12115 SW 123RD COURT ADDRESS:
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CITY OF TIGARD BUILDING INSPECTION DIVISION MSS.
24-Hour Inspection Line: 639-4175 Business Gine: 639-417.1
/
BLIP �
Dr-'MRequested. /I AM __ PM BLD _---
Location �a ! 1 Suite MEC
Contact Person a ,�12CG� ! ��'lC� /Aa:yk-Nfh _ X19-00/0 PLM
Contractor P!-, SWR
BUILDING 'tenant/Owner ELt.,
Retaining Wall ELP
Footing Access:
Foundation FPS _
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab — `_ Q`-� SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear —
Framing — ----- ------ — -------- ----—
Insulation
Crywall Nailing —
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misr: --- ------ —-- ---- — --- -- - --- —
Fin I
PASS PART FAIL ._.--- -- -- -- —
' L'UMB
Post& 3eam - —
Under S.ab
Top Sut
Water Service
Sanitary Sewer
Rain Drains
PA'' PART_ FAIL. _
MECHANICAL --
Post& Beam —
Rough In
Gas Line —
Smoke D rapers
Finai -- — -- - -- -- ---
PASS PART FAIT_
ELECTRICAL __ _-------__ ---- - _._ --
Service
'Rough In _ —
n UG/Slab - -- --- - -
cc Low Voltage
~ Fire Alarm
} Final
�-
PASS PART FAIL
SI1'E _
O Backfill/Gradin, —
Sac-tary Sewer
LU
Ston i Drain [ J Reinspection fee of$ —_required before next inspection. Pey at City Hall, 13125 SW Hall Blvd
Catch Basin ( ] Please call for reinspection RE
Fire Supply Line [ ] Unable to inspect-no access
ADA �J �j
Approaci/Sidewalk Date I Inspector rr�.(/ -Ex
IT
Other _-
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the J,)b site.
CITYOF TIGARD — PLUMBING PERMIT
DEVELOPMENT SE=RVICES PERMIT#: PLM1999-00364
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DILATE ISSUED: 11/04/1999
SITE ACDRESS: 121 1 5 w"J 123RD CT
PARCEL: 2S103BB-11100
SUBDIVISION: YE OLDE WINDMILL ZONING: R-4.5
BLOCK: LOT: 030 JURISDICTION: TIG
CLASS OF WORK: ALT 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: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: RP-lace existing tub in single family dwelling.
Owner: FEES
Type By Date Amount Receipt
PITSINGER, ROGER D AND MARLEEN —
12115 SW 123RD CT PRMT KJP 11/041199 $50.00 99-319551
TIGARD, OR 97223 SPCT KJP 11/04/199 $4.00 99-319551
Total $54.00 —
Phone 1:
Contractor:
REALISTIC PLUMBING INC
PO BOX 22.206
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Phone 1: 657-1177 Top-out Insp
Reg#: LIC 129026 Final Inspection
PLM 3-29bPB
ORIGINAL
Ln
>_ Tnis permit is issued sub;ect to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and a'i other applicable laws. All work will be clone in accordance with approved plans.
r This permit will expire if work is riot started 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 Utitfty
Notification Ci--�nter. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-00801
You may obtain co 01 of these rules or direct questions to OUNC by calling (50-3) 24&1987. 1
Issued By: � -�'_�c-�L�iy.�. � Permittee Signature:
Call ;503) 639-4175 by 7:00 P.M. for an inspection needed the hext business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'dBy�__
TIGARD, OR 97223 Date Rer,'d
(503) 639-4171 Date to P.E.
Print nr Type Date to DST
Incomplete or illegible applications will not be accepted Permit# hLh -6• . Y
rtelated SWR#
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 1 i rn
Address Street Address �+ Suite Lavatory 11.50
d l 15 SLA.) 3 _ Tub or Tub/Shower Comb i 11.50
Bldg# City/State Zip Shower Only 11.50
--- �- r
Name Water Closet/Urinal (Specify) 11.b0
II
K _ 1?St r C Dishwasher - 11.50
Owner Mailing Addroks Suilte Urinal 11.50
ri rn Garbage Disposal 11.50
City/State Zip Phone Laundry Tray 11.50
i Name Washing Machine/Laundry Tray (Specify) 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
-- 4" 11.50
City/Slate ZIp Phone - --
Water Heater O conversion O like kind 11.50
e Gas piping requires a separate mechanical permit.
/Ck( 1�.�.'^ , L MFG Home New Water Service 28.00
Contractor Mailing Address i1 Sue 11FG Home New San/Storm Sewer 28.00
( Ck; Hose Bibs 11.50
Prior to permit /State I Phone Roof Drains 11 50
issuance,a Copy �• L17JUp 7 7 ^'S 7
Drinking Fountain 11.50
of all licenses are Oregon Const.Cont Board Lic.# Exp.9ate
required if ac U / pp Other Fixtures(Specify) 15.00
expired in COT Plumbing Lic.*� Exp. ate
database 9-11"s c �a jk1 --
Name -
Architect Sewer-1st 100' 3800
Or Mailing Address Suite Sewer-each additional 100' 32.00
Engineer City/State Zip Phone "ater Service-1st 100' 38.00
g Water Service-each additional 200' 32.00
Describe work to be done: Storm&Rain Drain-1st 100' 38.00
New O Repair O Replace with like kind: Yes No O Storm 6 Rain Drain-each additional 100' 32.00
Residential Commercial O
Additional description of work: Commercial Back Flow Prevention Device 32.00
r Residential Backflow Prevention Device' 1900.
4_ Catch Basin 11.50
Are y u capping, moving or r p cing..ny fixtures? Insp,of Existing Plumbing or Specially Requested 50.00
Yes O No Inspectionsper/hr
If yes,see back of fonn to Indicate work performed by Rain Drain,single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
CX WORK COULD RESU I INCREASED'' WER FEES. QUANTITY TOTAL
/1 I hereby:zthat
dge at I havC res, s p cello ,that the informatlun Isometric or riser diagram Is required d Quantity Total is >s
given Is cm theowner aut o ed ag nt of the owner,and --
that Iantte are In In II ce h re on State Laws. *SUBTOTAL 1
e of Own HA t Dat
J ` I I c�• B%SURCHARGE
CgAtactftNon Name T P ne
I c,r � 1 ") 7 f1 "PLAN REVIEW 25%OF SUBTOTAL
J -�-=-, --- Required only If fixture qty total Is>9
1 BATH HOUSE$178.00
2 BATH HOUSE$250.00 TOTAL r
3 BATH HOUSE$285.00
(This tee Includes all plumbing fixtures In the dwelling and the first 'Minimum permit fee Is$50+B%surcharge,except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device,which Is$25+s%surcharge
All Now Commercial Buildings require plans with Isometric or riser diagram and
plan review
I rdsts`.In-m s�nluarUp doc 1011199 _
IF
PLEASE COMPLETE:
Fixture Type — Quantity by Work Performed —
New Moved Replaced Removed/Capped
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet _ J
Dishwasher
Urinal _
Garbage Disposal _—
Laundry Room Tray
Washing Machine
Flour Drain/Floor Sink 2"
411
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
L
t lditsVamslplumepp dux 1011N9
CITY CSF T I GARD MECHANICAL
COMMUNITY DEVELOPMENT DEPARTMENT PERM I I
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-071 PERMIT #. . . . . . . : MEC94-03CEZ-11'
639-4171 DATE ISSUED: 11/09194
PARCEL: 2SI03BB- III0CA
SITE ADDRESS. . . : 1,'7-'115 SW 1izf3RD CT
'31JBDIVISION. . . . : YE OLDS WINDMILL ZONING- R-4. 5
BLOCK. . . . . . . ., . . . L.0 I.. . . . . . . . . . . . . :30
GLASS OF WORK. :14L'I FLOOR FURN. . . . EVAiCOOLERS:
1-YPE OF USE. . . :SF UN I T HEATE=RS. . : VENT FANS. . . :
OCCUPANCY GRP. . : R3 VENTS W/0 PPPL. VENT STEMS:
f3TORIES. . . . . . . . : 1 BOILERS/COMPRESSORS H00rS. . . . . . . :
CUEL TYPES------___--._- 0-3 HP. Dr3MES. INCIN:
: /GAS/ 3-15 HP. COMML. INCIN:
MAX INPUT: BTU 15-3121 HP. REPAIR UNITS:
I"IRE DAMPERS?. . : 5121-- ;0 HP. . . . : WOODSTOVES. . :
6AS PRESSURE. . . 3)0+ I iP. . . . : CLO DRYERS. . :
NO. OF AIR Ur\1 I TS OTHER UNITS. :
FURN < 100K BTU: <= 10000 c-fm : GAS OUTLETS. : 1
��IJRN ) =100K BTU. > 10000 cfm :
Remarks : GAS FIREPLACE
Owner: FEES,
ROGER PI TE.I NGER type am a 1-int by date t-ecpt
i L-i 15 sw i23RD c-r PRMT $ 25. 00 Jr: 11/V--9/94 —
5PGT $ 1. 25 J1= 11/09/94 —
1-IGARD OR
-1hone #.-
untractor—.-
.EO RIPICZYKIDWSKI
14OLI SE 100TH
f'ORTLAND OR 97L66
Phone #: 761-7841 26. 25 1-01-AL
Hey #. . : 82930
REQUIRED INSPECTIONS -------
nis permit is issued subject to the regulations contained in the Gas Line I n s p
ligard Municipal Code, State of Ore. Specialty Codes and all other Mechanical 1nsp
ioDlicatle laws. All work will be done in accordance with Final Inspection
-+pproved plans. This permit will expire if work is not started
within 160 days of issuance, or if work is suspended for more
man 180 days.
V)
e t^M i t t e c, 1 11 t)0 t IJ r,P •
by
s 9 u ed
I
( all for inspection 6,O-41 75
INSPECTION NOTICE
city of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspdction Line (Rec-O-Phone: 639-4175 Business Phone: c3'99-417?
�---- - ��'_ ] �! -k --�. O
Fnspection: -
Footing Plbg. nderslab Mech. Rough--in Appr/Sdwlk
Found. Plbg. Top Out Gas Line
Post/Beam Struct. San. Sewer Framing --Bldg. '
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd.
C y'/-
Date Requeetedt / Time: AM PM
Addreca:
12l/-S �`� a — Permit
Bui ldertTHE FOLLOWING CORREC-rIONS ARE REQUIRED:
CL _
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Inspect r -�_ Datet
"PROV21) OlSAPPROVRD APPROVED SUBJR. TO ABOVE
T Call For Reinnp.
City of Tigard MECHANICAL PERMIT Planck/Rec. #
1.3125 SW Hall Blvd. APPLICATION Permit # 7-61 c)
Tigard, OR. 97223
(503) 639-4171
N»aoim� escripdon
Table 3A Aechanical Code On' PRICE AMT
Job 1) Permit Fee 0• 0• 10.00
Address
-7—, 1•--11/3--j 7)-J-3 2) Supplemental Permit 3.00 _
Furnace o
c Q r
Uh. t-f 1�� i y� �' 1) incl. ducts&vents V 6.00
NIN&V AMNO Furnace 100,000 BTU
Owner ISI l S S c�,-j ( -r D-(L, 2) incl, ducts a vents 7.50
UWSWA6_ //�� Floor umance -
I C-,>14 (J� 7 Z 3) incl. vent 6.00
Su"nd5d heater,wa seater
P,k n �' 4) or floor muuntod heater 6.00
Vent not=I.. ink n
Occupant I rZ-u S Jr� I J- r-J�_fS-Ztu 5) appliance permit 3.00
��7�_ eo�a+r oMa- g,reTng
1i ,r 6) coLling,absorption unit 6.00
' t
Boiler or comp, aerump,air cond.
/I�W�t-f 7) to 3 HP;absorp unit to 100K BTU 600
Goller or comp, heat pump, air con .
Contractor ` Ifh � 8) 3-15 HP;absorp unit to 500K BTU 11.1)0
�— Boiler or comp, heat pump,air-con—d—.
9) 15.30 HP;absorp unit.5-1 mil BTU 15.001—
Boiler
5.00 r er or comp, eaiFi t pump, air cond.
10) 30-50 HP;absorp unit 1-1.75 mil BTU 22.50
hereby ackiio;0gage that I have read thir app+ca ran, a a +er or comp,heat pump, aim
information given is correct, that I am the owner or authorized agent 11) >50 HP;absorp unit 1.75 mil BTU 37.50
of the owner,that plans submitted are in compliance with State Air handling-unit to
laws,that I am registered with the Construction Contractor's Board, 12) 10,000 CFM 4.50
that the number given is correct. (If exempt from state registration, Air handling un+
please give reason below.) 13) 10,000 CTM+ 7.50
��— on portable `
14) evaporate cooler 4.50
Vent an connec
15) to a single duct 3.00
Ventilation system not
16) includod in appliance permit 4.50
--- - --
Hood servod by
17) mechanical exhaust 4.50
Describe work new a ition a terauon repairCommercial or at ustnT—
to be done residential p non-residential 18) type incinerator 30.00
risung use of Other i.e.,woodslove,water
buildina or property 19) heater, solar, clothes dryers,etc. 4.50
r Proposed use of 20) Gas piping one to four outlets 200
t-- building or property
Type of fuel - oil CJ natural gas Q LPG Q electric Q 21) More than 4 per outlet_
L Minimum Fee$25.00 SUBTOTALS
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PERMITS BECOME VOID IF WORK OR CONSTRUC _
-� AUTHORIZED IS NOT COMMENCED WITHIN IN D �,l'ri 5%SURCHARGE 1 '
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAID REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED. - -
TOTAL
Special Conditions —
D?ta issued by _
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