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8939 SW Pinebrook Strut
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503) 639-4171
BUP - - -
Received --..___ ---Date Requested f!/'y AM . -- -__ PM BUP
Location -�J �'_ �2 � -�- _Suite _ M E _
Contact Person _.__ - __ _-_ Ph( ) ��O �/-/S f___ PLM =�
Contractor -_ Ph (_ -) _ SWR __--
BUILDING, Tenant/Owner _-___ _ ELC
-Footing - ELC -
Foundation Ar-cess:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post&Beam ---
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing
Firewall
Fire'Sprinkler - - - - -
Fire Alarm
Susp'd Ceiling _ - - - - . _ ____--•-----•-------
Roof
Other:
Finan ----- ----- -- ---
P P�R'T FAIL
MBI - _ — -- ------ -
m
Under Slab - - _--
Rough-In
Water Service - --
Sanitary Sewer
Rain Drains — —
Catch Basin/Manhole
Storm Drain —
Shower Pan
Other: ---- _� ------ - -- --
� A3 PART FAIL
_ -__.T ----- -._-.._. ------ -
HA_NICAL --------.----------. _ - -
Post& Beam -
Rough-In - --
Gas Line
Smoke Dampers - - - -- -- ---
Final
PASS PART FAIL -- - --� ^—
ELECTRICAL
Service -
Rough-In _ --
UG/Slab
Low Voltac3 --
FirQ Alarm
Final Reinspection fee of$_-_ —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - Please call for reinspection RE: _ ___-_ -_— Unable to Inspect-no access
Fire Supply Line 1
p7
Approach/Sidewalk roach/Sidewalk Date L Insillocto�r , -----_--._..._-_.--Ext-_
I
Other:
Final DO NOT REMOVE this Insrection record from the job site.
PASS PARL FAIL
CITY O F T I G A R D _—____PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002-00283
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6.s9-4171 DATE ISSUED: 7/17/02
SITE ADDRESS: 08935 SW PINEBROOK ST PARCEL: 2S111AD-04100
SUBDI11SION: PINEBROOK TERRACE ZONING: R-4.5
BLOCK: LOT: 038 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS MOBILE HOME SPACt-S:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: !
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: _ URINALS. GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB'SHOWF_RS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISH."ASH ERS: RAIN DRAIN: ft
Remarks: Install residential backflow preventer.
FEES
Owner: -- — ---- — --..._..------- ----—
Type By Date Amount Receipt
PASTERIS, PHILLIP A AND pRMT CTR 7117/01 $36.25 27200200000
ROSEMARY T
8935 SW PINEBROOK ST 5PCT CTR 7117/02 $2.90 27200200000
-__- _
TIGARD, OR 97224 Total $39.15
Phone 1:
Contractor:
JAMES R. DENNY
PO BOX 160
SHFRWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 590-1945 RP/Backflow Preventer
Reg#: LIC 11804 PLUS BACKFLOW Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of 0R.
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 requi es you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: i;,Z L (, Q ic_t _c -(_,_1, Permittee Signature;__
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Plui Bing Perinit Application
—`-- l)atereceived:Y /� � Permit no.��/hl� 70•� -'
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97 T_ Pro ecUa I'no.: Expire date:
City njTigard phone: (503) 639-4171 ) PPp --
Fax: (503) 598-1960 Date issued: By:L16 Receiptao.:
Land use approval: _ Case file no.: Payment type.
ifyPF.Olk PERM IT
U I &2 family dwelling or accessory U(•ulnincicial/industrial U Multi-family J Tenant improvement
U New construction U A(I(Iition/alteration/replacement U Food service J()(her..1011 SO E'INF611M _
ATION FEE IiieREDULE
Job address: < < BP'S SLU .vt'V Description tats. Fee(ea.) "Total
New 1-and 2-family dNellings only:
Bldg.no.; Suite no.:
(includon too ff.foreach utilil.s connection)
Tux map/tax lot/account no.: SubdivisSFR(1)bath
Lot: iSFR(2)bath
Block: �_on: —
Project name: �—� — SFR(3)bath
City/county: / 1Z U — Zlp�—L7 7 7 Each additional balli/kitchen
Description and loci tion of work on premises: Slteutllitles:
Catch basin/area drain
1st.date of onrptetion/inSpci'Ion: Drywells/leach line/trench drain
t Footing drain(no. lin. ft.)
PLUMIYNG Manufactured home utilities
BUSIt CSS mune: 76
>('A /!V�� Manholes
Address: C?• .�, �U.�- --- Rain drain connector
—city: i h/Z State:ci 7.1 P: 1 Sanitary sewer(no.lin.ft.)
Phone: qp 19 4 _ 'rax: E-mail: Storni sewer(no.lin.ft.)
CCB no.: 5-IgPlumb.hos.reg.no: Water service(no.lin.Il.) •_
City/metro Iia no: I `t O( Fixture or Item:
Absorption valve
Contractor':reiiresentative,signature: E Bac- (low preventer _ s l'7•
Print r:amc ) A!'1C 5 — N U Date: OoL Backwater valve _
Basins/la:utory
Name: �lYt S �Qn j7 Clothes washer _
Dishwasher
Address: P0. Drinking fountain(s) —
Cit 'T A,� State ZIP: �' �T
y: —� Ejectors/sump _
phone: i l 945 Fax: F: mail Expansion tank
VAN 'ixture/sewer cup _
Floor drains/noor sinks/hub
Name(print): t (- �.- _ Garbage disposal _ --`
Mailing address: �y 3� :J V� iN� ��` Hose hibb —_--- _
City: '-Fl,q Ni(C — Stirtc;0 _ ZIP: 97. Ice maker
Phone: j( . q — Fax: I E-mail: interceptor/grease trap
Owner installation/residential maintenance only; The actual installation Primer(s)
will he made by me or the maintenance and repair made by my regular -Roof (commercial)
employee on the property I own as per ORS Chapter 447. Sin (s),basin(s),lays(s)
Owner's si nature: Date: Sump
'rubs/shower/shower pan
Urinal _--
Name: — --- _ —_ Water closet
Address_: _ Water heater
State: Zlp: -- Other:
Phone Fux: Email: Total
Minimum fee................
Not all jurisdictions accept credit cnnts•please call jurisdiction for more information. Notice:'Mi $ Z_
s permit application plan review(at _— 91.) $
U Viso U MasterCard expires if a permit is not obtained r/ T—
Credit cord number, —_ — L within 180 days after it has been TOTAL State surcharge ... ....$ _
Name of c:vdholder u shown one it card — 1 accepted as complete.
Cardholder slp!alure Amount 440461616A)•OM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individual) QTY ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and',!ie first100 ft. QTY (ea) AMOUNT
1660 for each utility connection)
Lavato
ry . One 1 bath - - $249.20
Tub or TubrShower Comb 16.60 Two 2 bath i _ $350.00
Shower Only 16.60 I Three 3 bath $399.00
Water Closet 1660 SUBTOTAL
Urinal 16.60 _8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 TOTAL _
Laundry Tray 16.60
Washing Machine 1660
Floor Drain/Floor Sink 2" 16.60 --- PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater O conversion ce kind 1660 Quantityb Work Performed
Gas piping recuhes a separate mechanical Fixture Type: New Moved Replaced Removed/
ermit Capped
MFG Home New\Eater Service 46.40 Sirk
MFG Home New San/Storm Sewer 46.40 TubLavtory
or
_--
Tub or T ub/Shower
Hose Bibs 1660 Combination_
Roof Drains 16.60 y Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 16.60 Urinal _
Dishwasher —_
Garbage Disposal
Laundry Room Tray
Washing Machine
_ Floor Drain/Sink: 2"
Sewer-1 st 100' 55.00 3"
Sewer-each additional 100' 46.40 4"
Water Service•1st 100' 55.00 Water Healer
Water Service-each additional 200' 46.40 Other Fixtures
_ S ecif
Storm S Rain Drain-1st 100' 55.00
Storm&Rain Drain-each additional 100' 4640
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55 —
Catch Basin i 16.60
Inspection of Em;tng Plumbing or Specially 62.50
Re uested Ins ectlons perthr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 _-- --- --
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram Is required if
-
`SUBTOTAL ---"
8%STATE SURCHARGE --- -----
""PLAN REVIEW 25%OF SUBTOTAL
Required^ '/It fixture qty.total Is>g
TOTAL a
"Minimum permit fee Is$72 50•8%stare surcharge,except ResldentIM Backflow
Prevention Device,which Is$38 25 4 8%state surcharge
""All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
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