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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
3 , Cao BUP
_Date Requested C�� AM PM BLD
Location Ll < ,� ��- Suite EC got -,roC)5 r
Contact Person — Ph J ) LM 2O-D ) ` c�OC��
Contractor_ _ Ph — W zom
BUILDING Tenant/OwnerELC _
Petaining Wal — ELR
Footing Access:
Foundation FPS
Ftg Drain ---_- SGN
Crawl Drain Inspection Notes: �--�—
Slab
Post&Beam �—
Ext Sheath/Shear
Int Sheath/ShearI
Framing
Insulation !QO_ta'JO +
1
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
SuSp'd Ceiling ------- --.--_--
Roof — ------ � -
Misc -- ----
(-irral
PASS PART FAIL -------- ------ --- - ---- - -
,PLU1f31NG-->
Post Beam
Under Slab
Top Out _..- -- ---- -- ---- - --- -
Water Service
f�tn-Orgifis
PART FAIL
Post& Beam --- --- ------- -.__
Rough In
Gas Line
Smoke Dampers r
PART FAIL
i
ELECTRICAL ---- — - -
Service
V) Rough In
UG/Slab - _ — --- --
�- Low Voltage
-' Fire Alarm
Final
PASS PARI FAIL
SITE
Backfill/Grading ---' -- - ----- '—
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ )Please call for reinspection RF - _ [ J linable to inspect-no arcesi
Fire Supply Line
ADA
Approach/Sidewalk
Other Date ky)_ Inspectors _ Ext _
Final
PASS PART FAIL 00 NOT REMOVE this :hspectiorn record from the job cite.
CITY OF I IGARD PLJMBING PERMIT
~,... DEVELOPMENT SERVICES =KNIT#: PLM200000090
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 Di .3SUED: 3/20/091
SITE ADDRESS: 14875 SW 103RD AVE PARCEL: 2S111CB-00300
SUBDIVISION: LEL MONTE SUBDIVISION ZONING: R-3.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
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/SHOWERS: SEWER LINE: 68 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Line work for new sewer line from 5'from house to newly installed sewer lateral. Line work is approximately
68'.
FEES
Owner: -
-- - Type By Date Amount Receipt
TODD M. ZINDA PRMT DEB 3/20/00 $50.00 0000799
14875 SW 103RD 5PCT DEB 3/20/00 $4.00 0000799
TIGARD, OR 97223 —
Total $54.00
Phone 1: 598-8964
Contractor:
PHIL PAULSON EXCAVATION
1939 SE BROOKWOOU AVE
HILLSBORO, OR 97123 REQUIRED INSPECTION
Phone 1: 693-661C Sewer Inspection
Reg#: LIC 1413e3 Final inspection
un
C? This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
4 Specialty Codes and all other applicable laws. All work will be done in accordance wit 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 follow ,ules adoptee; 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 OI,NC by calling (503) 2.46-1 &7: -
I
t�
Issued By: aio-" Permittee S,gnature: _
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next busines�d4
Plan C�k
,ITY OF TIGARD Plumbing Permit Application
3125 SVh'HALL BLVD. Commercial and Residential Rec'd by
Date Rec'd J
TIGARD, OR 97223
Date to P.E. _
503) 639-4171 Date to D T
Print or Type Permlta/ '
Incomplete or illegible applications will not be accepted Related SWR#__
Called _
Name of Development/Project ----1 FIXTURES (individual) QTY PRIDE AMT
^ I Sink 11.50
Job i 1 l��C( r11, i f,1L --- 11.50
Address Street Address �r Suite Lavatory
5 Svl) it Tub or Tub/Shower Comb.
Bldg# �, -
Zip Shower Only11.50
'7L� 11.50
Water ClosetName`,'. 11.50
O` Lt Urinal
Mailing Address Suite Dishwasher 1 1.50
Owner 11.50
!i Q Gtn.Z Garbage Disposal _
CitylStale Zip Phone laundry Tray 11.50
Washing Machine/Laundry Tray 11.50
Name11.50
Floor Drain/Floor Sink 2"
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City/State Zip Phone11.50
Water Heater O conversion O like kind
Gas^I in re uires a separate mechanical permit
Name I_ Y MFG`come New Water Service 32.00
►I; ���(� 1� C (l1�GL 32.00
Palling Addr s Suite Hose Bibs
New San/Storm Sewer
Contractor g 11.50
5C ��
Prior to permit It / late Zip Phone Roof Drains 11.50
Issuance,a copy t ��T`yo 1 11. ^�" (UtU I Drink ng Fountain 11.50
of all licenses are Oregon Const.Cont Board. ..# Exp/Da ^ Other Fixtures(Specify) 15.00-
required If 1,41 -
expired In COT Plumbing Lic.# Exp.Date
database
Name
Architect n oo e-,, 'ewer-1st 100' - 38.00
Or Ma'ling Address Suite Sewer-each additional 100' _ 32.00
_ Water Service-1 st 100' 38.00
Engineer ;ity1State Zip Phone Water Service-each additional 200' 32.00
Describe work to be done:
Storm 6 Rain Drain-1 st 100' 38.00
New)0 Repair O Replace with like kind: Yes O No O Storm&Rain Drain-each additional 100' 32.00
Residential _Comrnercial O Commercial Back Flow Prevention Device _ 32.00
Additional description of work: Residential Backflow Prevention Device' 1£.00
_ Catch Basin 11.50
Are you capping, moving or replacing any fixtures? - I--,p.of Existing Plumbing or Specially Requested 50.00
Yes O No,R' InspectionsLrI er/thr
If yes, see back of forTn to indicate work performed by Rain Drain,single family dw^lling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
.~� WORK COULD RESULT IN INCREASED SEWER FEES.
_ QUANTITY TOTAL
I heret y acknowledge that I have read tills application,that the Information
Isometric or riser diag,am is required M Quantity Total Is >9
given is correct,that I am the owner or authorized agent of the owner,and "SUBTOTAL
that plans submit ed are i com liance with Oregon State La-.vs.
1JSlgnaturAof GOy Dale 8% SURCHARGE
j Z� L
Contact o ame Phone ••PLAN REVIEW 25%OF SUBTOTAL
()4 L i �`
Re ulq red ordy M lizture city total Is>9
HOUSEt178.00 TOTAL
neludes lI n 'Minimum permit fee Is f5u 4 Bpi surcharge,except Residential Backflmw Prevenrbn
Device,which is$25+0%surcharge
"All New Commercial Buildings require plans M11h Isometric or riser diagram and
plan review
r klelsVomn shplunenp dcx 11118199
PLEASE COMPLETE:
Fixture Type _ Quantity by Work Performed _
New MovedReplaced RemovedlCapped
Sink
Lavatory -
Tub or Tub/Shower Combination _
Shouter Only _ _ ----
Water Closet -
Urinal _
Dishwasher _ _ --
Garbage-Disposal —
Laundry Room Tray — _-- ---
Washing Machine
Floor Drain/Floor Sink 2" —
Water Heater —
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
11dflfVrxmfrlumnfp Aor_.1111fN9
CITYC F T I GA R D PLUP.IBING PERMIT
DEVELOPMENT SERVICES E ISSUED:
#: P20/00 00091
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/20/00
SITE ADDRESS: 14875 SW 103RD AVE PARCEL- 2S111CB-00300
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R-3.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR GARF3AGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFL,D'A' PREVNTRS:
OCCUi ANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: Sr RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Reverse plumbing and connection of newly installed sewer line to house.
FEES _
Owner: — -
--- Type By Date Amount Receipt
TODD M. ZINDA PRMT DEB 3/20100 $50.00 0000799
14875 SW 103RD
TIGARD, OR 97223 5PCT DEB 3/20/00 $4.00 0000799
Total $54.00
Phone 1:
Contractor:
Al EAGLE PLUMBING
745 ALETHIA WAY
MCMINVILL E, OR 97128 REQUIRED INSPECTIONS
Phor,o 1: 435-0985 Sewer Inspection
Rag ": LIC 118145 Misc. Inspection
PLM 36-74P8 Final Inspection
(t
H
N
H
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all ether applicable laws. All work will be done in accordance with approved plans.
111
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 18C days. /:TTENTlW Oregon law requires 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) 246-1�87�
Issu By: �, Permittee Signature:
Call (503) 39-4175 by 7:00 P.M. for an inspection needed the .text business d
'TY OF-TiGARD Plumbing Permit Application Plan eek
>125 SW HALL BLVD. Commerci-^i and Residential REQ,iBy
Date Recd
GARD, OR 97223 Date to N.E.
303) 639-4171 Date to D _ --'
Print or Tyke AU-1
Permit# /
Incomplete or illegible applications will not be accepted Related SWR# +"eke 7`7
Called --
FIXTURES (individual) QTY PRICE AMT
Name of DeveiopmenUPrp}�d J 11.50
( I 1 , Sink
Job �1�l ;� ;!"� � c l�-� --- 11.50
Address Street Address i Suite Lavatory 11.50
—
�, 2C caw Tub or TublShower Comb.
BId;7"#?, City/Scale ZIP/ Shower Only _ 11.,50
Water Closet _ 11.50
Name �� I � v :. Urinal 11.50
11.50
A'alliny Address Suite Dishwasher _
► Owner 11.50
Garbage Disposal
6t Phone 11.50
City'Stale ZIP Laundry Tray
Lt �� Washing Machine/Laundry Tray 11.50
Narre Floor Draimmor Slnk 2- 11.50
11.50
;Mailing.Address Suite 3' —
Occupant 4, 11.50
Clt /State Zip Phone 11.50
y Water Heater U conversion O like kind
_ Gas piping retq sires a separate mechanical permit. — 32.00
—— Name I l n( el MFG Home New'.Jater Service
—( _ 0
Suite 11.MFG Home New San/Slor1_ 11.50
Sewer
Mailing Add ,/
Contractor ) �h?Cu Hose Bibs —
ZI Phone Roof Drains 11.50
Prior to permit Clty/State (1 L 6 7 11 50
issuance,a copy –AL61 11, J 4 J 1 v , Drinking Fountain
of all licenses are Oregon Const.Cont.Board Lic.# xp'Dale _(y,1,pr—Fixtures(Specify) 15.00
required If , q ti
expired In COT Plumbing Lice Exp.Date =
database r --
Name
Sewer- 38
1st 100' .00
Architect �/�0 --- 32.00
Mailing Address guile Sewer-each additional'00'
_
or 38.00
Water Service-1st 100'
Clly/State Zip Phone Water Service-each additional 200' 32.00
Engineer 38.00
Storm 8 Rain Drain-1 sl 100'
Describe work to be done: 32 00
New O Repair C Replace with like kind: Yes No O Storm&Rain Drain-each additlor,al 100' - 32 00
Residential " Commercial O _ ---- Commercial Back Flow Prevention Device
Additional description of work: 1 I {I Residential Backflow Prevention Device- 19.00
l { Z I I Yu�'� 1 5 e�•i!► ' I -`_j Catch Basin 11 50
4 s � 50.00 [�
Are you capping,m ving or replacing any fixtures? Insp of Ex- isin �iurtlbina or S dalllq Req�ues d 0.00 J�)
Yes G No Ins edions I IL i Y 45.00
le family dwelling
If yes,see back of form to Indicate work perform ,i by Rain Drain,sing11 50
fixture. FAILURE TO ACCURATELY REPORT r' ;E Grease Traps
WORK COULD RESULT IN INCREASED SEW_E _ QUANTITY TOTAL
-- ition Isometri or riser dlaqram is required K Quantity 1 otal Is
I hereby acknowledge that I have read Ihls application,th. •SUBTOTAL
given Is coned,that
Cr
I am the owner or authorized agent of It and <yl,
that plans submitted are In o {,liagce with Oregon State La __ •v
Signature O r/Ag n 1 Dar 8% SURCHARGE /.( l'
zi,�
Contact Personalne J Phone — "P6104REVW IE25%OF SUBTOTAL
(�L I✓r'� � Z Required only K rirture qtr total Is>g i Y'
H USE 1 $.00 TOTAL
�T 0_.SE 23� _------
Tf ° E t r
�* jj 'I Urn ng 1x t qe 'Minimum permit fee u z.,i, B1�surcharge,except Residential Rackflow Prevention
j� Device.which is$25+a%su"arge
t" Ver n��-a�er E01v ce) »ATI Now Commercial Buildings requir plans with isometric or riser diagram and
pian review
I kfcuV,vm�y,wrnary -N'Kt 1111x199
PLEASE COMPI ETE:
Fixture Type Quantity by Work Performed _
Y`
New Moved Replaced Removed/Capped
Sink --
Lavatory _ _ _—
Tub or Tub/Shower Combination
Shower Only
Water Closet
Uriral --
Dishwasher _ _—
Garbage-Disposal
Laundry Room Tray
Washing Machine —
Floor Drain/Floor Sink 2" _
--— 3„
4"
Water Heater
Other Fixtures (Spec
— I
COMMENTS REGARDING ABOVE:
Lr
11 -
W
11dMVampAms{+P dM 1118/99
CITY OF TIGARD SEWER CONNECTION PERMIT
PERMIT#: SWR2000-00049
DEVELOPMENT SERVICES DATE ISSUED: 3/20/00 4
13125 SW iiall Blvd.,Tigard, OR 97223 (503) L39-4171 PARCEL: 2S111CB-00300
SITE ADDF.ESS; 14875 SW 103RD AVE
ZLCVING: R-3.5
SUBDIVISION: DEL MONTE SUBDIVISION JURISDICTION: TIG _
BLOCK: LOT: 002
TENANT NAME: FIXTURE UNITS:
USA NO:
DWELLING UNITS: 1
CLASS OF WORK: NEW
NO.
TYPE OF USE: SF (7F BUILDINGS: q
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection of existing house to newly installed sewer lateral. Septic tank must be pumped, filled
and inspected for proper abandonment. Reimbursement fee of$8,000.:0 paid on 3120/00 by check
#2220.
Owner: - FEES
TODD M. ZINDA Type By Date Amount Receipt
14875 SW 103RD PRMT DEB 3/20/00 $2,300.00 0000799
TIC ARD, OR 97223 INS? DEB 3/20/00 $35.00 0000799
Phone: Total _$2,335.00
Contractor: _ --
Phone:
Reg#:
Required Inspections
Sewer inspection
Septic Tank Filled
(L
N
r
G]
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
II' 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
J guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the aistance given If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oreo-n law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 9. -001-0010 through OASR 952-001-0080.
You obtain copies of these rules or direct questions to OUNC by calling t 03) 246-1987.
Issu by: Permittee Signature:
Call (503) 9-4175 by�7:0O .M. for an inspe--tion needed the next busine s ay
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —
BUP
Date Requested__ _AM PM
BLD
Location /* /S Suite MEC - L5
Contact Person _ Ph ����-,Sl��y PLM1-DCi��
Contractor Ph SWR
BUILDING Tenant/Owner ELC _
Retaining Wall ELR
Footing I Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: —
Slab
SIT
Post& Beam
Ext Sheath/Shear '
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -
Fire a U6-
Susp'd Ceiling .t'1y ✓�
Roof
Misc: -- --
Final
PASS PART FAIL — -
LUMBIN
Post&Beam -Under Slab
Slab
Top Out
Water Service
Sanitary Sewer -
Rain Drains
Fi _
AS FAIL
Post& Beam - - ------ ---- -
Rough In
Gas Line - --
Smoke Dampers
Fin --�----- - - -
A PART FAIL
RMTRICAL ---- -- —`
C- Service
Rough In
cn UG/Slab
y I ow Voltage
Alarm
Fina
PASS PART FAIL -
,� SITE
-' BackfilliGrading - — -
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line f 1 Please call for reinspection RE: [ ] Unable to inspect-no access
ADA
Approach/Sidewalk Date Inspector Ext
Other --
Final
PASS PART FAIL DO NOT RE- O E this Inspection record from th site.
CITY OF TIGARD
DEVELOPMENT SERVICES MEmmNTCAL
PERMIT
13125 SW Hall Blvd.,Tigard,OR 97223(503)6394171 PERMIT #. . . . . . . .. ME C99-00T51
DATE ISSUED: 02/03/99
PnRCEL: 2511tCB-00300
�'_JTTE ADDRESS. . . : 1.4375 P3W 103RD AVE
SUBDIVISION. . . . - DEL MONTE SUBDIVISION ZONING: R-3.
FLOCK. . . . . . . . . . . I_.nl.. .. . . . . . . . . . . . .LA@2 JURISDICTiniq: TIG
CLASS OF WORK. . :ALT FLOOR FURN. . . . . 0 EVAP rool_E7RS: 0
'TYPE OF USE. . . . :3F UNIT HEATERS. . : 0 VENT FANS. . . : I
OCCUPANCY GRP. . :R3 VENTS W/O APPL.: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL. 0-3 HP. . . 0 DOMES. TNrIN: 0
3--1 CHP. . . . : 0 CommL.. INCTN: 0
MAX INPUT: 0 BTU 15-30 lip. . . . : 0 REP.)TR UNITS: 0
FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVEE3. . : (7)
GAS PRLOSURE. . . 504 lip. . . . - 0 CLO DRYS R9. . : 0
NO. OF AIR HANDL TNG LIN I'S OTHER UNITS. : 17)
TURN \1 tOOK BTU- 17, 1.0000 r.fm : 0 GAS OUTLETS. : 0
FURN ) =100K RTU: 0 > 10000 C'fm : 0
Remarks . New vent fan.
041-ler: FEES
TODD ZINDA type amoimt by Bate recpt
14-875 SW 103 PRMT $ 2-5. 00 GEn 02103199 99-31261"?"17
TIGARD OR 97224 5PCT $ 1. 25 GEO 02/03/99 99 ;31 2G;'3
1711-ione #: 598-8964
I ll.)'TTnN, BARRY ALAN
P0 BOX 699
$ '-26. 25 TOTAL
YAWILL. OR 97148
PtIOTIP #: 662-4841
Reg it. . U 11r-'956 REOLITRFD TNSPECTIONS
This pe-sit is issued subject to the regulations contained in the Misc. ITispectioti
Tigard Municipal Code, State of Om Specialty Codes and all other Final Inspect ion
applicable laws. All work will be done in accordance with
approved plans. TjiS pereit will expire if work is not started
a- within 14 days of issuance, or if work is suspended for sort
rL
than 180 days. ATTENTION! Oregon law requires you to follow rules
Ln adopted by the Oregon Utility Notification Center. Those rules are
set forth in DAR 952-001-RIP through OAR 952-00I-8090. You toy
obtain copies of these rules or direct questions to OUNC by calling
U.)
I SI.le By Permi.ttpp SignAtUrP :
I F-++4-++f+++4-+++44-1 U +,+4-4 4 .........4•.............................4-+-++-++++++4-1- 1
Cal -1 r,39- 4175 lny 7:00 p. m. for iTispecl- ions nvorlmd ttip next hLisiiiess clay
+++ 1 1 +,,-+-+-+4-++4-4-++-4-4 4-4-+4.4-++++-+4 1.+.f+4-4++.++++++++++++•+++4+•+-+•F-++•4-+++++++++•+•1-++ F4
Plan Check __
CITY OF TIGARD Mechanical Permit Application Recd By_
131,25 SW HALL BLVD. Commercial and Residential Date Recd _
YIGARD, OR 97223 Date to P.E.
(503) 639-4171, X304 Date to DST
Print or Type Permft#/IIf:("?T605Y
_ Incomplete or illegible applications will not be accepted called
Name or DeveiopmentlProject Description
1 4 7t", Table 1A Mechani„al Code Oty Price Amt
Job Street Address ;,,nom A) Permit Fee A 10.00
1) Furnace to 100,000 BTU
Address ( /� including,ducts&vents 6.00
Bldg# cnyState ZIP 2) Furnace 100,000 BTU+
including ducts&vents _ 7.50
Name(or na business) 3) Floor Furnace
including vent _ 6.00
:.
C . s%r '/"} ja 4) Suspended heater,wall heater
Mailind Address r)
or floor mounted heater 6.00
11?Ju L5 5) Vent not included in appliance permit
City/Slate 7.Ip Phone 3.00
(-� Zly � CHECK ALL 'Boiler Heat Air
Name(or name of business)
THAT APPLY: or Pump Cond Q H Price Amt
Com _
6)<3HP;absorb unit to
Occupant Mailing Address 100K BTU 6.00
71 3•.15 HP;absorb unit
City/State Zip Phone 100k to 500k BTU 11.00
ll II B) 15-30 HP;absorb
unit.5-1 mil BTU 15.00
Contractor Na (,r, 1 9)30-50 HP;absorb
Y ' O✓, unit 1 1.75 mil BTU 22.50
Prior to permit Me Q�dd o G� 10)>50HP;absorb unit
issuance,a copy
M V 0%�: / f >1.75 mil BTU 1 _ 37.50
of all licenses C /State Phone 11)Air handling unit to 10,000 CFM
are required if 14!,!r W '?- � ' " /kr� / 4.50
expired in COT t#gpn Const Cpnt.Boyd Lk.# Exp.Date 12)Air handling unit 10,000 CFM+
database / 1C (e 7.50
Architect Name 13)Non-portable evaporate cooler
n 4.50
or
Mailing Address — 14)Vent fan connected to a single duct
_ 3.00
15)Ventilation system not Included in
Engineer city/Stale ZIP Phone appliance permit 4.50
15)Hood served by mechanical exhaust
Describe work to be done 4.50
17)Domestic incinerators
New 16 Repair O Replace with like kind: Yes O No O 7.50
Residential J6 Commercial O 18)Commercial or Industrial type Incinerator
_ 30.00
Additional� Information)or description of work ;� 19)Repair units a kl a� u XW 6�1 It (%r 1 4.50
/ 20)Wood stove
__ 4.50
21)Clothes dryer,etc.
-- 4.50
t Type of fuel: oil O natural gas O LPG O electric O 22)Other units
4.50
I hereby acknowledge that I have read this application,that the information 23)Gas piping one to four outlets
given Is correct,that I Pro the owner or authorized agent of 2.00
the owner,that plans dubmitted are In complianr a with Oregon State laws. 24)More than 4-per outlet(each)
—J — 50 ---
Signa re of 1:)wr�eNAkeat Date
J // Minimum Permit Fee:26.00 _- SUBTOTAL
7 �/c
�y \J- r-� / / / 5°rE SURCHARGE
71; Ot Pers n Nam Phone PLAN REVIEW 25%OF SUBTOTAL
Required for ALL commercial permits onY-
TOTAL -7
"Stale Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
I%mechperm.doc rev 07/20/98
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CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Hall Blvd.,Tigard,OR 97223(503)639-4171 PERMIT #. . . . . . . : P[_M')9.-0@21
DATE ISSUED: 02/03/99
517E ADDRESS. . . :
DDRESS. . . : 14075 SW 103PD AVE
nUTADIvIcTnN. . . . : DEL. r;"NTE SUBDIVIS
ION ZONING. R-3. 5
l3L.00l-'.. . . . . . . . . . JURISDICTION: TIG
LOT. . . . . . . . . .. . . . .002
CLASS) Or- WORV,. . :ALT OARDAGE DISPOSAI S. : 0 MOSILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : Q,
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . . 0
fi T()R T[—1_31. . . . . . . . : 0 WATER HEATERS. . . . . i 0 CATCH BASINS. . . . . . . . 0
r'r vArIJRES—.-- 1..n1JNDRY TROYS. . . . . .. 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . I URINALS. . . . . . . . . . . .. 0 GREASE TRPPS. . . . . . . : 0
LAVATORIES. . . . : I OT11E.R rIXTURES. . . . : 0
TUB/SHOWERS. . . : I SEWER LINE (ft) _ : 0
WATER CLOSETn. : 0 WATER LINE (ft ) . _ . 0
DT911WASHERS. . . . : 0 RATN DRAIN ( ft) . . . 121
Remarks : New t3ath room.
Ownv: FEES
TODD ZINDA type amoiint by rJate I-ecpt
'141375 SW 103 PRMT 27. 00 GEO 02/03/99 99-312623
TTOARD OR 97224 1. 35 GEO 993312f,23
rlirne # . 59889(�4
Al EAGLE PLLIMBING
745 ALETHIA WAY
MCMINVILLE OR 97128 .......
Pmone #: 435-0985 # 28. 35 TOTAL
REPUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Rai.igt-i—in Insp
Tigard Municipal Code, State of Ore, Specialty Codes and all other PL.M/Undpt-flonr
applicable laws. All work will be done in accordance -ith Mise. InspPC.,tion
approved Flans. This permit will expire if work is not started Final Tnspec.,tion
within 180 days of issuance, or if work is suspended for- more
than 180 days. ATTENTION: Oregon law requires you to follow rules
• adopted by the Oregon Utility Notification Center, Those rules are
set forth in OAR 9952-0P,�I-0010 through OAR 03552-ONI-M80. You may
obtain copies of th,rsr rules or direct questions to INK by calling
246-1987.
Tssi.ted Dy - _ Permittee Ti_gtlatUr_.�
+++++++ 4•+++++++4++1- +4-++4--L+++++4-+++4-++-4.......+++++++++4 1--1 4--+-g+4,+++I-+++ +
+ +++4- 1--4-
Call 63'3--41755 L)y 7:00 p. m. for an i,n s per-t j on needed t li L. I-P Xt bi.1 s i 11 e s s day
++++++++++++4•.+++4-+++4-+++++++++-1-+++++++4.+1.4•a +-4-+-++4,++4-•+++++++++++++++4 4-4++++ f-++
CITY OF TIGARD Plumbing Permit Application Plan Check#
7 3125 SW HALL BLVD. Commercial and Residential Rec'd By_
TVGAR[S, OR 97223 Date Rec'd
(503) 639-4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be ii�..:cPpted Permit*,_G/t1
Related SWR
Called
Name of Development/Project
( FIXTURES (individual) QTY PRICE' AMT
Job I Vl a 61 r�I CI e kx C Sink 9.00
Address Street Address I r /I Suite Lavatory 9.00
ILA ��' �`� Tub or Tub/Shower Comb. 9.00
Bldg* City/State Z.ip -
Shower Only nly 9.00
Name � ff Water Closet 9.00
1 ( C { - L l!1/i Dishwasher 9.00
Owner Mailing AddressSuite Garbage Disposal 9,00
4� ,,L,,) C/�,Z, ��e Washing Machine 9.00
CVState /'Zip 7 Phone Floor Drain/Floor Sink 2" 9.00
Name 3" 9.00
4" 9.00
Occupant Mailing Address Suite Water Henter O conversion O like kind 9.00
Gas piping requires a separate mechanical permit.
City/State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
;Maillng
me
k 14); Other Fixtures(Specify) 9.00
Contractor Address Suite 9.00
_ 9.00
Prior to permitI ate yy// Zi g Phone q Sewer-1 st 100' 30.00
Issuance,a copy /�1SG �J .' i. I Sewer-each additional 100' 25.00
of all licenses are �07gon Const.Cont.Board Llc.# Exp. ale
required If Q f ) ,� z Z )Op Water Service-1st 100' 30.00
expired In COT T_Iumbinq Llc.0 Exp Date Water Service-each additioi al 200' 25.00
database _ l7 Storm&Rain Drain-1 st 100' 30.00
lame Storrs&Rain Drain-each add tional 100' 25.00
Architect Vi r�t� L Mobile Home Space 25.00
of Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device _
Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation liming devices require a separate
De,,,Abe work to be done: restricted energy permit.)
New.�f Repair O Replace with like kind Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residentlal k Commercial O Catch Basin 9.00
Additional description of work: — —
!"r7f �`u 74a_/ '/i e4es 7Vt� ��q' Insp.of Existing Plumbing 40.00
erthr
�,totr (left 0j1 f1-,ecem— Specially Requested Inspections 40.00
erthr
Rain Drain,single family dwelling 30.00
Are you capping, moving or replacing any fixtures? Grease Traps g,po
Yes O No O
If yes,see back of form to Indicate work performed by ---- y,
QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
Isometric or riser diagram Is requhed M quantity Total is >9
WORK COULD RESULT IN INCREASED SEWER FEES.
'SUBTOTAL ov
I hereby acknowledge that I have read this applicatlon,that the information _
given Is correct,th.V I am the owner or authorized agent of the owner,and 6%SURCHARGE
that ilans submitted are In com liance with Oregon State Laws.
Signa re of Owner/Agert Date "PLAN REVIEW 26%OF SUBTOTAL ;�
Required only IF fixture qty.total Is>9 ate';
1 D — TOTAL
Contact Parson Name Phone _
�) 'Minimum permlt fee Is$25+5%surcharge,except Residential Backflow
ea r�(� Prevention Device,which is$15 • 5%surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
and plan review
vlstslvk rnapp doe MMA
i
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink
Lavatory_
Tub or Tub/Shower Combination
Shower Only
Water Closet _
Dishwasher _
Garbage Disposal
Washing Machine
Fluor Drain/Floor Sink 2"
3" —
411
Water Heater
Laundry Room Tray _
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1 w9tsVkxnepp eoc 7/7199