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12290 SW MAIN STREET IS NIVW MS 06ZZ6 1 co 0. Z TA S N O i5 C4 M W .J 12290 SW MAIN ST CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT N: PLM2001-00616 13125 SW Hall Blvd.,Tigard,OR 972:'1 (503)639-4171 DATE ISSUED: 11/29/01 SITE ADDRESS: 12290 SW MAIN S—3A PARCEL: 2S102AA-05000 SUBDIVISION: MORINS ADDITION ZONING: CBD BLOCK: LOT: JURtiDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2 OCCUPANCY GRP: FLOOR DRAINS: 1 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing fixtures for commercial TI. Fixtures include(2)commercial backflow devices, (1)hub drain, and(1) primer. See SWR2001-00307 for fees. _ FEES � Owner: Type By Date Amount Receipt BISHOP, WILBUR A AND MARTHA E PRMT CTR 1,1/21/01 $126.00 27200100000 PO BOX 23832 5PCT CTR 11/21/01 $10.08 27200100000 TIGARD, OR 97281 Total $136.08 Phone 1: Contractor: RAYBORN'S PLUMBING INC PO BOX 69 TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone 1: 503-692-4139 Rough-in Insp Reg#: LIC 87852 RP/Backflow Preventer PLM 34-166PB Final Inspection (L W N- JThis perm;t is issued Subject to the regulations 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. wThis 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 by the Oregon Utility Notification Center. Those iules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of thetse rules or direct questions to OUNC by calling (503)246-1987. Issued By: Permittee Slgnature:x Call(503) 6394175 by 7:00 P.M.for an Inspection needed the next business day N(-3v-20--01 01 : 17P Rayborn' s Plumbing, Inc . 15036912328 P-02 Plumbift Permit A i (� ,/ roceiveci__� o/ Perrritno. Pc,y OL—Ae�1jz_ Ci of Tigard v�� `� r Per it Nf.,, eo�o7ilang F��r,ni�fo 1 h' v .No. 1 �- 1 t 125 Sw H.0 Blvd "rig.rd.t>'R 9n23 -�-��--! Phone 5016494171.Fax Stl.i 59N-19611 Nov ,) o 200 Date issued B �Recei,,at-o. — Iand Use Approval Ca+e Nib No, Pavma+:'mon J 1 Rc 2 1•auniv dwelling or accessoiv Commercud/indust nil U Multi lerr►ily 7-enant improverns .1 New umsuuctwn U Addition/alteration/replacement U Fant nervi U Other: Jobaddress- 12290 SW Main Street/Suite 3A TleuTi Qty Fee Total New 1 &2 family dwelling only:/+100 It Bldg No Suite no. _ SFR(1)Bath M 324120 0 fax niap/tax lot/account no.: SI It(2)Bath 5350 0 SFR(3)Bath 5399 0 Lot Block: Subdivision : Each additional batt/kitchen S (> Project name: Tarrant/Dental Site Utilities:Catch basin/area drain $16.60 I► City/county Zip i wells/leach line/trench drain S 0 Footing drain(no Lin. it ) S 0 Description and Location of work. Manufactured Home utilities-each $46.40 0 Date of Completion/inspection. Manholes _ S _ 0 Rain drain connector 3 0 Sanitary Sewer(no of linear feet) Ion $55.(H) 0 Business name : RAYBORN'S PLUMBING Storm Scwer (no oflincar feet) 100' $55.(H) 0 Address : P O BOX 69 Water Service (no.of linear feet21(H)' 355 00 0 City . TUALATIN Slate: OR lip: 97002 Fisture or item _— Absorption valve $1660 0 Phone .503 692-4139 Fax . 501691-2128 hack flow preventer-Commercial 2 $46,40 _ 92.8 is Mail Address : Wayne(a!Rayborns.com Backwater valve $16.60 0 Basins/Lavatory $16.6() 0 ('CB no 87952 Plumb. Bus. No . 14-166PB Clothes Washer $16.60 t► ('itv/Metro Lic No.: 0111806 Dishwasher $16.60 0 -- - D rirrking Fountain(s) $16.60 U Contractor's signature Ejector/sump $1660 0 Print name: Wayne Siebold Date :11/20/)1 Er. nsion Tank $16.60 (► Fixture/sewer rap S16,00 0 Floor drains/floor sinks/i lub 1 $16.60 166 Name Gat,►age Disposal $16.00 0 Address. Ilose Bibb 516.60 0 City State ORZ,ip: lee maker $16.60 0 httcrccptor/Grease trap $1&60 _ Il Phone Fax Primer _ I 516.60 16.6 d Roof drain(commmial) $16.60 0 H Sinks(s),Basin(s),Lav(s) $16.60 0 N Notice This permit application expires if a permit is not obtained Sump $1660 0 within 180 days alter it has been accepted as complete. Tubs/shower/shower pan $16.60 0 J Urinal $16.60 0 iD Include Fixture fee breakdown sheet Water Closet S16.6G 0 (� Commercial permits require Scwer'i'ally sheet -- —111 W Water heater $16.60 J Other: 316.60 0 Tigard Takes Visa for Payment TOTAL 1 1 126 Minimum Fee 350 126.00 Visa Card Expire Date-09/010 0 3 Plan review#304/6 Cardholder it.. -How d . Ra. rn State char a.08% 10.08 SIGNA7UR ' Amounts 1 t/` .6$ row 136.08 NOV-20-01 01 : 17P Rayborn' s Plumbing, Inc . 15036912328 {P.03 • iof1vo0 FRI 10:" FAY 103 598 1960 CHN OF 'FIGARD Wo03 f r PLUMBING PERMIT FEES: -`- PRICE TOTAL Ntw i and 2-family dwellings only: FIXTURES JIndIvIdumQ,. _ CITY as AMOUNT (includes all plumbing fixtures In ORICE TOTAL Sink 16.60 1hd dwilling and the firs1100 ft. OTY (Na) AMOUNT - -- -- for each utility connections -.. ------- -- ----- Lavatory Tuer Cb 18.60 749 Z0 b or T uh/Showom "-' Twgj7.�+batty _ X350.00 -" 3howor Only �- -- 10.00 - - Thr ,J ba0t $199.00 - -- Water Closet _ 16.60 Urinal 16.60 _ eye STATE SURCHARGE Ubhwasher 16,60 -PLAN REVIEW 2s%OF 9U9TOTAL - Garbege TOTAL - 1 Gundry Trey �- 16 60 - - Weshinq Machine 16 60 r 2"" - 1 16.60 6o PLEASE COMPLETE: P o iD (1(I �/1 4• Water Flealer O conversion Q like kind 16.60 - �QUantitr b Work PbHormed� C3as piping requires a separalo mechanical rlxture Type: Now Moved Replaced Removed/ -permit Coed MFC)Home flew Water Service 46.40 Sink -___ - --------- - _------ MFG Home Now San/5lonLaval n Sewer 46.40 !lose Sibs �- _ 18.80 - - 1 uh or Tub/Shower Combination Root Grains 18.80 shower Only 15—Inkhtg fountain 1 60 Water Closet --- UTlnai 16,60 -- -- -- ---- cntrer rlxn,res tSpeclfy) � � V /4. (��_ Ulshwaaher Garbrige Uis osal laundDLRoom Tray --- - _ - - - Was --- __ 1 1._L 1 Sewer• 161 100' 55 OU Floor Drain/Sink: 2" - 1�e ' ' 3" - - Sewer each additional 100 �- 48.40 Water Service-1st 100' 55.00 -- Water heater- Water Service•each additional 200- - 46.40 _- - 0111sr Ftxturen _ (Spec) 1� _ - Slrxm 6 Rain Drain- 1ef 100' � 55 On ` I - Sturm JR Rain Orafn-each addlilonal t00- 48.40 - - Commercial Dark flow Prevention Device 40.40 �� A G W -�- -I L•Od- Residential Backflow Preventlon Device' 27.55 — ---- -- - Calch Basin _ - 16.60 Inspecllon of Exlsllno nlumbing or Specietly - - - 12.50 - � -_- T -- -- _ • • Requesled Inspedlo. er/hr. COMMENTS REGARnINO A"CVF! a (lain nraln,single family dwelling 65.25 ( grease U) QUANTITY TOT - -- - - - ` Isonre6k or ricer dtertrron ie rrgtdrs f —! OuargNY Tolal lf_ 1 9 — ,J •SU13TOTAL m oa m ---Oye STATE 9URCl1ARGE - y--- -- W _ _ /0-019 J "PLAN REVIEW 25%OF SUBTOTAL III equlrcdarddy llxhrrsgty_total Is s fl Tom' /'�fL.GY N 1 TOTAL A •Minlmum permit fee Is$72 50•6%state--rherge,excepl nesidenllxl nnci,.mov. ��H 1 i. [, r'rover,tv'n nevkn,wfikh Is$se 7S AY,alma rurchorpct/t All New Commerelal Buildings r"Om plans with Itomotrir or riser die7rnm end I,lon review CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspettion Line: 639-41175 Business Line: 639-4171 BUP Date requested ;— AM _PM BLD Locationrl Z Z GJ L u Suite 3�� MEC Contact Person w .c- Ph (r 9� � � PLM Conti a,�tot Ph SWR BUILDING Tenant/Owner �� r .� ELC Retaining Wall ELR _ Footing Access: Foundation FPS Fig Drain Crawl Drain Inspection Notes: SGN Slab SIT Post&Beam -- Ext Sheeth/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall — Fire Sprinkler _ Fire Alarm Susp'd Ceiling Ole —_ Roof -� Misr,: _ Final PASS PART FAIL PLUMBING Post&Beam — — Under Slab 1 ri Out �_— Water Service — Sanitary Sewer �--' Rain Drains ia PART FAIL. MEUHANICAI. Post&Beam — Rough In Gas Line -- Smoke Dampers Final — PASS PART FAIL IL ELECTRICAL —�--- — - Service _ Rough In - UG/Slab _ Low Voltage J Fire Alarm m Final PASS PART FAIL Lu SITE J Backfill/Grading ---- --- -- — — Sanitary Sewer Storm Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ J Please call for reir+spection RE:_ — I J Unable to Inspect-no access ADA Approach/Sidewalk 4?_ Other Date Inspector ZYZ --Ext _ Final PASS PART FAIL DO Nar REMOVE this inspection record from the job site. r CITY OF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT 0: SWR2001-00307 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 11/29/01 SITE ADDRESS; 12290 SW MAIN ST 3A PARCEL: 2S102AA-0F000 SUBDIVISIC N: MORINS ADDITION ZONING: CBD BLOCK: LOT: JURISDICTION: TIG TENANT NAME: TARRANT DENTAL USA NO: FIXTURE UNITS: 2 CLASS OF WORK- ALT DWELLING UNITS: TYPE OF USE: COM NO.OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: .1 EDU increase. Previous EDU =4.0 for a total of 64 fixture values. Addition of 2 fixture values, for a new total of 66 fixture values=4.1 current EDUs. Owner: — FEES _ BISHOP, WILBUR A AND MARTHA E Type By Date Amount Receipt PO BOX 23832 TIGARD, OR 97281 PRMT CTR 11/29/01 $230.00 27200100000 Total $230.00 Phone: Contractor: RAYBORN'S PLUMBING INC PO BOX 69 TUALATIN, OR 97062 Phone: 503-692-4139 Reg#: LIC 87852 PLM 34-166PB Required Inspections a oc rN G _J m This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 J 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 not so located,the installer shall purchase a"Tap and Side Sewer" Perm Issued by: X /,, /� r� 'i/_fes. Permittee Signature Call (503)639-4175 by 7:00 P.M.for an Inspection needed the next business day Accumulative Sewer Tally Tenant Name:Tarrant Dental This SWRA 2001-00307 _ Address: 12290 SW Main St.,Ste. 3A This PLM# 2001-00616 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off#s count # value #s vaiues Baptise /Font 4 0 0 0 0 0 _ Hath-Tub/Shower4 0 0 -� 0 0 0 -Jacuzzi/Whirlpool _ 4 0 0 0 0 0 Car Wash-Each Stall _ 6 0 0 0 0_ 0 _ -Drive through 16 0 0 0 0 0 _ Cus Lidor/Water Aspirator 1 0 0 0 0_ 0 Dishwasher-Commercial 4 0 0 0 0 0 _ -Domestic 2 0 0 u 0 0 Drinking Fountain 1 _ _0 0 0 0 0 e Wash _ 1 — 0 0 0 0 0 Floor Drain/Sink-2 inch _ 2 _ 0 0 1 2 1 2 _ 3 inch 5 0 0 0 0 0 4 inch 6 0 0 0 0 0 —�` Car Wash Drr 6 0� 0 0 0 0 _;arbaLe Disposal Domestic(to 314 HP) 16 0 0 0 0 0 Commercial(to 5 HP) 32 0 _ 0 _ 0 0 0 Mustrial over 5 HP 48 0 0 1 0 0 0 Ice Machine/Refrigerator Drain 1 1 _ 0 0 0 0 0 Oil Sed Gas Station 6 0 0 0 0 0 Rec Vehicle Dump station 16 0 0 0 0 0 Shower-Gang(per head) 1 0_ 0 0 0 0 _ - Stall 2 0 0 0 0 0 Sink- BL r/Lavato 2 0 0 0 0 _ 0 Bradley 5 0 0 _ 0 0 0 Commercial 3 0 0 _ 0 0 0 Seivice 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 _ 0 0 0 C Urinal 6 0 0 0 0 0 Previous EDU Count 4 44 64 Capped EDU Credit 0 rOTALS 0 64 1 0 1 0 1 2 1 1 1 66 0 Current Fixture Value_ 6E divided by 16= 4.1 Current EDU 1 EDU= $2,300.00 Previous Fixture Value 64 divided by 16= 4.0 Previous EDU J — Change 2 divided by 16= ^ 0.1 over (under) $ 230.00 Enter EDU Change Here 0.1 HISTORY Notes: Previous EDU per Jamie_ PLM# EDU# SWR# PLM# EDU# SWR# PLS EDU# SWR# Name:_ Date: sly ature of p,04on that calculated this tally sheet and date perfrntned 1 required CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4176 Business Line: 639-4171 BUP Date Requested (Jr� g-"d 0 AM PM BLD r Location /OQp9r7 Suite 3 MEC Contact Person Ph PLM Contractor , Ph lam? SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: — — Slab Post&Beam Ext Sheath/Shear _ Int Sheath/Shear Framing Insulation Drywall Drywall Nailing Firewall Fire Sprinkler _— Fire Alarm Susp'd Ceiling Roof Misc: -- Final PASS PART FAIL -- — x PJMN IN 0> Post 8 Beam ��-- -- ----_ __—. Under Slab Top Out Water Service Sanitary Sewer R ' Drains PASS PART FAIL HANICAL Post& Beam -- ---- -- --- — Rough In Gas Line — Smoke Dampers Final PASS PART FAIL ELECTRICAL !- 4' Service � Rough In —,—_- ---- - --___�-- U) UG/Slab Low Voltage J Fire Alarm m Final 0 PASS PART FAIL -- ---- — J SITE ---- - — -- — -- Backfill/Grading Sanitary Sewer Storm Drain. [ ] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ]Please call for reinspection RE. _ [ ]Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk pate , / �IC� Inspectors Ext Other Final PASS PART FAIL Db NOT REMOVE this Inspection record from the job site. CITY OF TIGARDPLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001 00467 ' 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 9/28/01 PARCEL: 2S 102AA-05000 SITE ADDRESS: 12290 SW MAIN ST 2 SUBDIVISION: MORINS ADDITION ZONING: CBD BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES. TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUBISHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Water heate replacement. FEES Owner: - Type By Date Amount Receipt BISHOP, WILBUR A AND MARTHA E PRMT CTR 9/28/01 $72.50 27200100000 PO BOX 23832 5PCT CTR 9/28/01 $5.80 27200100000 TIGARD, OR 972.81 _ Total $78.30 Phone 1: Contractor: STAN THE HOT WATER MAN PO BOX 33157 PORTLAND, OR 97292 REQUIRED INSPECTIONS Phone 1: 503-760-2992 Final Inspection �~ Reg#: LIC 130755 PLM 26-632PB a oc mThis permit is issued subject to the regulations 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 suspended for more than 180 days. 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 - Permittee Signature;�L Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day 09/27/2001 15: 13 7611115'A STAN THE HOTWATER MM PAGE 01 Plumbing Permit Applic.ation .. Dae►acaivad. P 0 h777 Pertnit no.: City of Tigard 7 /1 � —permit�• BuildinS per Cuyoj7�ord Adtlreu: 13125 SW Hall Blvd,7'Igartf, 5223Phone: (303) 6394171 Ptrtlect/aPpt.no.: Expire daa:Fax: (503) 598-19607f Data fastred: gSR. 0,'`u S 7' G./irJ�. .� 3 7-- S// z1 _ Y' R IL A uSe approval: Caro fik no.: payment type: U 1 &2 family dwelling or accessory 6)('ommercial/industrial O Multi-family U Tenant improvement U New construction U AddidoNalicradon/teplecement U Food service U Other: Job address: 11dg.no.. ��G' Suite no. - Now 11-rtad -fsaQ dw a Cyt Tobtl _Tax ntap/tax lot/accouni no.: ( laS.[oriutmy ) Lot: Blak: Subdivision: - - - SFR(1)bath }Y FR( )bub Project name: SFR(I bath City/county: -Ir 2[p: _ Each additiorutl-�W✓lutchen -' -�- Deac)iption and location of work on promises: SltegfWtlle� !_ lxc-,e/hF yrI", -- - Catch basic/arra drain Fast.date of coin iction/ins don: - • 77well�?_&ch..uwtJtmiiEh_dnun JAMKI Footma .ft.) T Business name: STAN THE HUTWATER MAN Manufactured home utilities Address: P.O. Box-T3—.5 1Manholes _7 sin drain connector City: ort an 1State: Or. ztP:97292- Saidtary sewer(no.tin.ft_) - Phone: 160•-2992 Fax:761-0159 E-mail: Storm savor(no.�in.ft,) CCB no„ 130755 Plumb,bun.reg. no. 26-632PB Water service.(no.lin. R.) City/metrolic.no.: 5670 - hlatisre or Itaw Cantractor's representative signature: Absorption valve Print name: I-d. - Bac ow venter ,!) Date:/ /l Bac water valve .sins/lavatory -- Name: 2/ AA/ 615 Clothes washer Address: is washer Uty: State: Z.IP n k1untain(s) — Photx: edon/ttum / Fax: F'maii: Upanst_u_n_ iF xttue/sewer cap Name nt):�ji I ttn Floor drai Dor cinke/hub LL Mailing address: _ Gatba di. Dial 71P Hose i b - - City: ~� State—�- Ice mrt u - d I'hone:� fe 7 Fax: E-mail: nteree ase tr�i� -" Owner installation/rmidential maintenance only: The actual installation Primers Nwill be made by me or the maintenance and repair made by my regular Roof drain(comrnetclal) --} - employee on the property I own as per URS Chapter 447. Si (s),basins,lays(a) Owner's signature: Dare: Sum J TIO- howe.,shower pan` - - m Name. LJFtnAI - � Address: _ JCLY: - State: attr treater - - TOW Phone: Fax: StT ��p: Kj9A pnWiedow wow cm*umk.0aw can ira wk jm r/.mm W-ft m Notice:'Ns permit Applies" Minimum fee................$ ut U MulwCar+d G� Plan review(at ^ %) S cmdh r d we 3permit d-4114 expires it a is not obtairw? 0flP within 130 days afar it has been Suue surcharge(8%) ....$ N dam�eut crd Accepted as octmpkto. TOTAL ...................... S l� S Gr Wd- tl A�otrr' - ao+ata tarv�cxaal CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 MST p .Bruafness Line: 639.4171 BUP , Date Requested hr, - 3 AM PM BLD Loc,tion Suite MEC Contact Person Ph (� PLM Contractor Ph SWR _ BUILDING Tenant/Owner _ ELC Retaining Wall c ELR Footing Access: Foundation FPS _ Fig Drain SGN Crawl Drain Inspection Notes: Slab _ 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 Servic f l Sanitary Sewer RA4LQrains Fi PART FAIL HANICAL Post&Beam — Rough In Gas Line — Smoke Dampers Final — — PASS PART FAIL ELECTRICAL d Service _ Rough In — W UG/Slab Low Voltage Fire Alarm _ Final _ m PASS PART FAIL W SITE J Backfill/Grading --------- Sanitary Sewer Storm Drain [ ]Reinspe,;tion fee of$ required before ext inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Please call for reinspection RE: Fire Supply Line [ ] _ [ ]Unable to Inspect-no access ADA Approach/Sidewalk ' Other _ Date 3 " 2/ Inspector_-L /G'f 1�y , Ext Final PASS PART FAIL DO NOT REMOVE this Inspection record from the Job site. CITY OF TIGARD DEVELOPMENT DEVELOPMENT SERVICES PERMIT#: PLM2000-00222 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/19/00 SITE ADDRESS: 12290 SW MAIN ST 3A PARCEL: 2S102AA-05000 SUBDIVISION: MORINS ADDITION ZONING: CBD BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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: Replace existing water heater with like kind. FEES Owner: Type By Date Amount Receipt BISHOP, WILBUR A AND MARTHA E PRMT DEB 6/19/00 $50.00 0003082 PO BOX 23832 TIGARD, OR 97281 5PCT DEB 6119/00 $4.00 0003082 Total $54.00 Phone 1: Contractor: GEORGE MORLAN PLUMBING + APPLIANCES 9806 SW TIGARD STREET CCB (EXP 6/2002) REQUIRED INSPECTIONS TIGARD, OR 97223 — Phone 1: 624-6895 Final Inspection Reg#: LIC 000027 PLM 026-60PB t. OC F- =D m 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 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 law requires ),ou 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 Permittee Signature: , 4 ^ (tel Call (503) 639-4175 by 7:00 P.M.for an inspection needed the next bu iness day JtW-01-2000 12:31 P-01 I r yr t IVI1r%U viumoing Permit Application Plan Chat*a 3125 SW HALL BLVD. RECEIVED Commercial and Residential - Rac'a By_ IGARD, OR 97223 Date Recd iO3) 639-4171 ,JUN or) ?Nq Date to P.E. Print or Type Date to DST lr> papf�itR�lf#��Mimble applications will not be accepted Permit Related SWR# _ U)/O# /05 7,?&O S D ;>h� -ds o a Called - Namep o Deveto mervPro/actPFJ RP., .�dlyldli l'•`':`:3 y} p"`;'l /" i 4QT,Y:Ii PF�JC ANIT Job rr sink Address Street Addv6) 'dre c' l/j� Suite n Lavatory 90 _S —�'1 Tub or Tub/Shower Comb, 11.50 Bldg# City/State ZIP Shower Only 11.50 Name r Water Closet 11.50 i � Urinal 11..10 Owner Mailing Address Suite Dishwasher 11.50 Garbage Disposal 11.50 City/State Zip Phone Laundry Trey 11.50 Name — Washing Machine/Laundry Tray 11.50 Floor Draln/Floor Sink 211.50 Occupant Mailing Address Suite 3' 11.50 Goy/State Zip Phone •- 11.50 Water Heator O conversion A like kind 11.50 5 rj Name Gas piping reuire%a separate mechanical permit. LoD_ /Q —1 MFG Home New Water Service 32.00 Contractor �k►g Address L MFG Hume New San/Storm Sower 32.00 Hose Blbc 11.50 Prior to perrnh CRY,State Z p 'hone Root Drains 11.50 sswnCe.acopy �{�_Q,70.23 4( — Drinking Fnuntain 11.50 of an licenses are Oneill0i Const.Cont.Huard Uc.a Ex al required M C �o�O�J Other Futures(Specify) 15.00 expired In COT Pknnbin Llc.t Exp. a database Cw —60 )0� OCI�I Name JC -- Archltect Sewer-1st 100' 39.00 or Mailing Address Svite Sewer-each additional 100' 32.00 Water Service-1 st 100' 39.00. EngineercIlyl5tete ZIPPhone Water Sevics-each additional 200' 32.00 lbscrfbe work to be done: Storm b Rain Drain-1st 100' 39.00 Jew O Repair O Replace with like kind: Yes No O Storm 6 Rein Oraln-each additional 100' 32.00 tesidentlal O CommerGal 4— additional description of work: —Commercial Back Flow Prevention Device 32.00 r��(4 e e e el L��a � CQ+Q y� y Catch B lel Badcllow Prevention Device* 19.00 l�l_� Z /l Catch Basin 11.50 la, arc you capping,moving or replacing am,fixtures? Inap.of Existing Plumbing or Specially Requested 50.00 '— Yes O Non ins cGona _ _perlhr _ N U) m `yes,see back of form to indicate work performed by Rain Drain.-Ingle family dwelling —� 45.00 xture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 ✓ORK COULD RESULT IN INCREASED SEWER FEES. --- J hereby acknowledge that I have read this application,that the IMQUANTITY TOTALormetlon m ven Is coned,that I am ft owner or authorized agent of the owner,and Isomefrk or User Map n is required M Orrerr TOOT b >9 V► tat plans submi led are In compliance 1th O on State Laws. *SUBTOTAL (,U Ignat of Ow r/Agent Date -� 8%SURCHARGE Peraort ane Phone / // S R trrd..PLAN REVIEW 5OF SUBTOTAL TOTAL (/ 7' -Minimum permlt Pse Is$SO•ax surf:hwipe,except RegWentlal Beddlow Prev",tion Devioe,wtild Is M•a%eurcherpe "All Now Commerefal oulldtnge maulm prr+s wilh Iv+metrfc or rigor dl3grem end P1on review'. Iam•lpkrmrpp.aoc t maree TOTAL P 01