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12501 SW MAIN STREET 12501 SW Main Street a CITYOF T I G,A R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00664 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/24/01 SITE ADDRESS: 12501 SW MAIN ST PARCEL: 2S102AB-02402 SUBDIVISION: ELECTRIC ADD. TO TIGARDVIL.L..--. ZONING: CBD BLOCK: LOT: 015 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: M FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS. FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: Y _ URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Move and replace water heater, install new commercial backflow prevention device. FEES Owner: — �_ --- --- -- - -- - Type By Date Amount Receipt ANKELE, MARVIN R + KATHRYN J PRMT CTR 1212.4/01 $72.50 27200100000 TIGARD, OR 97223 12511 MAIN 5PCT CTR 12/24101 $5 80 27200100000 _ Total $78.30 Phone 1: Contractor: MODERN PLUMBING 11120 SW INDUSTRIAL WAY TUALATIN, OR 97067 REQUIRED INSPECTIONS Phone 1: 691-6166 RP/Backflow Preventer �! Reg#: LIC 97906 Final Inspection PLM 34-250PB 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 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. Issue By: ' &_"p Permittee Signature:y�� �, �� ;'Yk�-fir( 1 Call (5031 1639.4175 by 7:00 P.M. for an inspection needed the next business day ' 12/19/2001 15:02 5036916771 MODERN PLUMBING PAGE 02/03 Plumbing Permit A 11 tion t1EDatereccived: /.4 9 "/ Perntiino.• C mak! City of Tigard - - Address. 13,1S SW Hall Blvd,T stard,OR 97 Sewer pci nit no.: Building permit nu Ciiyofngard Phone: (503) 639-4171 ! Projecdappl.no. -- 1 6xplredate: Fax: (503)598-1960 Dateiasued: (.1 �� V — By: Receipt no. Land use approval: _ 13UMI)INd�PITSION Case file no, ]Paynienttype-. O 1 &2 family dwelling or accessory "'„nrnlerual/indusUial U Multi family U Tenant rmpravcment LI New c:onsnuctioo LVAddition/alteratioiL/replacemenr Vprlod servrre U Other t Job address; `i(�l Sw f. f)rwcri duo (�tV. F�Icb.l Total Bldg.no.: cite no.: —�� - _Nets t nud 2-in:ntly rtr e114.91(r11W Tax map/tax lot/account no.: (includes 100 It,foreach itiliity connt cion) 5FR(1)bath Lot: Block: _Subdivislon: SFR(2)bath Project nattte: 1"1 a f d p -0— SFR(3)bath — City/cotm �11C, _��_U�S� ZIP: "I Eacha ditional bzdAjlchen Description and laca ' n of w rk on premises: [ 5iteutilities. ti F F1-.U,�, . ,4 1Q rajLft.� Catch bastiYarea drain _ Est.dale of o-omple6on/inspection: � ) _ D Drywells/leach lin r trench drain _ 115 Footing drain(no. lin.ft.) Manufactured home utilities Business Warne: U A M o es — Address: _1.11.0 t Rain drain connector City: /L' Stater ZIP: 171 Sanitarysewer(no,lin.R.) Phone: - F E•ma#l: torn)sewer(no, lin. Ft.) CCB no.: Plumb.bus,r0a, nWater service no.lin.ft. City/metro lic.no.:1XII I Fixture or item: Contractor's representative slgnant Absorpdon valve ac ow preventer Pont name: i J /� Date. /;1 / D Backwater valve t aslns/lOatory -� Ntune: Clothes washer 711W is er - - CitY: State: Z1P; �tnaion king fountains) -- torslsumpPhone Fax: E-mail: tank ixturc sewer cap _ Name(print): Floor draindoor sinks/hu Mailing address: Garbe a disposal Cil osc bi Y _ State.: ZIP: _ Ice maker _ Phone: Fax: E-rttail: Tnterce for cease trap Owner installation/residential maintenance only: The actual installation mer(s) will Ix-.made by me or the maintenance and repair made by my regular Roof drain commercial employee on the ptuperty I own as per ORS Chapter 447, Sinlc(s),basin(s), ays s Owner's si nature: Date: Sump Tubs/shower/shower pan Name: Uri- Address: Water closet _ ater hamar' _ City: _ -----LL3tate: T zIP Orlur. Phone: Fax_ >rmall oW Ntool1 jtviett a ampi cue ut cards.Picea cA luddkuwr rot thorn bdorsr l Notice:This permit applicatinn Minimum fee................ Ovisa rmlatarCuct Plan review(at _ %) S expires if a permit is not obtained CMilit curdLOS I , y 0 within 180 days after it has been State surcharge(B%)....$ v11AK__1-_ Q.Qt'_�t�t.i E:Pisa TO'T'AL . $ Jlme ut rordbol sh on it cue -- accepted a.+campleta, ......,... .. 9;i1� z a v ardhoatkvaixrta�urt - 4464616 raWcor,ti 12/19/2001 15:02 5036915771 MODEF J PL_1MRIH15 PAGE 0-1/03 PLUMBING PERMIT FEES: PRICE TOTAL Now 1+pnd 2•(ainlly tlyyelltnga only: _ FIXTURES Individual) _ QTY (ea) , AMOUNT (Includos all plumbing kkures In �� PRICE TOTAL Sink 16.6- Iho dwelling and the firxt100 ft, QTY (ea) AMOUNT Lavatory 16.80 for each utility connectio_n� Tub or tub/Shower Comb. — - One 1 bath _ 18. - Two 21 bath $35 .00 Shower Only s 16,60 Threey�hath —M S3 .00 Water Closet �' 13.60 _ Urinal - 1660 --___ St1BTUTAL _ 6%STATE SURCHARGE Ishwasher 16.60 ULAN RFV_IEW_25"/°OF SU9TUTAL -'-— Garbage Disposal - 18.60 ��0 TOTAL Laundry Tray 16.60 Washing Machine 18,80 Floor Drain/Floor Sink 2" 16.60 3" 16,66 --`- PLEASE COMPLETE: 4 16.60 Water Heater O conversion O like kind 16.60 1 Uuantlt b Work Performad Gas piping raquirea a separate mechanical Fixture Type: ew Moved Replaced Rempvad/ ennit. Ce ed MFG Home Now Water Service 46,40 Sin MFG oma New SatvStorm Sewer 46.40 Lavat Hose Sibs 16.60 - Tub or Tub/Shnwor e - Combination Roof Dra n 16,60 Shower Only _ Drinking Fountain 1660 Water Claset Other Fixtures(8peelty) - 80 - Urinal --- Dishwasher arba a Dis 0521 _ _laundry Room Tray Washing Machine Sewer•1at 100 -- or 55 ao Florain/Sink: 2' 3" Sewer-each additional-,RF —46.40---- 4' Water Service-let 100' 55.00 Water Heater Water service 8-8- additional 200' 46.40 Other Fixtures (specify) Storm it Rain to -1st 100 55.00 — Storm!r,Rain Drain-each additional 10 ' --46-.To-- Commercial 6. 0Commercial Back Flow Prevention Dev ce 46,40 �— Resldcniiel Sacktlow Prevention Device, 27,55 Catch Gain 18.60 - - — inspection of F,r sting Plumbing or Specially 72.56 Rertuested Inspections _ er/hr _ _ COMMENIS REGARDING AAOVE: Rain Draln,single famT dwelling a5.2S Greasa Traps - 16.60 QUANTITY TOTALt- isometric a deer diagram Is required If — "r, QuaMMtt_olal is ;-a •SU9TOTAL �s :I . J D _ Eiu •I LS e%STATE BURCHAROE V —� "PLAN REVIEW 25%OF SUBTOTAL ye ,� ' // --,..._. Required only if AxW�(y total i a g ►s-tN�.�,,F1 l;L 1 u✓ TOTAL "INinirnum permit fee is vzho r 8%VAIN surcherge,a■repl Residential Baclrllu v Prevention Devlu,whlCh is S35 28*e%state surcharge •"AII New commercial Buildings require plan!with Isometric or dear diagram and plan review, iAdstsVormaWlm•fees doc 10/10/00 \ CITY OF T I G A R D -- ELECTRICAL PERMIT PERMIT#: ELC2001-00657 DEVELOPMENT SERVICES DATE ISSUED: 12/31/01 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639-4171 PARCEL: 2S102AB-02402 SITE ADDRESS: 12501 SW MAIN ST SUBDIVISION: ELECTRIC ADD. TO TIGARDVILLE ZONING: CBD BLOCK: LOT : 015 JURISDICTION: TIG Proiect Description: Install 1 branch circuit to water heater. RESIDENTIAL UNIT _— TEMP SRVC/FEEDERS _ _ MI:'CELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION: TACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMi SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL ('10): _ SERVICE/FEEDER N BRANCH CIRCUITS ADD'L INSPECTIONS _ 0 200 arnp: W/SERVICE OR FEEDER: PER INSPECTION: ^^ _ 201 400 amp: 1st WIO SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW S_ FCT_ION __ __ 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only____ SVC/FDR >= 225 AMPS: _ CLASS AREA/SPEC OCC: _ Owner: Contractor: ANKE_LE, MARVIN R + KATHRYN J AL-LIED ELECTRIC 12511 SW MAIN PO BOX 1640 TIGARD, OR 97223 NORTH PLAINS, OR 97133 Phone: Phone: 614-8000 Reg #: LIC 38538 SUP 3195S EL.E 34-112C FEES Required Inspections Type By Date Amount Receipt Ceiling Cover PRMT CTR 12/31/01 $46.85 2720010000( Well Cover Elect'I Final 5PCT CTR 12/31/01 $3 75 2720010000( Total $50.60 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 approved plans This permit will expire if work is not started within 180 days of issuance or I 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 OAP,952-001-0080 You may obtain copies of these rules or direct questions to OUNC at(503) 246-6699 or 1-800-332-2344 Permit Signature: r , , r Issued By: OWNER INSTALLATION ONLY The installation is being made on property I own which is riot intended for sale, lease, or rent. OWNER'S SIGNATURE: _ DATE: CONTRACTOR INSTALLATION OWLY --- -------- SIGNATURE OF SUPR. ELFC'N: �'� ���� � ! Gt�� DATE: LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business clay 12%19 2001 18:25 F.4T 5075981880 �C'ITY OF TIGARD 002 rr Ele cal Per pplicadon — puerecetved: wrre++tno.:%11'_Av'- c: City of TigaR EC E I V E.D pro)ectiWPI.n0.: Expirc date, Address: 1 >frrr3125 SW Hall Blvd,Tigard.OR 91 Dateluued: d)� Receipino.: c,r � _ Phone: (103) 639-4111 rTC 3 7001 Case file no.: Paymcntt)pe! _ Fax:(503) 598-1960 Land use approval' Cd 1 &2 fwnily&gelling or aeCessory merciaVinduatrial Q Multi-family C3 Tenant impa•v-sment O Ne'a t:on�tructicrn ..AddirioN�ltrtattiurllrcpinccrnent U Other: O Psri:ai e ' k Job ad9ress. Ir l�t ©!dct.nct _'tiultc no: Tsx mapltsx lOdatxouet no.: I�y Block: 5ubdivlsloa: 1;' project name: ] _ Dtsctiption end locationof work on premiss: Flruhnateddate of c- pietiotirinspe.:uon- v _ Fee I1tax Job Doi _ -� p►arMplioa (e+) Total no.Lill Business name: '7( Z � IVrr.rf:odertbxl slatGk oru`atdd fa1■Ilpr, Address: .C1. t �•-_ dwctu,tetrw-br�Meee;eeaclregn�+. 1 J ; , State. ZIP, 7 13 srcr.iwY■ctuded t I x100 n n. I&ss.�_ _ Phone: I Or Fax: E-moll — h addltbn,l Sr10 cq.tL of pCM1lon thereof bus.lic.no: 12C: Lirnutedat revidv+dLL _ -- Cil r o lic no,' Um!txlener�y,rron•reddtnuu _ ' - �— Each nlaaufactufed heme ar frodulat dwelllma - service■ndror feeder J 51 n bur:o su i Ing trlrl■n t sired) Due erkaser�r■Ted■ 111 on. Lnae no: 1$ Sig ■l■ ansae(priat)' loosiler■uou or relooatbn, moo asps of lees 2 Name : �L t(L A _ 40 t■reps ra 600 r -- 1 Mlailindtrs rYl c r l 601■mps ,._._., CityStatef-- I L1P r t''1 L vtr l e or vola _ 7 ' _LLL.,, �_ ._. • , , E-irYtjt: R'°n. ttua:°"iy or feerltts_.__ towner irtstallatiwt:Tho installation is beteg read^on property I vwn yr1■llsetaa aNr+ytlosr,nrrstx>.Gon which is nc4 iutrnded for sale,lease,rent,or exchul4e sccordirig t„ 91 --M sof txa _^ 2 ORS 441.455.4'19,6i0.101. lot am1s1- bas. 4 1 io tate _ 2. Owners ai ptr4' r■o Te■ks-acre.,tterrtrlon, or exte■,le■Fr t*mL Name: A roe for btan4 cLrwfq with pvttb■w of Address: _ - _ J - ,evictor Fu+dr Meer ych briflch cl,w�l - _- � _ Fee for bnnc*eirruln wttMtut pttreh■ae City' �� --'�-- betier fee,firot brush citcWt 2 ! PITY fax mail sddibcns bMehclttur (9er„ce m Amer not U u r Goh Of itrtpdmt curse 1 O setvisruYe 225,seps Comae+cfW O llweh oarrfeetf!yLVM —� - 2 F.,ch sign of Outline I tl�s _ U Service m'rr IZO,rnpr•rstufi of l�'t U Nazv�weu auai Si red rircWttn or s Gated energy psni. f,milydnotlings D116104ovrr10rAlqu■lt(fWfour or slteretSOn,ae><gnf:an' i 0Srateme.'er600vollanomlarsi more residenr..alunits inons streefufe -- _ _-----, -- ! 0Buitdingnvertt■e0stonet 0Feeders.4001rtpsofroiM 'Desai ton: U Uccupav load or-s 99 persons Cl Manufactured rtrttcrurss or Rv pwt; t .1 pettlan ower the■Ilesrahk h eny of tIM a eve: O r figressr!rghuntplan l thwL -_. .__1--- Pet Inspscdon Sebald sets Of plain with any oftbt above. I,,-jadoe frc — -- _ lite above ate"ia sociable to tem cotton strdcc., _0th_0 —-- --- ---- _��- �Pcrmit fee �5 _�Se• " — Na all�franaein:du eradM arlfr 0■tdr.oreaM calf NrrMlcrlan fa rtrrt Infa+wvM R'crtwe.Thi%nrrrnit"PliatIon Plan Mview(at `4) S - I]Vire p Mss,sfCaM expires if a permit is+wt ot,taincd State sun Oarge C.+ut sera rwo*Or _ __ R� with+n 180 Jaye■Ree It hu been T0Tt%L __—_._.-__-._.------- aaost+tedssaxnPiete' .......... ...... •-"-�'p��' rr m�xsdir e`afd 440-011(MC'OM) CITY nF: TIGARD GUILD`NG INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 633-4171 --�- _-- BUP —Date Requested,_ — AM _PM _—__ BLD _ Location _ �,� ,��/ j ;yy,� — Suite MEC Contact Person ' — Ph -12Z:4 -79,-:�--- PLM G4-1) 4'Z)L-6 C Contractor / Ph SWR BUILDING— �— Tenant/Owner s -- ELC Retaining Wall EL.R - - Footing Access: Foundation FPS Ftg Drain `- SGN Crawl Drain Inspection Notes: Slab - -- ---- SIT' _ Post&Beam -T- 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 ti,Beam ——^ Under Slab Water Service _ Sanitary Sewer fitlll')rains FAQ._ PART FAIL ANICAL 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 dackfllllGrading � � --• - --- -----..._.___.___-------------- -...__- _ -_ _ Sanitary Sewer Storm Drain [ j Reinspection fee of$ __ required before next inspecting, Pay at City Hall 13,75 SW H-1!l 111vd Catch Basin Fire Supply Line [ [Please call f;.r reinspection RE _. i 1 Unable to 111spPct no access ADA Approach/Sidewalk Date Inspector �r/ / " �I'' e ' __--_ Ext Other ---�.' - ------ - -- Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 ----_--_----- _Date Requested r AM PM _ _ �— BUP — — Location_ � „�Z'L �I�LG�y/ Suite _ _ MEC ----- -_`_ { Contact Person �� _ ' ! _ Ph rL y � PLM Contractor ` �.d� ------ Ph _ SWR __-- --- BUILDING _ Tenant/Owner _—� �� _ ELC G f G C Retaining Wall ELR Footing `access: Foundation FPS Ftg Drain — SIGN Crawl Drain Inspection Notes — -- - ----— Slab SIT Post R Beam ----- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing F irewall Fire Sprinkler Fire Alarm RoofSusp'd Ceiling Root- Misc:__ ---- ,�Lf /� CG�YYI /�. 2��C�LI ✓"" — ---- Final - 7 PASS PART FAIL I --- -- ----- ��-----_--._�`_-------__-__-- PLUMBING Post& Beam - - — —- —---- Under Slab - �_ -- _—_• —_ _ Top Out Water Service Sanitary Sewer Rain Drains Final _ PASS PART FAIL MECHANICAL. _ Post& Beam -- ----- Rough In Gas Line Smoke Dampers Final PASS PART FAIT_ ELECTRICAL - - -- Service — A ` /Slab Low Voltage Fire Alarm S PART FAIL _ Backfill/Grading - ---- - -- -� -_ Sanitary Sewer Storm Drain [ ] Reinspection fee of$— - required before next inspection. Pay a!City Hall, 13125 SW Hall Blvd Catch Basin [ )Please call for reinspection RE Fire Supply Line [ ] Unable to inspect no access ADA Approach/Sidewalk Dated Ins ector Ext c Other p , Final _- PASS PART_-FAIL I DO NOT REMOVE this inspection record from the job site. CITY OF TI G,i R D _ PLUMBING PERMIT DEVELOPMENT SERVICES PERM!"#: PLM2002-00055 13125 SW Hall Blvd., Tigard, OR '17223 (503) 639-4171 DATE ISSUED: 2/22/02 PARCEL: 2S 102AB-02.402 SITE ADDRESS: 12501 SW MAIN ST SUBDIVISION: ELECTRIC ADD. TO TIGARDVILLE ZONING: CBD BLOCK: LOT: 015 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: CUM WASHING MACH: SACKFL.OW PREVNTRS: 1 OCCUPANCY GRP: M 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 CLOSES: WATER LINE: ft DISHWASHER 3: RAIN DRAIN: ft Remarks: Installation of back flow prevenler device to Ice Maker inachine. FEES Owner_ — Type By Date Amount Receipt ANKELE, MARVIN R + KATHRYN J PRMT CTR 2/22/02 $72.550 27200200000 12511 SW MAIN TIGARD, OR 97223 51'CT CTR_ _2/12102 _ $5,80272007.00000 Total $78.30 Phone 1: CoWractor: MODERN PLUMBING 11120 SW INDUSTRIAL WAY TUALATIN, OR 97062 REQUIRED INSPECTIONS Picone 1: G91-G166 Final Inspection Reg#: LIC 87906 PLM 34-250PB This permit is issued subject to the regulations contained in the l igard 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 of direct questions to OUNC by calling (503) 246-1987. Issued By: Permittee Signature: Call (503) 639-4175 by 7.00 P.M. for an inspection needed the ner.i business day 02/21/2002 10:18 5036916771 Ivt MODERN PLUMBING PAGE 01/03 I� Plumbing PernaitApplication City of TI�ai RECEIVga Datcreeeived; � 7��y Perntitno.: eY�C" –GAS Sewer permit no.' Building permit no.: Cit o Tigard Address: (3125 SW Ball C11vd,'ligard, UI: 9% 23 _-.T. Y J S Phone: (503 639-41-/1 Pro cct/a 1.no.: 1 PP C><I,ircdatc: Fax: (503) 598-1960 Date issued ny:�� Rcccipi no.' K.1 11 fit, ill.IrA,t� —Land --- use approval: _ Case file no; Payment type 7LJ1 &2 family dwelling or accessury Commr.rctaUin lustriat U MulefilTennnt ImprovementNew construction R'Addition/afteration/mplacement O Food service ❑Other _ = M t t Job address' �a�b 1 ala.) M �, 9cscription Qty. hcc(csr.) 'I'olnl Bldg.no.: v_ Suite no.: -- Ncw 1– a—t��•family dwellings only: Tax map/tax lot/accounl no.: (includes 100 ff.for eachutilky connectiau) SFR(1)bath Lot: Block! Subdivision: F (2)badi — — Project name:q 1:bAA&_ ttP SF t( ath — - clty/county:-rl6 Aflh IVA ZIP' -�j 22 3 tic t►_addition kitchen _ Description and location of work on premises:_ Sheufilltfrst _fid- sr �L Catch basin/area drain Est,date of completion/inspection: Drywe Is/leasline/trench drain PLUMBING tlt Footing drain(no.lin. t.) ane acwred home utl tt�' es— Business name: P 1�1� _ Manholes Address: onnector City: _vel a�T Stat ZtP: �Q Jer(no. ink —�-- Phone: tyt Fa 1) . 1 d E-mail: Storm sewer(no.lin. ft.) – CCD no.; Qjl qPlumb bus. rc. mp; Nater service(no. ul. t. City/metro lic.no.: `–'�-�- )rhturc or(tern; —a 1 l�(„ Contractor's rr resentntivo,signa[r► Absorption valve Back flow prevonter Print name• Backwater valveCONTALYPERSON � t" IL M nsJlavatory Name: lotltes washer Address: —'– Dishwasher ---- r nking fountain($ city: _ SLa_te: 711' ------— ��tors/sunt��� Phone: Fax. Ex mail: ansion tartTc � �x _-txturdsewcr ca _N -ne(print): Floor drains/ oor sin hu iviailing address: –�– Garbage disposal - ----- ose bb City: Slate: ZlP �– _ Ire maker Phone: Fax: C-mail: Intercc)romp _ Owner Installation/residential maintenance only: The actual installation Primer{$) will be made by me or the,maintenance and repair made•by my regular Goof drain(commercial) employee on the property I own as per ORS Chapt., 14?. Sin (s), basin(s).lays(s) Owner's signature: _ Date: _ Sump 1010 rubs/shower/shower t)nn Name Urinal Water closet Address: Water heater City Stale; ZIP: Other; Phone: trax:^� 13 mall: Total e-e.. .............$ Na all jurtmictlon:reept credit crud.,plratc call turisdiciicx�ror more Infonfrano" Notice-This permit application Minimum r O Visa O MasterCard eKpirca if u pennil Is not obtained Plan review(at _ %) S Crcd;t cud numbu, _ in withays after It has been State surcharge.(8%) . $ _�— 180 dTOTAL . fi i—o` accepted as com Ictc Name of r 1010rf Y�down n c it cbf�I_ ho ct�i�nalure S Amponl 44o4t.I0(NDnrt'o�t, CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 BLIP — - -- Received Date Requested fa AM_ -_ PM - ___ ____ BLIP Location _ �-�S� U Gt"_(iYI r4�t __..Suite- ---- ------__._ MEC _---- Contact Person ____ � 1A L4 Ph( } 62 r-jZ PLM 2 Contractor --_ __-_ Ph( ).. _ 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 ,.. ------- Insulat on \ Drywall Nail!;iq ----- _ Firewa l / Fire Sprinkler Fire Alarm Susp'd Celli Roof Other: Final PASS PART FAIL - �_-- - --- - PLUMBING Post&Beam - Under Slab Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Shower Pan Other. TtPART FAIL H4-N-ICAL _------- -- ------- ---- --- --_ Post& Beam - Rough-In - - -- _- --- -W�- --- -- _-- ------ Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service --- Rough-In UG/r.i ib Lcrv�oltage F,re Alarm Final PASS PART FAIL Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Nall Blvd. SITE_ _-_�_- ] Please call for reinspection RE: -__-� Unable to inspect-no access Fire Supply Line ADA ' //Z��10-- Approach/Sidewalk Dates .e� --__ Inspoctor - -971::' ' __-_Elft _ Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FA;L