12415 SW 122ND AVENUE ADDRESS:
ND
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` CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phone: 639-4171
Date Requested: ' 1 A.M. P.M. MST:
Location:_�OL '-1 5 l Z BUP:
Tenant:_ ` Suite: _Bldg: MEC:
Contractor: Phonc: _ Pt.M: 0"d d
Owner: P _Phoue: _l,W ELC:
ELR:
_ ------ , _ _ SCf:
BUILDING BLDG(con't)_ LUMING �� MECHANICAL ELECTRICAL SITE
Site Post/Beamos eatn Post/Beam Cover/Service Sewer/Storm
Footing Roof IJndt'I/Slah Rough-In Ceiling Water'.ine
Slab Framing Top Chit Gas Line Rouge-In UG Sprinkler
Foundation Insulation Se%vcr llo(xm)tict Reconnect Vault
Bsmt Damp Drywall Storni I urnace Temp Service MISC.
Masonry Ceiling Rain Drain AX UG Slah
Shear/Sheath Fire Spkh/Alm Crgwl/Found Ir Heat Pump Low Valt
Approved trov Approved Apprc ved Approved
Appr/Sdwlk Not Approved No d Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL
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Inspector:
Date: Page of�_
CITY OF TIGARD
DEVELOPMENT SERVICESPLUMBING PERMIT
PERMIT #. . . . . . . : PLM97-0204
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639 4171 DATE ISSUED: 05/23/97
PARCEL: 2StO3BB-08400
SITE FIDDRESS. . . : 12415 SW 122ND AVE
SUBDIVISION. . . . : LAKE TERRACE ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . : 1 1 JURISDICTION: T I G
CLASS OF WORT'.. . :REP GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. ; 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :R3 F-LOOR DRAINS. . . . . . . 0 TRAP'S. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 1 CATCH BASINS. . . . . . . : 0
FIXTURES--------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE. T'IAPS. . . . . . . . 0
LAVATORIES. . . . : 0 OTHER F=IXTURES. . . . : 0
TUB/SHOWER;. . . : 0 SEWER LINE (ft ) . . . : 0
WATEP. CLOSETS. : 0 WATER LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : REPLACE GAS WATER HEATER
In- --------------------------------------------------------. FEES
LINDA AND AND LARRY LEWIS type amoi_mt by date r ecpt
12415 SW 122ND AVE PRMT $ E5. 00 TAT 05/23/97 97-294961
TIGAPD OR 97224 5PCT $ 1 . 25 TAT 05/23/97 97-294961
Phone #:
Contractor —
Phone #,; $ 26. 25 TOTAL
Req
----- -- REQUIRED INSPECTIONS
- ---—
This perait is issued subject to !ho reaul.t Ions contr ned in the Water, Line I n s p
Tigard Municipal Code, State of Ore. Specialty Codes and 311 other R okig h—i n I n s p _
applicable laws. All work will be done in accordance with F'l_M/Underf I oor-
approved plans. This perait will expire if work is not started Gas Line
within 188 days of issuance, or if work is suspended for care Final Inspection
a than 180 days.
J Permittee Sig a 1_1}ie:
I s s I_t e d B y :
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J 'Call for inspection - 6313--4175
-1ITY OF TIGAR Plumbing Application Recd By
,3125 SW HALL BLVD. Commercial and Residential Dale Rec 5 ^� 7
TiGARD, OR 97223 Dale to P E.Date to DST
(503) 939-4171 Permit ('t At`-7
Print or Type Related SWR 9
Incomplete or illegible applications will not be accepted Called`_
'
Name of_DevelopmenU rolect FIXTURES (Individual) QTY PRICE AMT
Job � f�_ \r' ClZ__--- Sink 9.00 ---�
Address Street Addre_s-s
3w 1 1 l Suite Lavatory g 00
1 o,`-),I 5 - Z Z,N J At Tun or Tub/Shower Comb 9.00 --I
Bldg A City/state Zip `:power Only _900—
TIG�/kk D O e, ci-7 � Water Closet
Nemo 9.00
" A L-l�hi i S Dishwasher 9.00
Owner Mailing AddressSuite Garbage Disposal 9.00 —�
j I� !� 12-Z+�/ Washing Machine 9,00
Ci (State Zip Phone Floor Drain 2- 9.00
1I(pfkl'_ - ZL3 5 O-`7 1U 9.00
Name
3 4" - 900
Occupant Mailing Address Suite Water Neater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal
i
Other Fixtures(Specify)Name ,. � /#r,Ion _
5..
Contractor Mailing Address Suite 9.00
'z S tnJ A,/', N - -- 9.00
(Prior to issuance City/State ZipPhone
s
applicant mustG�r� [%t // I�Z �,G 9.00
provide all Ore on Const.Cont.Board Lic x Exp. Date9.00
contractors 2 J LOf 1611 ) _ 9,00
license Plumbing Lic.• Exp.Date Sewer- 1st 100'_ - 30.00
information 2.L..'Coc)P(?> 01')Ulct-, Sewer-each additional 100' 25.00
for COT COT Business Tax or Metro 0 Exp�Date Water Service- 1st 100' 30.00
database) 1 1(,, 1 I I �("�
Name Water Service-each additional 200' 25.00
Architect ✓jam / Storm 3 Rain Drain- 1st 100' 30.00
or Mailing Address Suds Storm 8 Ram Drain-each additional 100' 25 00
Mobile Home Space 2300
Engineer City/Stale Zip Phone Commercial Back Flow Prevention Device or Anti- 2500 -
I
Pollution Device
:escnbe work New O Addition O Alteration n Repan O'" Residential Backflow Prevention Device' 15 00
'o be done. Residential 0-- Non-residential O Any Trap or Waste Not Connected to a Fixture 900
Additional description of work —
14 Calcti Basin 900
Insp.of Existing Plumbing 40.00
perthr
:x+sting use of Specially Requested Inspections 4000
audding or property C6:51 per/hr
— Rain Drain,smg!e fam ly dwelling 30.00
_ proposed use of Grease Traps 900 i
F building or property
_r _ _ QUANTITY TOTAL
Are you capping, moving or replacing any fixtt.:es) Yes L-j No p Isoirietnc or user c-i,am s required d Cuanity Totals 9
(If yes see back of form) 'SUBTOTAL
jI hereby acknowledge that I have read this application,that the information
--t I givens correct,that I am the owner or authorized agent of the owner and 514 SURCHARGE
that plans submitted are in compliance with Oregon State Laws
Signature of Owner/Agent Data PLAN REVIEW 25% OF SUB OTAL ]I
4eauwred only 'fixture oty Io >9
tass TOTAL
Contact Person Name Phene
*Minimum permit tui is S25- 5'.1 surcharge.except Residential Barkflow
Prevention Device.which is S 1 r • 5%surcharge
— 1 �: plmapp.doc 12.'96 (dst)
?LEAaECOMPLET AS APPR I T TO PROJECT:
Fixtur�:s 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------ 3„
4"
%A4ater Heater
Laundry Rocm Tray
Urinal _ ---
Other Fixtures (Specify) —
COMMENTS REGARDING ABOVE: -
--------------------
- -- —
I: plmapp.doc 12.96 Ids
INSPECrION NafICE
City of Tigard Building Department-
13115 811 Ball Blvd. Tigard, dragon 97223
Inspection Lina R��eic 639-4175 Bueineaylhhone: 639-4171
Inspections i LL ��f I e,/L _C
PL
Footing Plbg. Underelah Mach. Rough-in Appr/8dwlk
Found. Plbg. Top out (Sas Line /FINALS
Post/Beam Struct. San. Sewer Framing rBIdg.
Post/Beam Mach. Ra).n Drain Insulation -plumb.
Plbg. Underfloor Water LiM Gyp. Bd. -Hoch.
Date Requested:^� ✓Tisues AN PM
Address s / CL Pettit
Builders 1——
TBE FOLLOWING CORRECTIONS ARE REQUIRED:
2c �•r .y e c� C +q
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No cA/vA-
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Inepeotors v/ / Dates
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DISAPPROVED APPROVED SUB.7ECT TO ABOVE
/ )� _ ✓ Ca11 For ReInsp.
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INSPECTION 1COTICE
City of Tigard Building Department
13125 Bal Hall Blvd. Tigard, Orey.,n 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspections Ix r (? �y TA'.
._r
Tooting Plbg. Underelab Mech. Rough-in Appr/Sdw1K
round. Plbg. Top Out Gas Lino fI1fALf
Post/Beam Str-uct. San. Sewer Fremin -Bldg.
Poet/Beam Mach. Rain Drain Inaulatlon -Plumb.
Plbg. Underfloor Nator Line Gyp. ad. -Koch.
s e.
Date Requeeteds 1 Z 0 .c• i _Times AM _ / _PM
hadreee:_I 2-4 .� `?L,\)/ ,LZ-N 1� •_ Permit #t�/�'3-' G0} /�ip(�
Bu i'_der: t9 C" y✓� 1/�(19✓ Z' J ` 1O i 3
THE FOLLOWING CORRECTIONS ARE REQUIRED: -- �
`f`�'• I� �_ Cil �-� ln�� � 1 tit-�„�S h��:_�
LY 40, w
Ln
Cz
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Inspectors v� Z ^ `—�--- Dates Z " OV '
APPROVED _ DISAPPROVED �V APpRpyED BUHJECT TO AEMWE
C. L)1 L __Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Department
13125 8w Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)1 639-4175 Business Phones 639-4171
InspOCtiont
tooting P)bg. Underelab Hoch. Rough-in Appr/Sdwlk
Pound. Plbq. Top Out GGi Lina FINALt
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Ra.r. Drain Insulation -Plumb.
Plbq. Underfloor Nater Line Gyp. B'!
Date Requestedt 11- 10 -15 Timet 1` 111f _pK
Addreset 17 Ll Ir7- ? i,—A Ptirmit S� el3
Builder:_
THE rOLLOWINO CORRECTIONS ARE REQUIREDt
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Inspector: _ Date
AYPRrrM DISAPPROVED i� AF}�D Bd10W! 10 AM"
Call For Baine.
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MST9:3-0566
13125 SW Hall Blvd.Tigard,Oregon 07223eg1QyY,'ti$ *6:V_J171 DATE ISSUED: 11/08/93
PARCEL: 2S 103BB-08400
SITE ADDRESS. . . : 12415 SW 122ND AVE
SUBDIVISION. . . . : LAKE TERRACE ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 11
BUILDING
REISSUE: DWELLING UNITS:O BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. :ALT BEDRMS:O BATHS,.O GARAGE. . . . . . . . . . :0 sf
TYPE OF USE. . . :SP FLOOR AREAS-_-.- -__.--- REQUIRE.)
TYPE OF CONST. :5N FIRST. . . . :0 S LEFT. . :O ft RIGHT. :0 ft
OCCUPANCY GRP. :R3 SECOND. . . :us sf FRONT. :O ft REAR. . .0 ft
STORIES. . . . . . . : 1 THIRD. . . . :0 sf REQUIRED-------------_------
HEIGHT. . . . . . . . : 8 ft TOTAL- ------:0 sf SMOKE DETECTORS. :
FLOOR LOAD. . . . :60 psf VALUE. . . . . $ : 7000 PARKING SPACEG. . :O
Remar-ks : REPLACING DECD. AND ADDING STORAGE ROOM UNDER DECK
------------------------------------ PLUMBING
SINKS. . . . . . . . . . :0 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :Qi
LAVATORIES. . . . . :0 WATER HEATERS. . . :O TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :0 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . -0 SEWER LINE (ft ) . :0 UREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . :0 14ATER LINE (ft ) . :0 OTHER FIXTURES. . . . . :0
GARBAGE D I SP. . . :0 RAIN DRQ?I N (f t ) . :O
WASH 1 NG MACH. . . :0 SF FRA I N DRAINS. . :0
----------------- MECHANICAL ----------------------------------- FEES
FUEL TYPES------- -- - UNIT HTRS. . :0 type amol_tnt by date recpt
VENTS . . . . . :0 BPRT $ 62. 50 JLH 11/03/93 93-x'45697
MAX INPUT:O STU VENT FANS. . :0 BPLC $ 40. 63 JLH 11/03/93 93-245697
FURN ( 1O0K . . :0 HOODS. . . . . . :0 BSPC t 3. 13 JLH 11 /03/93 93--245697
FURN ) =1O0K . . :0 WOODSTOVES. :O
FLOOR FURN. . . . :0 CLO DRYERS. : 0
BOIL/CMP ( 3HP.-0 OTHER UNITS:O
VAS OUTLETS:O
Owner:
LINDA AND LARRY LEWIS
12415 SW 122ND AVE
TIGARD OR 97224
Phone #: 590--7544
Contractor,: -----------------------------------
GORDON USHER CONSTRUCTION
7941 SW 64TH
PORTLAND OR 97219
Phione #: 245-9693
v~i Reg #. . : 7558: -----------------------
> $ 106. 26 TOTAL
I" This perait is issued subject to the regulations contained in thr -•------ :IEUUIRED INSPECTION5
-
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp
appl icaale laws. All work will be done in accordance with approved Fran i TI g I n s p
ULJ plans. This permit will expire if work is not started with) 1,80 Rain drat i n I n s p _
-J I dans of issuance, or if work is sus ded than 180 ayi. Building Final
_ Er,o s i on Cont r-o 1
Call for, inspection - 639-4175
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PURM)SE OF PAYMU-N U 0yl(!(1NV VIA10 PURNISF* OU Pt4YW,-.N I AMOUN f 1:4.1 i U
1111ILDINO PF-RM 1po PLAN F+ 411. 63
1,.415 !iW I POND
M10( OMO(INT POID 106. P6
0_Residential Building Permit Application '
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobslte Address: /Z `/ % s _ �SNf 2S YVco q
�{ Only
SubdiVl.,lon: G J/��'ci �.�( _ Lot # 8�J0 Office Use O
It PianciclRec# '
Valuation:
Permit # j�
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Owner: ,L 1�clO/# � �✓l f Reissue of
Address: / Z`f/.!r ,S w l Z 2-
Approvals Required
Phone: Planning
/ Engineering
Contractor: U- t-
/C�..-bN �-f Other
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Address: �1`f l ��� 6 y
Items Required
Phone: et3 ibcontractors
Contractor's License # S"S Z-
Truss Details
(attach copy of current Oregon license) Other
Subcontractors:
Plumbing: -- --
Mechanical:
(attach y of current OR Contra::toi's License)
Arch i t ect/E rig i rree r:
Address:
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~ Ptyine:
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,;; COMMENTS: "CACE;J6X-/' aF X/ss-rWyEue GJ �Z ivEz✓
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Z U.5--q � 4 3 ��,��r-�s�r--o� Cxv��c,. ul�,�-►t
Appiicant nature & Phone number
Recei4d by: /L Date Date Received: - 3
Permit # Account Description Amount Amt. Pd. Bal. Due
CSG� Bldg. Permit (BUILD) 2-
Plumb.
Plumb. Permit (PLUMB)
Mech. Permit (MECH) _
/3
State Tax (TAX) 7 i
Bldg:
Plumb:
Mech:
� tv
Plan Check (PLANCK) 'Ci
Bldg: _
Plumb:
Mech:
Sewer Connection (SWUSA) i
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS) _
v~i Office TIF (TIF-0) _
Water Quality
Water Quantity (WQUANT)
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Fire District (FIRE)
TOTALS:
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G h
- C =� PLAIT APPLICATION
C11YOFTIOAr RD - CTTYOF
PLAN C1= f
COMMUMTY Ia MOPMi7JT DEPAR'MENT wr«»r i`
rnxsswwer&p _eocrssv la•4cti.�. n�ao-M»s PERMIT ! J 77 - "i 5(,
�... — VATE ISSUED
JOB AWWRM: /Zq l S Sw Z 2 ku ' ,^ � TAX H&P/LOT62.51z)j!3-8 -D ?Y&O
SUB: !r/4 {r✓4 t c j LAND [TSB:
VALVAEM.- v SETBACKS: MONT: REAR: LEFT: RICHT:
li0l� CLAS4S EMIGBT: �`� TOTAL ARS:
M TSPS: FL008 LOAD: 1ST:
COMM TTPS: N MAX TYPE: 2ND:
CLQ!° COW: DWELT UNIT'S:~ 3RD:
OCCR LOAD: NO BEMOOMS � BASFlOR f. S �, r/y Sy
NO STI3RISS: �_ NO BE.TNS: CARACE:
DW SMIYACM.
AMMAIS !MID SPECIAL NOTES IIF21S RiD _
KARIUM: _ RYISSUB OF: LIST
19G: LAST-REISSUE: i BUS TAX: _
PILE 1lSt'T.: FLOOD PLAIN/ CAL(UIMMS:
O790Mz SEN I". _ TOSS DETAILS:
PAR1QZ+iG PLAN:
T.ANDSCAPS PLAN:
PIAN CM= BT: OTm:
O -- — Y --
pawl a e1pG'L / DESCRIPTION F+H("n±�lt JM4-%'T PO_ BAL. DUE
�J 3-6)5610-432 00 Bui.ding Permit Fees �L� ..-
10-431 00 Plumbing Permit Fees
10-431 Ol Mer.hanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Pluri3ing T
Mech _
10--433 00 Plans Check fee �-
Building
Plumbing
Mech
30-202 00 Sewer Connection .__.
- 30-444 OU Sewer Inspection
51-448 00 Street System Dev G!►arge (SDC)
52-449 OO Paries System Oev Charge (POC) _
>- 31-450 00 Storm Drainage Syst Dev Chrg (SSOC)
10-230 09 TRFO -
-
10-230 OG Washington County Fire ql (951)
10-220 00 Amart/Wedgewood
TOTAL /�(•�.� _ /U 1
RFC a _ r
APPLICANT SIGNATURE
Received By: Date Received:
cn/3587P/18P
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