9455 SW MARTHA STREET-1 IS VHIHVW AAS 99b6
,a
i
cn
a
rz
a co
oc Ul)
as
W
9455 SW MARTHA ST
C�
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour 1 on Line: 6394175 Business Phone: 639.4171
fl
Date Requested. pz -�y��_ _ A.M. _ P.M. MST:
Location: _ q��� /,'1 ��� ,_ B(UP: —
Tenant: _ Suite: _Bldg: MF.C: _
C(Nitrac or: _ Phone: 6�V Q7o ,3 Z _ PLM: ^
Own1 _ �072i� Phone: p
���.� ,6 F.I C:___._�
SIT:
BUILDING BLDG(con't) LUMBIN MECHANICAL ELECTRICAL SITE _
Site Post/Beam rofflirmm Post/Beam Cover/Service Sewer/Stonn
Fooling Roof (IndFI/Slal� Rough-In Ceiling Water Line
Slab Framing Top"it A(/�/l/ Ons Line Rough-In UO Sprinkler
Foundation Insulation Sewer �(�"" Ilocxl/Duct Reconnect Vault
Ijsmt Dwnp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Thain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found lh Beat Pump Low Volt
App;c)ved ov Approved Approved Approved
Appr/Sdwlk Not Approved ed Not Approved Not Approved Not Approved
FINAL, '`1INA1, FINAL FINAL FINAL
D Call for reins tion �� 0 Reinspection fee of Srequired before next inspection O Unable to inspect
Inspector: !y____.`� Date: Page of
i�
CITY Off' TIG,ARD
DEVELOPMENT SERVICES PI LIMPITNIS PIC- 11ITT
13125 SW Hall Blvd., 77prd,OR 97223 (503)6394171 PERMIT #. . . . . . . : PLM17-009P
DATF TSCUED- 03/;:T/97
9! MORTHn ST
1! rfaf lihI'' njr. r-1--,Tr)7r, Hn, 2, 7 0 N 7 N C3- R--4.
I..fTT . . . . : .i2'1 TUR T F')0 T CT T ON
n I-, I J r11 r'I •r` I" P11IRPnSE PTTPOSCILS. - 0 mnPTIJ�" HOMt7 5r)nrF.1;. - 0
I-- - -' 'H. . . . . . .. 0 l3(4C.VFL..rJW r'REVNTRI.;. . : 0
11 WOSH'r Nif; M,-T
F7 F-I OnR T)PO.TNS. TPPPS. . . . . . . . . . . . . . : 171
5*P I-Ir.'PT17RF.
W017 I CATCH SASTNS. . . . . . . : 0
1. PUNPPY TrOnYS. . . . . . ef 5F RPTN DRAINS. . . . . :' 0
0 UPTNOL S. . .. . . . . . . . . : 0 GREASE TPAPT). . 0
171 nTHrJ-1 r-TYTUPr1,.. : 0
I-T KJF (ft
0 Wp*rt7- P 1J11.IF (1---t ) , 0
0 P(ITN nRATN (ft ) . 121
`77 m(W."111() T r,PMT t P5. 00 TAT 03/R,7/97
r., nn 1. L"-'5 TAT 03'j-'7/"a'' 17 P
111*1 T Nlf-,
-I-,C,,--P, ;T,
17,-
26. 29 TnTnl-.
PrOUTRED TNISPECTTONS
to the -er"latiom contained in the TnsppvtiOn
ccee, sl?lr, 01 0,- 7�pcialtv Codes and all other Final Insperti(m
I I 1,v to^? it accordprte with
5. ?tic -?rs4t will ty--p if wor4 it not stArteO
IL 15j1p—r re ill wr-4 iS fol- N .--
..............
ca
...........
UJI
Recd By
.ITY OF TIGARD Plumbing Application
13125 SW HALL BLVD. Commercial and Residential Data Recd
TIGARD, OR 97223 Date to P E.
l 3 3 Dare to DST
(503) 639-4171 Permit a 7-
Print or Type Related SWR a
Incomplete or illegible applications will not be accepted called
I
Name of Deveiopmenuprolect FIXTURES (Individual) QTY PRICE AMT
Job Sink 900
Address
Street Address Suite Lavatory 9.00--
r,1-/
.00(1-/ S SL„i It f� Tub or TubiShower Como. 9.00
Bldg a GGtyrSlate Zip Shower Only
7 i r,W 0� Z Z9.00
Water Close! 9tH)
i
Name �J /
sCv4 '4016 i l oy) Dishwasher 9.00
} Own*r Meiling Address Suite Garbage Disposal 9.00
�GI S S w arfllk Washing Machine 9.00
City/State Zip Phone Floor Drain 2" 9.00
Alta DX 117711 1620 -W3 r 900
4- 9.00
Occupant '0 Address Suite Water Heater 9.W
-` Laundry Room Tray 900
City/State Zip Phone Unnal 9.00
Name Other Fixtures(Specify) 9.00
GeU, . /110r1-40 __ 9.00
contractor u��a� ��-,,
iili^9Adddress /1 Suite 9.00
L.�5_a� 41l/i! Aiw i- 9.00
C:y/State Zip Phone
Al 1,4
Z 21 9.00
Oregon Const.Cont.Board Lic.11 Exp.cave _ 9.00
Aft"Copy of C>2 7 3-f 4 4"7 9.00
c4wn"t PlumbeN Lic.s Exp.Date Sewer-1 st 100'
30.00
lkertsee 2 G ° �! Sewer-each additional 100' 25.00
COT Business Tax or Metro a Exp.Date Water Service-1st 100' 30.00
Name Water Service-each additional 200' 25.00
i Architect Storm A Rain Orain • 1st 100' 30.130
or Nsiling Address St.to Storm d Rain Drain-each additional 100' 23.00
Mobile Horst Space 25.00
Engineer C ry,state Zip Phone Commerasi 3ack Flow Prevention Device or Anil- 25.00
Pollution Cewce
Describe worn New O Addition O Alteration O Repair O Residential Backflow Prevention Deice' 15.00
to be done: residential O von-resioential O Any Trap or Waste Not Connected to a Fixture 9W
d I Addlbonal descripuen of worts
Catch Basin 9.00
Insp.of Existing Plumbing 40.00
fn
_ perlhr
Speaarly Requested Inspections 40.00
�csorp
use of - -'- _ Derrhr �-
'� 4Ading or property__ Rain Crain.singie family dwelling 30.00
m Proposed use of Grease Traps 9 0O
Wbuilding or property -- -
J _ QUANTITY TOTAL.
I Are yoc gypping, moving or replacing any fixtures? Yes a No(] )sornatne a riser jogis ragiiiree if CwnRy tonal is •g
lit yes see back cf form) 'SUBTOTAL
I hereDv acknowle:ge that I ha•.e read this aopiication,that the Information _
3tven.s;orrect.!nat I am the owner or authorized agent at the owner. iris 5%SURCHARGE
:nat clans submitted are in comoliance with Oregon State Laws. -P I
Signature of Owner/Agent date PLAN REVIEW 25%OF SUBTOTAL
iJ ) 4r1ou'ed only R fth"my.total is>;
T/f G r/110 TOTAL / f
Contact Person Name Phone Ir•�)
'Minimum permit fee is S73*S%srucatarge,except Residential Backflow
61q-747 Prevention Cevtee.which is S IS•S%surcharge
dststplmspp.doc ty98
PLEASE COMPLETE ASF�PROPRIAtE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sank
Lavatory
--
TuL )r `-ub/Shower Combination
Showe; Only
Water Closet
Dishwasher
Garbage Disposal
Washing Mac0ine
Floor Drain 2"
3"
_ 4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING OVE:
H -
J_
m
LU
J