Permit / /6(
CITY OF TIG
PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00017
J�1 =., DATE ISSUED: 1/16/2003
' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S136DA-00700
SITE ADDRESS: 11530 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: 2/24/06: THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTIONS FOR A
PERIOD OF THIRTY DAYS. Disconnect and reconnect fixtures: (3) lays, (2) urinals and (4) water
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 2 GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 4 WATER LINE: ft
•
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
HI HAT INC
11530 SW BARBUR BLVD Description Date Amount
PORTLAND, OR 97219 [HRPLM] Hourly Plurn 2/24/2006 $57.87
[HRTAX] Hourly 8% St 2/24/2006 $4.63
Phone : [PLUMB] Permit Fee 1/16/2003 $149.40
[TAX] 8% State Tax 1/16/2003 $11.95
Total $223.85
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W COLUMBIA RIVER HWY
TROUTDALE, OR 97060 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 235 -8784
FAX 503 -491 -2932
Reg #: LIC 23847
PLM 26 -208PB
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 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: TAC „,Z Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
c, vs_ CA- ("Vd: 9
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00017
*14104 . DATE ISSUED: 1/16/2003
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S136DA-00700
SITE ADDRESS: 11530 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: 2/24/06: THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTIONS FOR A
PERIOD OF THIRTY DAYS. Disconnect and reconnect fixtures: (3) lays, (2) urinals and (4) water
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 2 GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 4 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
HI HAT INC
11530 SW BARBUR BLVD Description Date Amount
PORTLAND, OR 97219 [HRPLM] Hourly Plum 2/24/2006 $57.87
[HRTAX] Hourly 8% St 2/24/2006 $4.63
Phone : [PLUMB] Permit Fee 1/16/2003 $149.40
[TAX] 8% State Tax 1/16/2003 $11.95
Total $223.85
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W COLUMBIA RIVER HWY
TROUTDALE, OR 97060 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 235 -8784
FAX 503- 491 -2932
Reg #: LIC 23847
PLM 26 -208PB
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 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: .rOj 4 Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
4: CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2003 -00017
jyA DEVELOPMENT SERVICES DATE ISSUED: 1/16/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11530 SW PACIFIC HY PARCEL: 1S136DA -00700
W
SUBDIVISION: ZONING: C -G
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: • CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 2 GREASE TRAPS: -
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 4 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Disconnect and reconnect fixtures: (3) lays, (2) urinals and (4) water closets.
FEES
Owner:
Description Date Amount
HI HAT INC
11530 SW BARBUR BLVD [PLUMB] Permit Fee 1/16/03 $149.40
PORTLAND, OR 97219 [TAX] 8% State Tax 1/16/03 $11.95
■
Total $161.35
Phone :
Contractor:
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone : 667 -1781 Rough -in Insp
Final Inspection
Reg #: LIC 23847
PLM 26 -208PB
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
Issued By:
<'a5 lL� Permittee Signature: /fl �/�/ e4---770
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Jan -16 -03 02:40P Wolcott P 503 667 9891 P_02
4 Plumbing Permit A li c a t i o n t 1 I n I, I ()NI
City of Tigard R E 'E I V E D Date received: / 46 0.3 Permit no.: O Lly'l0 03 1 9
N(� - �� i„ � Sewer permit nn.: Building permit no.:
Address: 13125 SW Hall Blvd, 7•i J ,i p K
c;,y ,�fT,Aard Phone: (503) 639 -4171 Projeeuuppl. no,: Expire date: . -
Fax: (503) 598 -1960 CITY OF TIGARD Date issued: Ry: • - Receipt nn.:
Land use approval: BUILDING DIVISION Case file no.: Payment type:
I 1I'F: IIF PF.R \II I
U I. & 2 family dwelling or accessory U Commercial /industrial U Multi - family U Tenant improvement
U New construction ke Addition/alteration/replacement O Food service U Other: _
Atilt 11) I I \ Ft)It NI • . I IO \ 1. i:1•..ti( III- lit I.I• Ow >pecj it inlorin:tlinn u.L. t lieckli'I )
Job address: /153 (7 w , lek /F., AbAY Description Qty. Fee(ea.) 'Fatal
131dg. no.: Suite nn.: •- New I- and 2- family dweltlgga only:
(Includes 100 ft. for each utility connection)
Tax Wrap /tax lot/account no.: SFR (1) bath
Lot: Block: Subdivision:
� � Subdivision: SFR (2) bath
Pmject name: N/ ...#47' � uxt�Ivr SFR (3) bath
City /county: 7 .,1 QD ZIP: Each additional bath /kitchen
Description and location of work on premises: ( /,SCOA/AlCr Site utilitles: -
___4494,41/ MT . q __ / Irri[ZOFS__ . Catch basin/area drain
F. st.dateofcompletion/inspection: / — - Utywcllsllcachline /trench drai - _ _
Footing drain (no. lin. ft.)
1'I. \1111 \(: t't /\ I It l( '1111i Manufactured home utilities
Business name: it( /Lult(�f/tl(o �l / / G M anholes
Address: PZ7, 736K 3007 Rain drain connector __
-
City: Statet9/Q_ j ZIP: g7050 Sanitary sewer (no. lin. ft,)
Phone: 7 ?-frgi 1 ax 7 {/ F: -mail: Storm sewer (no. lin. ft.) _
7 1 reg. - 208 'Ar Water service (no. lin. ft.)
X, CCB no.: 'L ¢- Plumb. bus. re no:
- 4 - "- Fixture or Item:
City /metro Iic. no.: al - - -
Contractor's representative signature: j ') r Absorption valve
d0 Print name: / % • Back now preventcr ,
py 4.- ♦ Dale: / - /G"" t'J Backwater valve _
('I)\ I \4 I I'1.11 .. )\ Basins /lavatory - 4 /6. O - Yr, t ep
Name: Clothes washer
— -- - - Dishwasher
Address: Drinking fountain(s)
Cit _ ZIP: Ejectors/sump - _
Phonc: _ F ax: E - mail: Expansion tank . •
Fixture /sewer cap
Name (print): Floor drains/floor sinks/hub _ — _
Mailing address: — Garbage disposal
Hose hibh
City: !Slate: ZIP: Ice maker • _ _
Phone: FFax: Ili—mail: , interceptor /grease trap
Owner installation /residential maintenance only: . 1hc actual installation Priiner(s) -
will be made by me or the maintenance and repair made by my regular - - Roof drain (commercial)
employee on the pmperty I own as per ORS Chapter 447. Sink(s). hdsin(s), lays(s) .
Owner's si nature: _ Date: Sump
Tubs/shower/shower pan
Urinal -- /4 •G o 33..20
Name: _ .. . - Water closet _ 04 /4, 44 G( Ye)
Address:
• _ ._ Water heater _ . --
City: I State: I ZIP: Other:
Phone: I Fax: 1E-mail: - Total . _
Minimum fcc $ _ /Y9. 5V0
r Ntn all juristtit iwta a;vt crcdil =rib, pkaan .sill jurisdictiun sus more belinna Notice: This pe nnit applicatitm o S
Via J Hastert:Rod Plan rtivicw (at • %)
cxpinni if a permit a not obtained u --
U vi crudit card number. .• — _ I I. -- within 180 days alter it has been Slate surcharge (H /.) S 1/. 9.5
Nmne u accepted as complete.
• �dMlder as shuwu nn credit ear – T -
• — C.adiuT isnnmre
$ Amount. a�a 46u' (11,03/CUM)