12405 SW MAIN STREET Graphic presentation only.
Please see representative
for actual color and
material samples.
Presentation for:
13" TIGARD CHIROPRACTIC CLINIC
12405 SW MAIN Sr,
TIGARD, OR
Drawing #: 99337
Date of original drawing: 11/15/99
TIGAR
D
+ Sales: PG _ Design: LS
.�
CHIROPRACTIC,�
Revisions:
N = 11/17/99: change copy, change
color5, add retaincr5, add
CLINIC
another opt:on with peak.
1/14/00: Chanee to extruded
._ t cabinet, Lexan face, change
` 12405 color5, no wri5co laminate.
{ i f ? r.
C]Z:1 all
LL
? m :
V M C1/2" V'Q'
i""" ' Q O U. Q v
r z Please 'ntlai & date
_ _
4" pipe in a 2' x 2' x 3'-6" deep concrete footing. o -6 o .1 °; Q Colors:
Vcrlfy with permit. a o o w CC o >, Spelling;
d U U. Cl. Cn -� m - ,, — -----
Graphics: �C-
Date: _ — �Y►
.�. r.. Landlord Approval:
' pate: ---
f � ol ,
Sales Approv
Date:
Manufacture and install one Dli~ Illuminated monument sign � � ; •- i� � ___.L—_�'�---___a
This design presentation
Aluminum extruded cabinet with texcoal: finloh. faint the Same color as base, 2" retainers. C'3 '� ;r� is the property of ES&A Sign
Whit,, Lexan face with opaque Duranodic '4 30-69 background. White bhow-thru copy, I— m and Awning Co. til rights
Aluminum texcoated base palt-ted Light "an - VmifF color number. �i �.ut !a- .� 871 VJ IM%STq ft tC14 u. a� � � _.` � to Its prohibited without
reproduction
a a o are prohibited without written
internally Iilumitiated with 8OO ma high output lamp6. a Y , permission.
Single ateel pole mount dire:by buries in concrete footing I,� d o U-- q-A
Artwork: AvantGard Medium type style. 6-1/2" letter height. V ph. SO.i-b91-8474
3/8" Black FCO Slntra. � = °' U ° '� fax 503-691- 573
Addreea numerals: �° E z
,.., M C
m O +•
NOTICE: iFTHE PRINT ORTYPE ONANY -f! i-jl ' I I ! I � III
IMAGE IS NOT AS CLEAR AS THIS NOTICE, IiIIi ! I iii { IiI 1 ! 11111 IiI � I ! 1 i ! I { i ! i lll ( iII 1111111 1 ! 11111 Illlill III { Ill IIi � I � I llliil ! III � II ! Iililll iIII ( iI iII I ! { ► ! li Ii . I � IIiI0i1z
II � I iIi Iljllll iiI { i { II { � III I � �}
II II I II I I I II
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ITIS DUE TO THE QUALITY OF THE No.36
ORIGINAL DOCUMENT ' 111119 , 11111" 11,!!II IIII !!!! !!!! II 1! .II11 "11.111 "111110 ,1111,
LI !! 11 ilII IIII IIIl !! .II !! !111!!! I6 8 5
II� I! 111L1ZIyI! II 11!IlllII I!EI! IIZ!1. 11Zli IIOZI! Ii6 [ II 1! I! I!
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
Date Requested_ - AM_ PM g[p
Location L���S /�'L a4i"l Suite MEG _
Contact Person Ph �/- S S Sy PLM _
Contractor _ Ph SWR
LDS !�O � Tenant/Owner (7 't (��,i /� ; ELC �—
Retam ng Wall ELR
Foundation Access FPS
Ftg Drain SGN
Crawl Drain Inspection Notes ---- —
Slab ----- - -- --- �L�=- - ------- SIT
Post&Beam -------- —_____
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation - - --
Drywall Nailing
Firewall
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling - -- -- -
Roof
VSS ) PART FAIL
TNG
Post& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final - - - - - -
PASS PART FAIL
MECHANICAL
Post&Beam
Rough In
Gas tine
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, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( J Please call for reinspection RE:_ _ —___ ( j r enable to inspect no access
ADA
Approach/Sidewalk
Date ate l � �l�flapector � /r� - Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CI'►Y OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST
/ BUP
Date Requasted� U-Z% _AM —PM _ BLC
Location 'ZZV�S ���/�.� _ Suite _ MEC
Contact Person _ PhPLM
Contractor �.S /} ,� Ph _ SWR —
BUILDING Tenant/Owner _ _ ELC ,fit°�� —
Retaining Wall ELR
Footing Access: - -
Foundation FPS
Ftg Drain -- - -
Crawl Drain Inspection Notes: SIGN
Slate SIT
Post& Ream ----- -- _----p
Ext Sheath/Shear
Int. heath/Shear
Framing - _ ---
Insulation
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: -- - ------- C�
Find --- - --------.
PASS PART FAIL - - ---- -- ------ _- ---
PLUMBING
Post& Beam -- -- - - . _ --- -.—__-_�.__.---..---------- -------
Under Slab
Top Out ----
Water Service
Sanitary Sewer --
Rain Drains
Final - -- -
PASS PART FAIL.
- - . -
ME�HANICAL -- ------- -
Post& Beam - - - - --- ------------ .. - -
Rough In
Gas Line - ---- -- -- -- - __------ ... ---------- --- --
Smoke D;rapers
Final
PAp-- RAt3. FAIL —_-__----
c LECTRICAL -- - _-- ---- -- -- —------ - �_
iP
-----_."-------
Rough In
UCS/Slab
Low Voltage �_--__--- --- ----- _- - - -_-------- -- ---------------
Fire Alarm -
PART FAIL
Backfill/Grading -- — ------- ---- ---.- ----- -----------�— - -_....
Sanitary Sewer
Storrn Drain [ )Reinspection fee of$ _-_- required before next inspection Pap at City Hall, 13125 SW Na I Blvd
Catch Basin
Fire Supply Line [ J Please call for reinspection RF _ _ ( ] Unable to inspect-no access
ADA
Approach/Sidewalk f�
Other DateX4 _- Inspector
Ext
Final
PASS PART FAIL O NO/T REMOVE this inspection record from the job site.
CITY OF T I OA R D -- BUILDING PERMIT _
PERMIT#: BUP2000-00021
DEVELOPMENT SERVICES DATE ISSUED: 2/3/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S102AB-03500
SITE ADDRESS: 12405 SW MAIN ST
SUBDIVISION: ELECTRIC ADD. TO TIGARDVILLE 2 ZONING: CBD
BLOCK: LOT: 1-2 JURISDICTION: TIG
REISSUE: / FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: N ( i S FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? —
TYPE OF CONST: UNK sf Pi: S: E: W:
OCCUPANCY GRP: TOTAL AREA: sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT. sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RAT'D:
BSMT?: MEZZ?: _ READ SETBACKS _ _ _ REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT:N ift FIP SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,729.00
Remarks: Construction of 7'6" x 3' 6"freestanding sign.
Owner: Contractor:
ERDMAN. TERRANCE & THOMAS ES + A SIGN + AWIJING
12405 SW MAIN ST 1210 OAKPATCH ROAD
TIGARD, OR 97223 EUGENE, OR 97402
Phone: Phone: 541-485-5546
Reg #: LIC 00111286
FEES REQUIRED INSPECTIONS _ --_
Type By Date Amount Receipt Foot/Found Insp
PRMT DST 1/21/00 $59.25 00-321305 Final Inspection
5PCT DST 1121/00 $4.74 00-32.1305
PLCK DST 1,121/00 $38.51 00-321305 ORIGINAL
FIRE DST 1/21100 $23.70 00-321305
Total $126.20
This pert-nit is issued subject to `he regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other apt.�licable law. All work will be done in accordance with approved plans.
-chis permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENT1W Oregon law requires you to follow the rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You
may obtain a copy of these rules or direct question,- to OUNC by calling (503) 246-1987
Pe rm itee /
Signature: tv\ �A-A( (" 1� — ----- —
Issued By:
Call 639-4175 by 7 p.m. for an inspection the next business day
!1 Pcc'd � _
CITY OF TIGARD Commercial Building Permit
Da,e Recd
13125 SW HALL BLVD. Tenant Improvement
P Date to P.E
TIGARD, OR 97223osr"
(503,) 639.4171 � J� I ��,,�,�1 ; �� Permits iu
Print or Type ,_; . ', �., wlu,t -'AA "4 Related SWR r
Incomplete or illegible applications will no accQpted taupe
— Name of Developmeni,11'rufed —^--- Existing Building p New Building p
Job 112 f°�l b
Address StreetAddress Suite Building
( ?L4 SCJ r I rJ Data _ _ _
log• y tale Zip Existing Use of Building or Property
TtOAPD o�Gj�zz�
Name I- _. -- --...----------
Pro en 1 I�`in•P,1 ) 04 Il � i IC �l I�,I( Proposed Use of Bulla ny or Property
�,f. „q add rcr, Suite
Owner
I)l r ,w VV\I � No Oi Stories
RCityrstate Lip PhOr'
CIA C12�1?7l Sq. Ft Of Project.
Occupant Name --"--
-r WAt'-IJ CNK CvC CqNIC, Occupancy Class(es)
Name
Contractor �� 4 - 96Q 4 Type(s)of Construeben
Prior to ps'm't Mading Adore&$ Suite J -- - --
,a,„a,1Ce a COPY lqw)<W M0Z
( Will this protect have a Fire Suppression Systern>
Of en ocenec _
ars nequved if etlytstole p hone Yes E] N0
expired in c O.T. Lfl l Americans with Disabilities Act (ADA)
1 LAI-A i I Q 0k- `� ]O( to-1y Valuation x 251/c = $� _ Participation
Oregon Conti
GGcoMt Board Lie Env oete Gomf'eleAccess! ility Form
Project $ C —
Name Valuation _ 2--
Architect Plans Required See Matrix for nutTibei of sell to submit
Matting Address suite on back
C ty/5hte Zip Phone 1 hereby sonowlaigs that,have road ibla application,that the nformahon
given is correct,that I am the owner or authorized agent of the owner and
_ / m tubtted are n ccw+D ancs wnh Oregon State laws
Engineer Name --- - - --- -------
Signal IF of r; l n1 Dale
Mal i,g Address suite lVr 1�t `
nlaat Pe s Phor*
C ty;Stat, ro hone t 1 I ) ( - )LL ti C Tl I
F-3*Pi'sit ir-
�- ------� "'-" FOR OFFICE USE ONLY
Indicate type of worts N:w O Addit'on O De nnHion O MtpRlft �` Land Use
Acoesaory 5truc+ure n Foundation Only 0 Alwitlon O
Repel,0 other O
Description of work
r•rlte: EshmatadeOti -a ��— --�` 'j �n (.� _
Note LM Woitr Permit App -ids or accompany Building 1 y
Permit Appi-cal-on
CITY OF 7'1(3ARD NI:r..''I p'I" OF PAYNE N'r RUCL IPT NO. s 00 3i 1305
cj-1177CV, AMOUNT 37
U1,411ITT CPPUI a 0. OQI
( I]ANGI-7 0. IAO
14AME E 9 R A INC: Ci74"i1i AMOUNT s 0. 00
ADDRESS Jc810 CIAKPAT(71-4 RD P(4YMVN-f DA11'... s 01/?t icIo
00 F,-.LJGF-N'. r.)R
97 0 4
PLIRPC, 4 (iF* PViYMEN'T AMUUNT PA IT) Pi l CISE OF' POYMC'NT AMC RANT PCP I D
00 Ft. I'll. r`[_PH IT 42. 700
1) Pr.R 3. 4E' P111 i I r!! P �_.f!o 1 59.
Bf I NLI PL AN C HE r.,K .3*(A. 5 1 FT Pf-_ I I! F 5AFEV PLAN CK 8: "0
r, I
I bt i I L D PR R 4. 74
Pof.AN CHECK #I , 41G, �311iN/811)irl_f_ (-*;IrPMT7 r-0p 7101-RD
CHINO CI INIC, JJAO , 5W MAIN, -rjrAP1_) C.HK W3738
37
SEE 35MM
ROLL # 20
FOR
OVERSIZED
DOCUMENT
--�-�
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CITY OF TIGARD SIGN PERMIT _
DEVELOPMENT SERVICES PERMIT#: SGN2000-00007
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 213/00
EXPIRATION DATE:
BUSINESS NAME: TIGARD CHIROPRATIC CLINIC
PARCEL: 2S102AB 0350
SIGN LOCATION: 12405 SW MAIN ST
APPLICANT/AGENT: ZONE: CBD
BUSINESS TAX NO: JURISDICTION: TIG
--- — - — SIGN - — --
PERMANENT: X FREESTANDING: Y FREEWAY:
TEMPORARY: WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3'6" X 6'
TOTAL SIGN AREA: 21 sq. ft.
WALL AREA: sq. ft.
WALL. FACE (DIRECTION):
SIGN HEIGHT: 7 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: INT
DESCRIPTION OF SIGN: Replace existing freestanding sign with new sign of approximately 21 square feet.
MATERIALS: LEX & ALUM
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: Y
BUILDING PERMIT REQUIRED: Y
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 50.00
[DDY
1 his permit is issued subject to the regulations contained in toe Tigard Mums;nal Gcae, State of OR Specialty Codes
and all other applicable laws. All work will be done in accordance with app ied plan A sign permit shall expire 90
days from approval date. A temporary sign shall expire 30 days from approval date A balloon sign shall expire 10
rine-, from annrnval rinfr,
APPROVED BY: -
PERMITTEE SIGNATURE: 7-� — ---
DATE: 2/3/00
CITYOF T I G A R D ELECTRICAL PERMIT _
PERMIT#: ELC2000-00037
DEVELOPMENT SERVICES DATE ISSUED: 2/3/00
13125 SW Hall Blvd., Tigard, OR 97223 (503') 639-4171 PARCEL: 2S102AB-03500
SITE ADL,-2ESS: 12405 SW MAIN ST
SUBDIVI,'I'JN: ELECTRIC ADD. TO TIGARDVILLE 2 ZONING: CBD
BLOCK: LOT : 1-2 JURISDICTION: TIG
Proiect Description: Installation of sign lighting for one freestanding sign.
RESIDENTIAL UNIT —_ TEMP SRVC/FEEDERS _ _MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 2.0'I - 400 amp: SIGN/OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF 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 FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION _
10010004- amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:__ _
Reconnect only: SVC/FDR >= 225 AMPS: �— CLASS AREA/SPEC OCC:
Owner: Contractor:
ERDMAN, TERRANCE & THOMAS ES + A INC
12405 SW MAIN ST 1210 OAK PATCH RD
TIGARD, OR 97223 EUGENE, OR 97042.
Phone: Phone: 541-485-5546
Reg#: LIC 111286
SUP 435SIG
ELF 20-255CL
FEES _ RP4uired Inspections
Type By _ Date Amount Receipt Elect'I Servic3
PRMT DST 1/21/00 $42.75 00-321305 Elect'I Final
5PCT DST 1/21/00 $3.42 00-321305
Total _ $46.17This Permit is issued subject to the regulations contained in the Tigard Muniapal Code, State of OR Spea-My Codes and all other applicable laws.
All woA will be done in accordance with approved plans This permit will expire if work is not started within 1,80 days of issuance or d 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 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503)
246-1987
PERMITTEE'S SIGNATURE `1 — ISSUED BY:
_LNL'�.1��.�,�
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: y� a " (A4
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application PlanC-k1:,125 SW HALL BLVD. Rec'
TIGARD OR 97223 Date Recd-/ c9/ �
Date to P.E.
Phone (503)b39-4171, x304 Print or Type Date to DST _
Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit
Fax (503) 684 72.91 Called-
1. Job Address - 4. Comp.. 'e Fee Schedule Below:
Name of Development Number of Inspections per permit allowed -
Name(or name of business)TlEik'1) Chtfd! Fj%!111L,U.Ifj Service included: Items Cost Sum
Address I ZLiU�)
� r7 t� t 0 �` . _ 4a. Resldentlel-per unit
CI /State/ZI TI�YA K.D. L)R _11 2-,2L4 1000 sq.ft.or less -_---_ $110.00 -_ q
City/State/zip p _ Each additional 500 sq.ft.or
Commercial Residential ❑ portion thereof $25.00
Limited Energy $25.0('
Each Manuf'd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $66.00
(Attach copy of all current licenses) 4b.Services or Feeders
Electrical Contractor L`7 LL 4 AldeNlInstallation,alteration,or relocation
�_ .-
Address MCOUI- C T 200 amps or less $80.00 2
�-- 201 amps to 400 amps $80.00 2
CityjGftATif,; State C Glp (t 1yL 4.. 401 amps to 600 amps � $120.00 2
Phone No. L L-5`11 J$glf 1- 601 amps to loon amps _ $160.00
Job N0. Over 100 amps or volts -_ $340.0 _ 2
Elec.Cont. Lice. No.C"t.)INC Or.rim Exp.Date 'AFIL. 1 _ Reconnect only $50.0 2
OR State CCB Reg. No. kjaa Exp.Date4c.Temporary Services or Feeders
COT Business Ta ietro No ZtI1�Ex .DI Installation,alteration,or relocation -
�/ 200 amps or less $50.00
Signature of Su r. Elec'n_ _= 401 amps to 600 amps $10 201 amos to 400 amps 0 00
Over 600 amps to 1000 volts,
License Nr �� _E Uate�L_[ _- see"b"shove.
Phone.N �J TA 4d.Branch Circuits
New,alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase or service or
Print Owner's Name feeder lee.
Address Each branch circuit $5.0 _-. _ 2
-- - - -- b)The foo for branch circuits
City_ State_ 'ip_ without purchase of
Phone No._ service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own wt Ich is not Each additlonal branch circuit- $5.00 2
intended for sale,lease or rent. 4e.Miscellaneous
(Service or feeder not included)
Owner's Signature __ ._ _--__ _____. Each pump or Irrigation circle $4000 2
Each sign or outline lighting _ 3g4e0�
3. Plan Review section (if required):* Signal circult(s)or a limited energy
panel,alteration or extension $40.00 2
Minor Labels(10) $100.00 - --
Please check appropriate Item and enter fee in section 5B.
4 or inure residential units in one structure 4f.Each additional Inspection over
_Service and feeder 225 amps or more the allowable In any of the above
y-System over 60 volts nominal Per inspection $35.00
_ Classified area or structure containing special occupancy Per hour $55.00
as described In N.E.C.Chapter 5 In Plant $5500
i
"Submit 2 sets of plans with application where any of the above apply. S. Fees: �� q
Not required for temporary construction services. 5a.Enter trial of above feesy $
-Sw.15urcharge(.05 X total fees) 8/ $ -
NO"agE Subtotal $ --- -
5b.EnV?r 25%of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reguir (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 190 DAYS AT ANY
TIME AFTER WORK tS COMMENCED. ❑ Trust Account iil
$ .
Total halance Due
10stskerc9s APP Rev ass
/ CITY O F T I G A R D PLUMBING PERMIT
DEVELOPMENT" SERVICES PERMIT#: PLM2002-00166
J,OIL 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/20/02
SITE ADDRESS: 12405 SW MAIN ST PARCEL: 2S102AE 03500
SUBDIVISION: ELECTRIC ADD. TO TIGARDVII_LE 2 ZONING: CBD
BLOCK: LOT: 1 2 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DloPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 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
DISI!WASHERS: "^.IN DRAIN: ft
Remarks: Installation of 2 commercial backflc N p, :ers.
_
Owner: �- FEES _—
' —
hRQMAN, TERRANCE E AND P
Type By Date Amount Racei t
ERDMAN, THOMAS M PRMT CTR 5/20/02 $92.80 27200200000
12405 SW MAIN ST 5PCT CTR .5120102 $7.42 27200200000
TIGARD, OR 97223 _ Total _ $100.22
Phone 1:
Contractor:
KENNEDY PLUMBING
13965 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone 1: 643-•5535 ISP/Backflow PreventerYJ__. _______
Reg #: LIC 10967
Final Inspection
PLM 34-42PB
This 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 aODrovr J 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. nose rules are set forth in OAR 952-000 i-0010 through OAR 952-0f`J1-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987
Issued By _ _f 1.i "u� ,� ; j ( � Permittee Signature.
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next bu:.lness day
Plumbing Permit Application
Datereceived: ;10 0 'I- Permit no PLA.2002- -
CityCit of Ti a
g Sewer permit no.: Building permit no.:
Address: 13125 SW 1 FW1� —
City of7'igard Phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: -J I Receipt no.:
(pl Case file no.: � Payment type:
Land use approval: c ► L i,ihkb I
U 1 &2 ;•imily dwelling or accessory leCommercial/industrial 0 Multi-family U Tenant improvement
U New con.truction U Addition/alteration/replacement U Food service U Other: _
JOB S11 E'INFORN1,11,J ION FEE �UIIF1I)t.1F_(for%liecial Information u%e checklist)
Job address: le'kOJ 5tJ VYIGtr'1 _ Description _ Qt Iee(ea.) 'Total
— New 1-and 2-family dwellings only:
bldg.no.: Suite I().-- --- (includes lo0ft.for each utility cnnnecliun)
Tax map/tax lot/account no.: _ SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath _ --
Project name: i c r� VN%/'0 f C1 i r) L_ SFR(3)bath --
City/county: r vo 'LIP: Gl`) Each additional hatlAitchen
Description and I ation of work on premises:_ Siteudlities:
Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drain
Footing drain(no.lin. ft.)
Manufactured home utilities _
Business name: Ke 1 tic Manholes
Address: /rpt _ Rain drain connector m
City: T;e,p I C1 _ State:0('1 ZIP: C 1 a A.3 Sanitary sewer(no.lin. ft.)
Phone: Au"M 0 IF= I E-mail: Stc in sewer(no.lin.ft.)
CCB no.: I Uqb'l Plumb.bus.reg.no: 34{—'}7. Water service(no.lin.ft.)
4Nanic
etro lic.no.: 13-)3 � Fixture or item:
actor's representative signature: ----A Absorption valve
l+�.tF.� Back flow preventer _ �4''�0 �•
name: L Y-\P S ate: 5,13.I)�� Backwater valve _
Basins/lavatory_
Clothes washer
Dishwasher
Address: Drinking fountain(s) _
City Stale: ZIP: Ejectors/sump _
Phone: Fax: E-mail; Expansion tank _ __ _
Fixture/sewer cap
Nance(print): V, G fp1 h\,(p �( Cit, [ (i<ll L Floor drains/floor sinks/hub
Mailing address: I yp 5 (1 Hose e disposal
Floss t•ihb
City: t e,��� State: W ZIP: �-Ja-A3 Ice maker
Phone: 6 a 0 `t `S K D 1 Fax: I E-mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sink(s)—basin(s).lays(s)
Owner's si nature: Date: _ Sum
Tubs/shower/shower pan
Urinal
Name: Water closet
_
Address: Water heater
City: _ State: 7.IP: Other:
Phone: Fax E-mail: Total
Not all jurisdictions accept credit cards,please call jurisdiction for more inrormatirxrNotie:e:This permit application
Minimum fee................
U Visa U MasterCard expires if a permit is not obtained Plan review(at __ %) $
Credit card number: within i80 days rifler it has Ixcn
State surcharge(8%)....$
- ----
Expires accepted . .......................$
—Name or cardholder u lows on credit cud accepted as complete.
S
C r sieranree Amount 4104616(6i0000M)
PLUMBING PERMIT FEES:
PRICE TOTAL New rill!!!
end 2-family d��,allings only: PRICE TOTAL
QTY ea AMOUNT (Includes all pl,•,bing fixtures In
FIXTURES_End 1660 the dwel-ing and the flrst100 ft. QTY (ea) AMOUNT
Sink for each r ItU n
oonnectlo
16 60 One 1 bath 5249.20
Lavatory _ $350.00
Tub or TublShower Comb 16.60 two 2 bath ---- - $399 00
---- 16.60 Three 3 bath i
Shower Only - -
WaterC;loset 16.60 --"'— SUBTOTAL ____
Urinal — 16.60 8'/.STATS SURCHARGE
OF
ts,s0 PLAN REVIEW 25'/. SUBTOTAL
Dishwasher TOTAL.
Garbage Disposal 16.60 - -� ---
Laundry Tray �- 16 60 --
Washing Machine - 16.60
Floor[rainlFloorSink 2" 1660 PLEASE COMPLETE:
3" 1660
4" 16.60 Quantic b Work Performed
Water Heater O conversion O like kind 1660 Fixture Type: New Moved Replaced Removed/
Gas piping requires a separate mechanical - - Ca ped
ep rRlll. 46.40 Sink -
MFG Homo New Water Service Lavatory - -
MF'G Home Iva::SanlStorm Sewer 46.40 Tub or Tub/Shower
- 16.60 Combination - --- --
Hose Bibs Shower Only
- -
Roof Drains - 16.60 _ -
16.60 Water Closet
Drinking Fountain Urinal —
Other Fixtures(S?e1ify) 16 60 Dishwasher - -
-- -
Garbage Disposal
L_aund Room Tra -
_ - - Washin Machine --
_ Floor Drain/Sink: --
Sr1$1 100' - _-- - 55 00 r "4 _-
46 40 4„
Sewer-each additional 100' -- AE.Le Heater
Water Service-1st 100' .500
Other Fixtures Y
\Nater Service-each additional 200' 46.40
Storm 8 Rain Drain-ist 100' 55.00
Sturm 8 Rain_Drain-each additional 100' 46.40 ---- _- __
Commercial Back Flow Prevention Device ---
Residential Backflow Prevention Device- - 27.55 -- - _-
16.60 - --
Catch Hasin ----- __ -----�- -
Inspoction of Existing Plumhing or Specially 72 50
er5tr COMMENTS REGARDING ABOVE:
RequestedInspections -
Rain Drain,single family dwelling -
--- 1660 ----- --
Grease T raps
QUANTITY TOTAL - -------- _—'
Isometric or riser diag,am is required it --
Quantity Total is >P _
"SUBTOTAL
- 8°/a STATE
`PLAN REVIEIM 25%OF SUBTOTAL
Required only if fixture qtY total Is>0 —
TOTAL S
"Minimum permit fee is$72 50•s%state surcharge,except Residential Backflow
Prevention Device,which is$36 25+B%state surcharge
"All New Commercial Buildings require plans�.kh Isometric or riser diagram ani
pian review
1:\dsts\fonrns\plm-fee,doc 10110100
:,:TY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
z_ BUP _
Received -_____ __- Date Requested ' _ AM - -_ PM - __ BLIP
Location ��' �� S✓ /�1 �1�j -__ - Suite ---___ _ _ MEC _
Contact Person Ph(-- _--) /---- ---- - -- . PLM �o
Contractor _.-- - -___ - - -- Ph(-- -) � r SWR ._
BUILDING Fenant/Owner _--------- _ _----- ELC _
Footing
Foundation ELC
Access:
Ftg Drain ELF _
Crawl Drain
Slab Inspection Nates: SIT -__—
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - - ----
Firewall
Fire Sprinkler ---r- --— --
Fire Alarm
Susp'd Ceiling �--- - --
Root +
Other-
Final
ther Final
PASS PART'"FAIL_ _r ------ -- _.
PLUMBING
Post& Beam
Under Slab
Rough-In
Water Service -
Sanitary Sewer
Rain Drains - ---
Catch Basin/Manhole
Storm Drain
Shower Pan l
Other.-� - -
PART FAIL
IStHANICAL _
Post& Beam
Rough-In - - -
Gas Line
Smoke Dampers
Final
PASS PART FAIL —
ELECTRICAL
Service
Rough-In - --
UG/Slab
Low Voltage - -_
Fire Alarm
Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL �•-�
SITE - - LI
—_ [] Please call for reinspection RE: _ Unable to inspect- no access
Fire Supply Line
ADA
Approach/Sidewalk Date' ? 7- --- Inspector '+' �I_ "� _Ext ------
Other:
Final DO NCIT REMOVE this inspection record from the Job site.
PASS PART FAIL