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CITY OF TIGARD BUILDING INSPECTION 'VISION MST
24-Hour Insrict:ion Lire: 639-4175 Buc"dness Line: 639-4171
BLIP
Date Requested y y C161—AM >-/� _PM BLD
Location ( � ?U ( nySuite _ _ MEC
Contact Person -►'V1 LC_ C r Y)l Ph ' 8'Z- PLM
Contractor Ph SWR
BUILDING Tenant/ ���( � Q{�yyj}�LF� [LC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab I SIT
Post&Beam
Ext Sheath Shear _
Int Sheath/Shear
Framing
Insulation
DQ-.vall NailingFirewall f
Fire Sprinkler
Fire Alarm c i -
Susp'd Ceiling ____- J i Oft
Roof
Misc:
Final
P ART FAIL -
PCUMQW)
ost& Beam -- - --
Under Slab
Top Out ------------- — � __
Water ice
Rain L75—Ins
*� PART FAIL
MECHANICAL _ -
Post& Beam ---- ---- - ---- --
Rough In
Gas line
Smoke Dampers
Final - --- --- -- --- --
PASS PART FAIL
ELECTRICAL —
'" Service
Rough In
UG/Slab
F- Low Voltage
=, Fire Alarm
Final
PASS PART FAIL
SITE
J
Backfill/Grading - _-- - -
Sanitary Sewer
Storm Drain I ] Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line I ]Please call for reinspection RE: [ ]Unable to inspect- no access
ADA �-
Approach/Sidewalk Date L9
Other Inspector ^Ext
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the Job site.
CITY OF TIGARD PLUMBIN(I PERMIT
DEVELOPMENT SERVICES HERMIT#: P6/99 00128
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/226/99
SITE ADDRESS: 14570 SSV 100TH AVE PARCEL: 25111 BD-00310
SUBDIVISION: PEMBROOK HEIGHTS ZONING: R-3.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE. SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOD DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: 5u ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Add sewer line to an existing dwelling.
FEES
Owner: --� — —A �—
Type By Date Amount Receipt
A
DENN , WILLIAM R PRMT DST 4/26/99 $30.00 99-314852
14570 S1�J 100TH ST
1L MISC DST 4/2.6/99 $1.50 99-314852
4570 _
TIGARD, OR 97223 Total $31.50
Phone 1:
_Contractor: _
�2�00 9�v /7�18"
(9*_ y-pd Ogli REQUIRED INSPECTIONS
Phone 1: 5 9 ' -i�t5-17 Sewer Inspection
Reg #: Final Inspection
i--
This permit is issued subject to the regulations contained In the Tigard Municipal Code, State of OR.
;a Specialty Codes and all other applicable laws. All work will be done in accordanoe 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 regoires you to follow rules ac'opted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 thro Igh OAR 952-0001-0080.
You may obtain copies f_#hese rules or direct questions to OUNC by callirg (503) 246-1987.
Issued B G ���- Permittee Signature.
Call (5 3) 639-4175 by 7:00 P.M. for an inspection need d t e next business day
CIT Y OF TIGARD Plumbing Permit Applicatiosi Plan Check#
13125 SW HALL E LVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date R3c'd
(503) 639-4171 /( Data to P.E.
Print or Type Date to DST_
Incomplete or illegible applications Will not be accepted Permit#PZ < -ooio`
Related SWR#�J��- 0667
Called_
//Name of udvelopment/Proje--t �r FIXTURES 'Individual) QTY PRICE AMT
,
Job l/">Gfr on<-A r�r—S ec) �V Sink -- 9.00
Address Street Address Suite Lavatory 200
5 ;7,,) SGC��C� Tub or Tub/Shower Comb. 900
E'dg# City/State J Zip Shower Only _ 9.00 -
Name Water Closet 9.00
!f / i �/��/�7 4 u/ /' G" v Dishwasher 9.00
Jwner Mailing Address _ Suite FGarbage Disposal 9.00
;t �h�� Washing Machine 9.00
City/State Zi Phone
%-/ / -,/ 7 - �-, C Floor Drain/Floor Sin', 2" 9.00
Name`J � _
4" 9.00
Cccupant Mailing Address Suite Wpf�i Heater O conversion O like kind 9.00
_ Gas pipI21requires a separate mechanical permit.
City/Stale Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name Other Fixtures(Specify) 9.00
Contractor milling Address Suite 9.00
' 9,00
_ _ _
Prier to permit City/State I -Ip ��r PiLoAe. k, Sewer-1st 100' �r 30.00 ' 1
Issuance,a c.,py '�'� 77 $ -
Sewer-each additional 100' ?5.00
of all licenses are Oregon Const.Cont.Bot L.c..# - p. a
72
required If r n �T _L �{-Cy/ Water Service-1st 100' 30.00
expired In COT Plumbing Lic.# Exp.Date Water Service-each additional 200' 25.00
database _ Storm&Raln Drain-1st 100' 30.00
Name Storm&Rain Drain-each additional 100' 25.00
Architect _ _ Mobile Home Space 25.00
or Mailing Address Suite Commercial Back Flow Pi,pvention Device or Anti- 25.00
_ Pollution Device
Engineer City/State Zip - Phone Rasidential Backflow Prevention Device' 15.00 '
{irrigation timing devices require a separate
Describe work to be done: restricted energy ermit.) -_
New O Repair O Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential O Commercial O Catch Basin 9.00
Additional description of work:
Insp of Existing Plumbing 40.00
er/hr
Specially Requested Inspections 40.00
_ er00 --�
Are you capping, moving or replacing any fixtures? �— Rain Drain,single family dwelling 30.00
v~ I Yes O NO O Grease Traps 900
If yes, see back of form 4.o indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram Is required H Quantity Total Is >9 0�0 WORK COULD RESULT IN INCREASED SEWER FEES. •SUBTOTALI hereh;acknowledge that I have read this application,that the Informationco given is correct,that I am the owner or authorized agent of the owner,and 6%SURCHARGE
that plans submitted are in compliancewith Oregon Slate LawsL
Signature of nwnerlAgent Date —PLAN REVIEW 25%OF SURTO'AL —
Pequired only H fixture qty total Is>9 _
TOTAL
Contact Person Name Phone
'Minimum permit fee Is$25 4 5%surcharge,excep,Pesidential Backflow
Prevention Device,which is$15+5%surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram
and plan review
�u1�r,v,iuniarr,�x;,ten
PLEASE COMPLETE:
Fixture Type _ Quantity by Work Performed
New Moved Replaced Removed/Capp,-d
Sink_ _ ---
Lavatory _
Tub or Tub/Shower Comoi,istion
Shower Only _
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sir k 2"
411
Water Heater
_Laundry Room_ Tray
Urinal _
Other Fixtures (Specify) —^–
COMMENTS REGARDING ABOVE:
1
W
141snyhxn nip Anr 7f'Ff1
CITY OF TIGARD► SEWER CONNFCTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR1999-0C(`8
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 63! 1
DATE ISSUED: 4/26/99
SITE ADDRESS; 14570 SW 100TH AVE PARCEL: 2S111 BD-00310
SUBDIVISION: PEMBROOK HEIGHTS ZONING: R-3.5
BLOCK: LOT: 010 JURISDICTION: TIG
TENANT NAME: ROMMEL, WM & DEANNA
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNfrS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Sewer line connection for an existing dwelling.
Owner: ---
_ FEES
ROMMEL, WILLIAM R
DEANNA L Typo By Date Amount Receipt
—
14570 SW 100TH ST PRMT DST 4/26/99 $2,300.00 99-314852
TlrARD, OR 97223 INSP DST 4/:6/99 $35.00 99-314852
Phone: Total $2,335.00
Contractor:
Ax
Phone:
Reg #: –GJI-O�sS C/
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
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 distance given. If no+ so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNS by calling (503) 246-1987.
Issued by: Permittee Signature,;�f�J =, ,
�- Call (503) 65G- 175 by 7:00 P.O.Q. for an inspection needed the next busir.ass day