14450 SW FERN STREET-1 Ul
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144,0 SW Fern Street
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST _ ----- --
INSPECTION DIVISION Business Line: (503)639-4171
BLIP - - - -- --
Received . Date Requested_ _`. _ AM-_ ___-- PM -_ - BUP
Location _,__ 5 L% _ �- __ _Suite MEC
Contact Person _-_ _—.. Ph( )
�
FPLMo� OOa
Contractor ---- - Ph(__—) Sr2� � SWR
BUILDING _ Tenant/Owner _ _ ELC
Footing ELC -.
Foundation Access:
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 ------ - - ---- --- - - ---
Root - -
Other: ---
Final
PASS PART FAIL - -
PLUMBING
Post&Beam
Undei Slab
Rough-In
Water Service -- -- - ---'
Sanitary Sewer
Rain Drains ----- - --'-'�
Catch Basin/Manh, le
Storm Drain -
Shower Pan other:
PART FAIL
CHANIC_AL --
Post& Bourn
Rough-In --- -
Gas Line
Smoke Dampers --- -- -- ---- -
Final _
PASS PART FAIL -
ELECTRICAL
Service
Rough-In ----
UGI'Slab
Low Voltage - -- -- --- ---- -
Fire Also it
Final El Reinspection fee of$ __required before next inspecticn. Pay at-,ity Hall, 13125 SW Hall Blvd.
PASS PART FAIL.
SITE--.r.___ F] Please call for reinspection RE: Unabie to inspect-no access
Fire Supply Line n �
ADA �,t�►
Approach/Sidewalk Data "�_Q ---__ Inspector � .!--- ?y
-`" ------_._ L-
Other:
Final DO NOT REMOVE this Inspection record fry°,rri tho Job site.
PASS PART FAIL.
/ \ CITY OF T I G A R D __PLUMBING PERMIT -
DEVELOPMENT SERVICES PERMIT #: PLIW2002-00035
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2i5/02
PARCEL: 2S10413C-05100
SITE ADDRESS: 14,150 SW FERN ST
SUBDIVISION: ML096-0011 JEFFERY ZONING: R-7
BLOCK: LOT: 002 _ — �— JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR GRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAI ATORIES: C .-IER FIXTURES:
TUr,ISHOViERS: SEWER LINE: ft
WATER CLOSETS- WATER LINE: 360 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 360 ft water line.
FEES
Owner-
Type By _ Date Amount Receipt
JEFFERY, HARRY F- + JUDITH A PRMT CTR 215!02 $101 40 272002000010
12985 FEW ASCENSION DR 5PCT CTR 2/5/02 $8.11 27200200000
TIGARD, OR 97223 - — - ----- —
Total $109.51
Phone 1:
Contractor: —
BUMBLE BEE PLUMBING
PO BOX 373
TROUTDALE, OR 97060 REQUIRED INSPECTIONS
Water Line Insp
Phons 1: 503-618-8978 Final Inspection
t2"g #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Odes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not staged within 180 days of issuance, or if wo,-k is suspended for moic.
than 180 day 3. ATTENTION: 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) 246-1987.
Issued By: -L`-<c,�c. .c L�. _ Permittee Signature(/
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Datereceived:' �' �fI Permit no.: jjt, ry ;
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City of Tigard phone: (503) 639-4171 !'rojecUappl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: /I L r _____, Case file no. Payment type:
=Ul family dwelling or accessory U c'ununcn:tal/inrlutilral U Multi-family U Tenant improvement
onstruction U AddilioNulterautm/replacement U Food service U()(her:
U
1�l < l ,. r�u escri tion (jt Y. hee(Co.) "I ota
Job address: l
Bldg,address:
no. Suite no.: New I-and 2-family dwellings only:
(includes 10011.foreach utility connection)
Tax map/tax lotiaccount no.: j SFR(1)bath
Lot: Block: Subdivision: k 5FR(2)bath
Project name: L_ , ;G SFR(3)bath
_S� �L-4 ! -
City/county: 4 -k, ZIP: Each additional bath/kitchen _
Description and location of work on premises: it.c►r.11.U4—L,,.Ar-,L Site utilities:
Z`` Catch basin/arca drain _
t.date o""completion/inspeclirr„� brywel leac litre/trench drain
Footingdrain(nr,, lin. 11.)
Manufactured home ut;'ities
Business narnr_�? �1, OAJ„c,,,�6' L Manholes
Address; ” 7� � _ Raiu drain connector
City: t-a- Stater, ZiP:c31d6o Sanita y sewer(no.lip. ft.)
Phone: �� Fax: E-mail: Storm sewer(no.lin.ft.)
CCB no.: j 1�,�� Plumb.bus.reg.no: Water service(no.lin.ft.)
City/metro lie.no.: Fixture or Item:
Absorption valve _
Coelrat.tor's representative signature_. y Bac flow reventer
Prin:r^me: Date: Backwater valve
LM Basinstlavatory
Name:
Clothes washer
`�`= ^S'"L Dishwasher _
Address: 5� v Drinkingfountain(s)
City: State:o� I_IP ~ 1 Ejectors/sum
Phon r Fa 1:-mail Expansion tank
Fixture/sewer cs.p _
Floor drains/floor oinks/hub
Name(print):,r ( darba,te disposal _
Mailing address: 6 10 . 6--%j Y 6 V OL Bose bihb
City: n.l g w E„<«, State: ZIP: Ice maker
Pho Fax E-mail; _ Interceptor/ reale trate I_ t =`
Ottner m allation/residential maintenance only: The actual installation Primer(s)will be made by me or the maintenance an;;repair made by my regular Roof drain(commercial)
employee on the pr,)perty I own as per URS Chapter 447. Sin (s),hasin(s), ays(s)
owner's si mature: Date: Sump
Tubs/shower/shower pan
Urinal
Name: r• Cyd. ,y��,Ntv.� r'`1 -��--�`^� Water closet _
Address: 1�54t�; S 4 X11 l Water heater
City ;f„ — Stater r I ZIP: - , Other:
Phone: , 's Fax: E-mail: ora
Not dl jurisractim accept credit cards,preen call iuridiction for marc in(ortnation. Notice:This permit application Minimum fee................$
U vine U MulerCard expires if a permit is not obtained Plan review(al ,_ %) $
Credit card numtxx:_ I— �� within 180 days after it has been Slate surcharge(8%)....$
Expires TOTAL ..................... .$
Named .ol r as shown no credit card accepted as complete.
_ S
Cardholder iiputure^—' Amount 1101616(6000COM)
PLUMBING PERMIT FFES: -- -�__
-TOTAL New 1 and 2•18mily dwelllnp ns o lY: PRICE TOTAL
AMOUNT (inrludes all plumbing fixtures in AMOUNT
FIXTURES individual; QTf-- ea the dweIII and the tirst100 ft. QTY '
ea)
`- tt,so for each utUlt connection
Sink - ---'"�'-"_ - $249.20
18.60 One 1 bath -
Lavatory �---- $350.00
16.80 _Two 2 bath j $359,00
Tub or Tub/Shower Comb. Three bath _ __ --
18 F,0
Shower Only 16 80 SUBTOTAL _
Wider Clo g•/.STATE 3URCHAR_GE
16.60
U,inal 18.80 KLAN REVIEW 25%OF SUBTOTAL
-- TOTAL -
Dishwasher 16.60
Garbage Disposal
�-- ----' � 18.80
Laundry Tray
18.80
Washing Machin+
- --
16.60 PLEASE COMPLETE:
Floor Dre,rn:F loor Sink 2" 1 -
3" 16.60 PLEASE
__ -
4" - 16.60 T-du b Work Performed
like kind
16.60 Fixture Type: New Moved Replaced Removed/
Water Heele O conversion O __fid
Gas piping requlre3 a separe.te mechanical
ermil. 46.40 Sink
MFG Home New Water Service_ Lavato -
MFG H-3me New Son/St o m Sewer
46.40 Tub or Tub/Shower
-- 16.60 Combination
Hose Bibs _18.80 Shower Onl
--------
Rnof Drains - Water Closet
Drinking Fountain Urinal
18.80 -
Other Fixtures(Specify) _ Dishwasher -�_
Garbage Disposal
Laun" d Rourn Tra i-
_ Washing Machine `-
Floor Drain/Sink: 2" _
55.00 3"
Sewer-1st 100' 4" --
46.40
Sewer-each additional 100' 55.00 Water Heater
Water Service-1st 100 Other Fixtures -
--- 46.40 S ed
Water Service-each additional 200'
dtorm 8
55.00
Rain Drain-1st 100'
48.40 --
Storm 8 Rein Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 27.55 _
Residential Beck ntion Device' 16.80 r
Call:Basin 2.50
Inspection of E� 8
9 Plumbing or Specially 2.50 COMMENTS REGARDING ABOVE: �-
Re r uet sted Inspections ert65.25
Rain Drain,single family dwelling -�
_ 18.80 --____--_--Grease Traps
Traps --
- QUANTITY TOTAL --------- _---
Isometric or riser diagram Is required it ---- -
QuanlR 10181 Is >B ---'- -- _--,-
*SUBTOTAL --- __
l3%STATE SURCHARGE -
**PLAN REVIEW 25%OF SUBTOTAL
Rettulred only II future t total Is>B -
--- TOTAL i
*Minimum Permit tee Is$72 5o•e%stale surcharge,except Residential Backllow
Prevention Device,which Is$ia 25+a%state surcharge
**All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
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