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11500 SW MANZANITA STREET-1 iS V1INVZNVW MS 005 6 6 — 4 co z z a co r n m W 11500 SW tOANZANIT►A, ST - CELECTRICAL PERMIT CITY O F T I G A R D PERMIT#: ELC2000-00320 DEVELOPMENT SERVICES DATE ISSUED: 6/12/00 13125 SW?call Blvd.,Tigard,OR 97223 (503)639-4171 PARCEL: 1S134CA-00524 SITE ADDRESS: 11500 SW MANZANITA ST SUBDIVISION: PANORAMA NO.2 ZONING: R-4.5 BLOCK: LOT : 045 JURISDICTION: TIG Proiect Description: Installation of 3 branch circuits. RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS _ 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: VIANF HM/SVC/FDR: 601+amps -1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1 st W/O SRVC OR FUR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 2 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: SARAH LAV]TON OWNER 11500 SW MANZANITA STREET TIGARD, OR 97223 Phone: Phone: Reg#: (FEES _ Required Inspections Type By Date Amount Receipt Elect'I Service w PRMT DEB 6/12/90 $48.20 0002872 Elect'I Final -5PCT DEB 6/12/00 $3.86 0002872 QN� \V Total $52.06 0 This Permit is issued subject to the re(lulations contained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or if work is d. suspended for more than 180 days. '•,TTENTION: Oregon law requires you to follow rules adopted b the he Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-,010 through OAR 952-001-0080. You may obtain copieselfiiese ruTesRrdirect questions to OUNC at(503) F- 246-1987, N PERMITTEE'S SIGNATURE ISSUE BY: " P to _ OWNER INSTALLATION ONLY C9 The installation is being made on property own ich is not intended for sale, lease, or rent. OWNERS SIGNATURE: DATE:— CONTRACTOR ATE:CONTRACTOR INSTALLATION ONLY _ SIGNATURE OF SUPR. ELEC'N: — DATE:_ LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day CITY OF TIGARD Electrical Permit Application Plan c 6k 13125 SW HALL BLVD. Recd ` TIGARD OR 97223 Date Rec�- -CO Date to P.E. Phone(503)639-4171, x304 Date to DST Inspection (503)639-4175 Print of Type Permit*?PLAd Y CL^ Fax (503) 598-i960 Incomplete or illegible will not be accepted Caned 1. Job Address: 4. Complete Fee Schedule Below: Name of DevelopmentNumber of Inspections F2r permit allowed Name(or name of business) _ A� , Q w' ✓1 Service included: Items Cost Sum Address es Q V 7.01/1 j, a 5f 4a. Residential-per unit City/State/Zip7 I Q -7 ? 3 1000 sq ft.or less $ 117.75 _ 4 Each additional 500 sq.ft.or Portion(hereof S 265 1 Limited Commercial ❑ Residential li_Y mited Energy S 80.00 _ Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance,applicants must provide contractor license 4b.Services or Feeders Information for COT data base). Installation,alteration,or relocation Electrical Contractor 200 amps or:ess $ 64.25 2 Address 201 amps to 400 amps $ 85.50 2 City State` -Zip 401 amps to 600 amps $ 126.50 2 601 amps to 1000 amps $ 192.50 2 Phone No. ` Over 1000 amps or volts S 363.75 _ T 2 Job No. - Reconnect only _ $ 53.50 �~ 2 Elec. Cont. Lice. No. Exp.Date 4c Temporary Services or Feeders OR State CCB Reg. No. Exp.Date Installation,alteration,or relocation CC)T Business Tax or Metro No._-,-_Exp.Date 200 amps or less $ 53.50 2 201 amps to 400 amps _ $ 80.25 2 401 amps to 600 amps $ 107.00 2 �.ynatllre of Supr EIeC'n_ _ _., Over 600 amps to 1000 volts, -" see"b"above. License No._ -Exp Date_ 4d.Branch Circuits Phone NO _ New,alteration or extension per panel a)The fee for branch circuits 2b. For owner Installations: with purchase of service or feeder fee. Print Owner's Name_ � - N.17-D 14 Each branch circuit $ 5.35 2 Address b)The fee for branch circuits without purchase of service City State Zip t 22 n?3 or feeder fee. Phone No 4i �219-7so _ First branch circuit $ 37.50 Each additional branch circuit - $ 5.35 The installation is being made on property I own which is not 4e.Miscellaneous intended for sale, lease or rent. (Service or feeder not included) Each pump or irrigation circle _ $ 42..75 Owner's Signature Each sign or outline lighting _ S 42.75 _ Signal circuit(s)or a limited energy 3. Plan Review section (if required):* panel,alteration or extension $ 60.00 °[ - a_ Minor Labels(10) - $ %;Z-ee �- - Please check appropriate item and enter fee in section 59. 4f.Each additional Inspection over ice,.oo 4 or more residential units in one structure the allowable In any of the above �--_ Service and feeder 225 amps or more Per Inspection $ 50.00Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 _Classified area or structure containing special occupancy as W described in N.E.C.Chapter 5 r. Fees: aU ,,,,) Sa.E ter total of above fees $ ` Submit 2 sets of plans with application where any of the above apply. Surcharge(.06X total fees) S Not required for temporary construction services. Subtotal 'OF $ 5b.Enter 25%of line Be for NOTICE Plan Review g required(Sec.3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WI THIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account 0 AT ANY TIME AFTER WORK IS COMMENCF-D. Total balar1 3 Due $ i\dsts\fornslelectric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 — BUP _ Date Requested (,^I q 00 AMPM BLD ter'' Location �S�C' _ht,I'L( Suite EC 's u� Contact Person SCLr7A-k .� Ph 5-?rj-"2S S – -7p � Contractor Ph �, _ SWR BUILDING Tenant/Owner Retaining Wall ELR Footing Foundation ACC@SS: FPS Ftg Drain Crawl Drain Inspection Notes: SON — Slab bD SIT Post Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm — Susp'd Ceiling _ Roof Misc: Final PASS PART FAIL — 05 19 G PZiffA eam — - Under Slab Top Out — - — — Water Service _ Sanitary Sewer — —-- Rain Drains PART FAIL _—�_.— ---._ — ------- --..— CHANT Pos eam --- -- --- Rough In Gas Line -- -- --- — — --_ Smoke Dampers RT FAIL L TRIC L - ----- a service Rough In UG/Slab — Low Voltage Fire Alarm m m PART FAIL SITE JBackfill/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 [ ] Please call for reinspection RE:_ — [ )Unable to inspect-no access ADA ` /) Approach/Sidewalk Other Date ! D(/ Inspector_ Ext Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site. CITY OF T I G A R D PLUMBING PERMIT ,�. DEVELOPMENT SERVICES PERMIT#: PLM2000-00194 13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171 DATE ISSUED: 6/12/00 SITE ADDRESS: 11500 SW MANZANITA ST PARCEL: 1 S134CA-00524 SUBDIVISION: PANORAMA NO.2 ZONING: R-4.5 BLOCK: LOT: 045 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: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of new gas water heater, conversion. Owner: FEES SARAH I_AWTON Type By Date Amount Receipt 11500 SW MANZANITA STREET PRMT DEB 6/12/00 $50.00 0002872 TIGARD, OR 97223 5PCT DEB 6/12/00 $4.00 0002872 Total $54.00 Phone 1: �— Contractor: OWNER REQUIRED INSPECTIONS Phone 1: Top-out Insp Reg#: Final Inspection C o This permit is issued subject to the regulations contained in the Tigard Municipal Cade, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. J 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 iaw 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 rob I ies of these rules or direct questions to OUNC by calling (503) 246-1987. Iss d By: Permittee Signature: - ` - Call (503) 6 175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan CV- 13125 SW HALL BLVD. Commercial and Residential Recd By 1 � - TIGARD, OR 97223 Date Recd 6f (503) 639-4171 Date to P.E. _ Print or Dale to DST Type -r, Incomplete or illegible applications will not be accepted Pem,ure__(' t�( 5� Related SWR t Called__ Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job Sink 11.50 Address Stj et Address _ 11.50 Tub or Tub/Shower Comb. 11.50 Bldg 0 City/Slate Zip Shower Only s 11.50 q Water Closet 11.50 Name d V Urinal 11.50 Owner Mailing Address 'le Dishwasher 11.50 11;1v 56v ftnZat7lbi.1Gaibage Disposal 11.50 /State Zip Phone _ f (W /J 9 s 21-7.sio� Laundry Tray 11.50 �Y Name (� Washing Machine/Loundry Tray 11.50 Floor Drain/Flor. ' nk 2" 11.50 Occupant Ma ing Address Suite 3" 11.50 4" 11.50 City/Slate Zip Phone Water Heater 41 conversion O like kind 11,50 - Gas piping requires a separate mechanical permit. Name , r 'r MFG Home New Water Service 32.00 Contractor Mailing Address Suite MFG Home New San/Storm Sewer_ 32.00 Hose Bibs 11.50 Prior to permit City/Slate Zip Phone Roof Drains 11.50 Issuance,a copy Drinking Fountain 11.50 of all licenses are Oregon Const.Cont.Board Lic.0 Exp.Dale Other Fixtures(Specify) 15.00 required If expired In COT Plumbing Lic.0 Exp.Date database Name Architect Sewer-151100' 38.00 or Mailing Address Suite Sewer-each additional 100' 32.00 Water Service-1st 100' 38.00 Engineer City/State Zip Phone Water Serdce-each additional 200' 32.00 Descri work to be done Storm&Rain Drain- 1st 100' 38.00 Newt Repair O Replace with like kind: Yes O No O Storm&Rain Drain-each additional 100' 32.00 Residential Commercial O Additional description of w - Commercial Beck Flow Prevention Device 32.00 /�"1G1�/1L� lvc7 i ,A+0f W (/I1119 y/�9llQ 5 i'esidenlial Backflow Prevention Device' 19.00 Catch Basin 11.50 Are you capping,moving or replacing any fixtures? Insp.of Existing Plumbing or Specially Requested 50.00 d Yes O No O Inspections I per/hr If yes,see back of form to Indicate work performed by Rain Drain,single family dwelling 45.00 t` fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 Cn } WORK COULD RESULT IN INCREASED SEWER FEES. V QUANTITY TOTAL F- I hereby acknowledge that I have read this application,that the information Ise-,-Iric or riser diagram is requked If Quantity Total Is >9 J given is correct,that I am the owner or authorized agent of the owner,and m that plans submitted are in compliance with Oregon State Laws. "SUBTOTAL 50 �, 0 Signature of Owner/Agent ate 8%SURCHARGE J Contact Person Name Phone "'PLAN REVIEW 26%OF SUBTOTAL rFl HOUSE,i178.00" Required onlyN fixture qty.total Is>9 Q I: 260;00 TOTAL n s a A 'Minimum permit fee Is W+0%surcharge,except Residential Backflow Prevention a _ Device,which is$25*0%surcharge -All New Commercial Buildings require plans with Isometric or Ater diagram and plan review. I%dsts\formstpl-xnapp doe I III M9 PLEASE COMPLETE: Fixture Type Quantity b ` New Moved R Ped Sink Lavatory _— Tub or Tub/Shower Combination Shower Only Water Cf6set Urinal _ Dishwasher Garbage Disposal — Laundry Room Tray Washing Machine Floor Drain/Floor Sink 2" --311 Water Heater — Other Fixtures (Specify) REGARDING ABOV : \ COMMENTS � C - - J — I\dsbtlaamdp"Wp.d-11/1 Mg CITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2000-00219 13125 SW Hail Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 06/05/2000 PARCEL: 1 S 134CA-00524 SITE ADDRESS: 11500 SW NIANZANITA ST SUBDIVISION: PANORAMA NO.2 ZONING: R-4.5 BLOCK: LOT: 045 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: Sl UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50+ HP: CLO DRYERS: FURN < 100K ETU: AIR HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Install a new gas furnace and gas line. Owner: FEES _ SARAH LAWTON Type By Date Amount Receipt 11500 SW MANZANITA STREET PRMT GEO 06/05/20( $50.00 0002688 TIGARD, OR 97223 5PCT GEO 06/05/20( $4.00 0002688 Phone:503-579-7502 Total $54.00 Contractor: MORRISON CONTRACTING SERVICES SANUEL J MORRISON 5513 SE 58TH REQUIRED INSPECTIONS _ PORTLAND, OR 97206 Gas Line Insp Phone:503-774-6576 Heating Unt Insp Reg #:LIC 110395 Final Inspection a ORIGINAL m W This permit is issued suhiect to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance 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 requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set for in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct quest' o OUNC by calling (503)246-9189. Issue By: j Permittee Signature: Call (503) 639-4175 by 7:00 P.M.for Inspections nee 0 next business day Plan Check 0 CITY OF TIGARD Mechanical Permit Application Recd By .__ 13125 SW HALL BLVD. Commercial and Residential Date Recd TIGARD, OR 97223 Date to P.E. (503) 639-4171, X304 Date to DST_ _ Print or Type Permit'w Incomplete or illegible a plications will not be accepted called Name of Developmenl/Prolect Description Table 1A Mechanical Code Qt Price Amt Job Street Address SureM A Permit Fee 16.00 l r 1) Furnace to 100,000 BTU Address I J(:U including ducts&vents see footnote 1,2 9.65 Bidgn CRY/Statezip 2) Furnace 100,000 BTU+ 19 7 Z Z Including duds&vents see footnote 1,2 12_.00 Name(or name of businesq) 3) Floor Furnace Owner c,�+p\ Including vent see footnote 11,2 9.65 - Mailing Address C� 4) Suspended heeter,wall heater y or floor mounted heater see footnote 1,2 9.65 11-1 M) ;W V0 41�Z� t 14 S i 5 Vent not Included in mance rtnN 4.75 CM /Slate Zip Check all that apply: *Boller Phone Ilea. Air G 722 Jd�9_7.0-L For Items 8-10,see or Pump C- Qty Price Amt N (or name business) footnotes 1,2 -Comp 6)<3HP;absorb unit to 100K BTU _ 9.65 Occupant Mailing Address 7)3-15 HP;ebsorb unit 100k to 500k BTU 17.65 _ Cay/State Zlp Phone 8)15-30 HP;absorb unit.5-1 mil BTU 24.15 _ Name 9)30-50 HP;absorb Contractor Name 1-1.75 mil BTU 36.00 �, �• 10)>50HP;absorb unit Prior to permit Mailing Address >1.75 mil BTU 1 60.15 Issuance,a copy r 3 Sl` 11 Air handling unit to 10,000 CFM of all licenses wState zip Phone 7.00 are required H u-+ l 6r 72�'ti 7Y 65 7 12)Air handling unit 10,000 CFMF expired in COT Oregon Coni '.ont Board LIc N Exp.Date 11.85 database /o '') (7"'/3-°'" 13)Non-portable evaporate cooler Architect Naf1e 7.00 14)Vent fen connected to a single dud - - _ 4.75 or Mailing Address 15)Ventilation system not Included in applianoe permit 7.00 Engineer City/State zip Phone 16)Hood served by mechanical exhaust _ 7.00 Describe work to be done 17)Domestic incinerators 12.00 i New p' Repair O Replace with like kind Yes O No 0 18)Commercial or Industrial type incinerator Residential df Commercial O - 46'25 19)Repair units Additional inforrIation,Qr description of wont: 8.40 N.etir �n j f l�H c ,� J- ��r 1� 20)Wood stove/gas FP/other units/clothe dryer/etc. 7 .00 NOTE: For Commercial projects only;Units over 400 lbs require 21)Gas piping one to four outlets structural gas calks. See footnote 1 I 3.75 t Type of fuel: oil O natural gas K LPG O electric O 22 More than 4-per outlet each .75 Minimum Permit Fee$50.00 SUBTOTAL '7 D I hereby acknowledge that I have read this application,that the information 8%SURCHARGE 1 given is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL the owner,that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only I TOTAL jSignature of er/Agent Date -- - Other Inspections and Fees: 1. Inspectleas outside of normal business hours(minlnum charas-two Contact Person Name phone hours) $911.00 per hour 2. Inspections for which no fee Is specifically Indicated (minimum ✓,..t �� /J a r i s� -7 71� -6,r 7 charge-half hour) $50.00 per hour 'oonotes for commercial projects only: 3. Additional plan review required by changes,additions or revlsiow-i to 1. Provide full schemati..of existing and proposed gas line and pressure. plans(minimum charge-one-half hour)$50.00 per hour 2. Provide drawings to scale showing existing and proposed mechanical units. -Residential Contractor Boller Certification required - -- -- -Residential A/C requires site I Ion showing placement of unit I:\mechperm doc rev 7/19/99 CITY CF TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMIT #. . . . . . . .. PLM99-0007 DATE ISSUED: 01 /12/99 PARCEL: 113134CA--00524 OITE ADDRESS. . . : 11900 SW MANZANTTA ST SUBDIVISION. . . . : PANORAMA NO. 2, ZONING: R--4. 5 BLOCK. . . . . . . . . . . LOT. .. . . . . . . . . . . . :045 JURISDICTION: TIG - CLASS OF WORK. . :ALT -__. GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 FIXTURES-------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 LOVf1TORIES. . . . : 0 OTHE-.R FIXTURES. . . . : 0 TUB/SHOWERS. . . : 0 SEWER LINE (ft) . . . : 35 WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarl(s : REPLACE AN EXISTING SEWER LINE (.351 ) . Owner,: __._..___.__.___________---.------_._-_------__-.----_____.._________ FEES ---------------- SARAH KRIEGAL type amoi-mt by date i-er--pt 11500 SW MAN7ANITA PRMT $ 30. 00 GEO 01 /12/99 139-31.212t TIGARD OR 97223 SPCT $ 1. 50 GEO 0 ' /1.2/99 1.39-312121 Phone #L: Cont Tact or- ----- RANGER ROOTER PLUMBING INC 605 NF .';='ND STRE=ET AATTLFGRC)UND WA 98604 ___.____.___._._.._--_-----,------------------- Phone ------------------ Phone #: 503-274--?367 $ 3t. 50 TOTAL Reg #. . : 131969 ---- -- REQUIRED INSPECTIONS ------- This permit is issued subject to the regulations contained in the Sewer Inspection Tigard Municipal Code, State of Ore. Specialty Codes and a' other Final Inspection applirable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started M� CL within 180 days of issuance, or if work is suspended for more Irthan 188 days. ATTENTION: Oregon law requires you to follow rales _ N adopted by the Oregon Utility Notification Center. Those rules are _ set forth in OAR 952-MI-0010 through OAR 952-MI-0080. You may _ J obtain copies of these rules or direct questions to OUNC by calling m (503)246-1967. W / �---- T r y,.i e d BY : _.__. _ Permittee S i g n a t r.t r e : +++ 4-++•++++++•+.}++++ +++++++++-4+++++++++++++++ i-+++.++++++++++++++++++++++++++++ Call 639-4175 by 7:00 p. m. for an inspection needed the next business day +-+++++++•++++++4•++-++4.+++++++.4-+++•+++++++++++++++++++++++++++++-1-++++++++++++++++. CITY OF I'IGARD Plumbing Permit Application Plan Checks 13125 M HALL BLVD. Commercial and Residential Rec:'d By TIGARD, OR 97223 Date Recd (503) 639-4171 � - Date to P.E. Print or Type Date to DS Incomplete or illegible applications will not be accepted Permitale L ty' a Y' Related SWR 0 Calw Name of DevelopmenUPro)ect Job Sink 9.00 Address Street Address Suite Lavatory 900 00 j.GJ M h ca, Tub or Tub/Shower Comb. 900 Bldg 0 /State Zip Shower Only _ l,c c rt 4 `1 9.00 NaMA Water Closet 9-00 fl /c - f,— Diatnvasher Owner Mailing Address_ ft ®00 _ Garbage Disposal 900 4 ltd //1 Washing Machine — 9,00 City/ tate ip Phone — — a Floor Drain/Floor Sink 2' 900 Name 3' 9.00 — 4' 9.00 Occupant Mailing Address Suite Water Heater O conversion O like kind 9.00 Gas piping requires a separate mechanical permit. City/State Zip Phone Laundry';oem Tray 900 dame — — Urinal 9.00 �ic.\ta 1�1 NM�„' T.,t Other Fixtures(Specify) 9.00 Contractor Malll Add—mas Suite 9.00 00 Prix to permit Cky/Slate ZIP Phone Sewer-1 at 100' r 3 9.. Issuance,a copy (`i:c., R SC- -77kf` 00 67 --- of all licenses are Oregon Const.Cont.Board Lic.a Exp.Date Sewer-each additional 100' 25.00 required If Water Service-1st 100' 30.00 expired In COT Plumbing Llc.R Exp.Date Water Service-each eddltlonsl 200' 25.00 database _ Storm 6 Rain Drain-1 a 100' 30.00 Name Storm R Rain Drain-each additional 100' 25.00 Architect Mobile Home Space 2500 or Mailing Address Suite Commercial Back Flow Prevention Device or AMI- 25.00 Pullution Device Engineer City/State ZIPIp Phone__ Residential Backflow Prevention Device* 15.00 (Irrigation timing devices require a separate Describe work to be done: restricted energy pernH.) New • Repair O Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00 Residential A Commercial O Catch Basin9.00 Additlon;sl description of work: � � _ Fru- h o-A t c P• w' Insp.of Existing Plumbing 40.00 40.00 Specially Requested Inspections 40.00 a � Are you capping,moving or replacing any fixtures? Rain Drain,single family dwelling 30.00 Yea O No • Grease Traps 9.00 If yes,see back of form to Indicate work performed by QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE IsorrMfrk a riser dispram h rsquked K Quantity Total u >9 J WORK COULD RESULT IN INCREASED SEWER FEES. •SUBTOTAL m I hereby acknowledge that I have read this application,that the Information given is carted,that I em the owner or authorized spent of the owner,and �^ 6%SURCHARGE W that plans submltted are in compliance with Oregon State Laws. _.1 31 eture of Owner/ en! � v 9 Date —PLAN REVIEW 267E OF SUBTOTAL Raqulred only K fMm qty.total is>9 v Contact Person Nartta TOTAL Contact ` P one / `I�1 (/1��/n�+s SU3_Z7y Ci 'Minimum permit Ma Is$25+5%surcharge,except Residential Backflow Prevention Device,which Is$15+5%surcharge **All Now Commercial Buildings require plana wirh Isometric or riser diagram and plan review WvtsVA wp doc 7/2M PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed/Capped Sink Lavatory Tub or Tub/Shower Combination Shower Only _ Water Closet Dishwasher GarbageDisposal Washing PlKhme _ Floor Drain/Flo Sink 2" 3" Water Heater _ Laundry Room Tray _ Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I%doft".n..pp ex MW CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 6394171 - — i BUP /Z,) !ZVj,, Date Requested / AM PM _, BLD Location %/� � ���,�� ' gaX'x -�w- Suite MEC Contact Person � xi G�d��r�- _ Ph 7-�� PLM ����D 7 Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR — Footing Access: Foundation FPS _ Flg Drain Crawl Drain Inspection Notes: s�� 8GN - Slab s��J SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing — Insulation Drywall Nailing Firewall Fire Sprinkler —_— --_—� Fire Alarm Susp'd Ceiling _ — Roof Misc: — - — Final PASS PART FAIL — — PLUMBING Post&Beam Under Slab _ Top Out Water Service _ Sanitary Sewer _R_��n Drains _ FiJFRO PART FAIL — HANICAL Post&Beam --- — Rough In Gas Line -- — Smoke Dampers Final -- —' — --- PASS PART FAIL ELECTRICAL -- -- Service — Rough In UG/Slab — _ __— Low Voltage Fire Alarm - Final PASS PART FAIL —. --- SITE Backfill/Grading — Sanitary Sewer Storm Drain [ J Reinspection fee of$— —required before next inspection. Pay at City Hall, 1312 i SW Hall Blvd Catch Basin Fire Supply Line [ J Please call for reinspection RE:_ — _ [ ]Unable to inspect no access ADA Approach/Sidewalk Other _ Date _Inspector Ext --- Final PASS PART FAIL io NOT REMOVE this Inspection record from the job site.