: Oregon law requires you to follow rules _ adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-8001-8810 through OAR W-0081-ON90. You may obtain ropies of these rules or direct questions to OX by calling (503)246-1967. _ _ _-- ----`-- Permittee Si gnat e r-e: F 1-++++++++-P•++++++++++++-1++++++++++++++++++++4•+++4-++++++++4•++++++++++++++++++++ Call 639-4175 by 6:00 p. m. for an inspection needed the next br_rsiness day ++++"1+++++++++++++++++++4.+++++++++++++++++.t+++++++f++++++++++++ 1-+-++++++++.+++++ ITY OF TIGARD Plumbing Application Recd ft_ 0J, 1125 5W HALL BLVD. Commercial and Residential Dau Rec"i - 1 IGARL, OR 97223 Datum P E. 503) 639-4171 ( Date to DST 1 3 K Permit 0 PLI°��1-n Print or Type Related SM s Incomplete or illegible applications will not be accepted called .FIXTURE ��dw� _ Nam of DevelorrtlenVPropct <n ,�:'At[�a13� t07 .� Job 'tt 9.00 Address Street Address Surle Lavatory 9.00 Y J ( � ('Il Ct• Tub Or Tub/Shower Comb. 900 Bldgs City;S:ats Zip ShowerOnfy 9.00 OX cl 712 water closet 9.00 Name Owner Me"Address Surto Surto Gari� aal oo � � 9.00 6;�S f or S� 4V1 L/ • waw*v macMne 9.00 clty/StateZIP Phone— 900 — -EnvY� �ZL tO Z flea Crsz: 3' 9.00 Name • fVw •' 9.00 Occupant Mailing Address Suite water'+eater 4.00 — t atndry Room Tray 9.00 Gay/State Zip Phone Urinal 9.00 Other Fixrires(S"C fy) 900 Name ( - 4. �D✓I�U►1 --- 9.00 ,:ontractor ma&q Address Suds 9.00 (Prto is usnc s CrtyfMate ?i Phone ` — 9.00 ior applicant must j,t Gv /� 7127 �ol'I' �ty� —. 9.00 provide all Oregon Const.Cont.Board lice Exp.Date — 9.00 contractors G, uj 9.00 license Pkrmbirrg Lic to 7 �� Exp.oats sewn =1st 10(- — 30.00 information �0 Sewer-each additional 100 hx COT CO T Biness Tax or Metro 0 Exp.Date 25.00 n database). water Servwe-1st 100' 30.00 Name Water Servoce-each additional 200'-—r� 25.00 Architect Storm 6 Ran Drain-1st lar —1036 or Ma0m.-I Address Surto Storm d Rain Oran-each addltlonal tar 25.00 _-- 'Mobae Homs Spaee_ 25.00 Engineer Gty/State Zip _ Phone i;onrherual Back Flow Prevention Device or Anti- 25.01 "o6ition Device_ "srnbe work Now O Addrbon O Alteration O Repair O Residertial Backflow Prevention Device' — _ 15-01 o'doneResidential O Non resrdentlal O Any Trap or Y:_.:;a Not Connected to a Fixture 9.00 ditional descatpbon of wtxk --yy-- /_ 1 Cates Basin ..1.-N �,hi/ (Ju: l� NIP — - 9.00 1r M C1& — Insp.of Existing Plumbing 40.00 ;+ec/hr ;sang ne of — Specially Ree.••sced Inspecoons - 40,00 ,,JCrrg or prop" _ perthr Rain Drain,single farMy dwe" 3000 - oDosed use of Grease Traps ring x p y ��trtSe _ — ----QUANTITY TOTAL ;tib 1t!n app ^cmq or ea+sanqI! any rhms"? r'.s® No[J — erneurc a neer dlaQram n r•ture0 a Qwnrty Total a >9 i .,», i:.► '"a"� V k-,"I _ 'SUBTOTAL ir'"• sa•r�� •a 14,0V oso T" spob:anon Tut 7M nformatxx+ ----- L 7 ^Y •: r-vs. T. er- rrt :4rrr Ar ar rtrrtted argent of 7+e 7wrw and 5% SURCHARr=F, a ;para a rim~ re r �rcilrarr t wow'err'>rate swt __ �}n:inii•s v rwnwra,pwr.r --- pay PLAN REVIEW 25%OF SUBTOTp. //� //// G Weovryl aw 1 fhrnrw- or cotai a 9 TOTAL 5 wtsrr >rnvu horror _ � ' /j �// 1Mnimvm permit fM s S25• SX scnctarge.except Re_iden"'Bac*Aow P•ewm»n Uewwa which ke f15 • 5%surcharge �� Llpimapp.doc 11,96 (dst) ';.F. aE COMPLETE AS APPROPRIATE TO PROJECT: FF-iitiures to be capped, moved or replaced Qty Sink Lavatory Tub or Tub/Sh.)wer Combination Shower Only Water Closet Dishwasher I Garbage Disposal Washing Machine Floor Drain 2" 3" 4" Water Heater Cilin;3iiRoorn Tray Urinal Other Fixtures (Specify) .'OMMENTS REGARDING ABOVE: Lptmapp.doc 11-96 (dst) CITY OF TIGARD PUILDING INSPECTION DIVISION 24-Hour Inspection Linc. 6394175 Business Phone: 6394171 l� q , Date Requested: a` 1_I I � A.M. P.M._— MST: Location: b —7 BlJP: —— Tenant: U _ _ Suite: Bldg: MEC: q :7 �—, Z-G Contractor: — Phone: — PLM: Owner: _ Phone. _ _ ELC: ��_ - c,�rx -- .tomSIT: BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE Site Post/13eam Post/Bew, Post[Beam Cover/Service Sewer/Storm Footing Roof U11dFI/Slab Rough-hi Ceiling Water Line Slab Framing Top Out Gas Line Rough-In UG Sprinkler Fouutdation Insulation Sewer Ilood/ uct t� Reconnect Vault Bsmt Damp Drywall Storm Furnace V(,1, t Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shear/Sheath Fire Spklr/Alco Crawl/Found Dr Beat PUML Low Volt Approved Approved '/- C._A-pmvCd Approvc:i Approved -- Appr/Sdwlk Not Approved Not Approved *-Mppr qtr i Not Approved Not Approval FINAF, FINAL FINAL FINAL FINAL C]Call for reinspection O Reinspection fee of S- r uired before next inspection C7 l finable to inspect '7 6 Inspector _ < <.( -- Date: Z, Page_ of —__--