Permit CITYOFTIGARD
""' ' I '
. � h DEVELOPMENT SERVICES PLUMBING PERMIT
+� PERMIT # • PLM98 -0008 13125 SW Hall Blvd., Tigard, OR 97223 503) 639.4171 A DATE ISSUED: 01/15/98
PARCEL: 1S136DA -00100
SITE ADDRESS...: 11308 SW 68TH PKWY
SUBDIVISION . ZONING: MUE
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B FLOOR DRAINS • 0 TRAPS : 0
STORIES : 0 WATER HEATERS 0 CATCH BASINS : 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS 1 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Capping and replacing a sink
Owner: FEES
PROVIDENCE HEALTH SYSTEMS type amount by date recpt
1235 NE GLISAN PRMT $ 25.00 B 01/14/98 98- 302494
PORTLAND OR 215 -6282 5PCT $ 1.25 B 01/14/98 98- 302494
Phone #:
Contract or
FULLMAN SERVICE CO LLC
5805 SW HOOD AVE
PORTLAND OR 97201
Phone #: 224 -5221 $ 26.25 TOTAL
Reg #..: 122310
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Rough—in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Rough—in Insp
applicable laws. All work will be done in accordance with Top —out Insp
approved plans. This permit will expire if work is not started Final Inspect i o n
within 188 days of issuance, or if work is suspended for more
than 188 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 - 0881-810 through OAR 952- 8001 -088. You may
obtain copies of these rules or direct questions to OINC by calling
(583)246 -1987.
Issued By: , Perm Signature:f - 0( S
++++++++++++++++++++++++++++++ + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
CITY OF TIGARD Plumbing Application Rec3 By e` '
13125 SW:h 1LL BLVD. • Commercial and Residential Date Recd EEO ■
TIGARD', OR 97223 ^ace to P E.
503) 639 -4171 Cate toD
Permit s LilA °Lp
Print or Type Related SWR * 1 0
Incomplete or illegible applications will not be accepted called
Name of CevelapmenvProlect 1� kjry� dj,,,,� FIXTURES (individual) QTY PRICE AMT '
Job �/;19v l4eyI P, t"t2af{i9 4 /WS
Sink / 9.00 q.
Address Street Address Swte lavatory 9.00
//3o6 5, W 6 9/ /3 a y Tub or Tub/Shower Comb. 9.00
313g s ' . City/State Zip Shower Only 9.00
N lm p! amb Or Water Closet 9.00
ldD /IOe (�„P/,y 1'
y5 Dishwasher 9.00
Owner Malin AAdd eCsss ri ,� 4 ' f f` Suite Garbage Disposal I 9.00
1 235 NAG 6L6 I Washing Machine ! 9.00
C7 a e Zip Phone Floor Drain 2" I 9.00
2
l� 215 -1'02132
t�me 3" I 9.00
i 5 Q, .0 cc,1,6144s- • 4" 9.00
Occupant Mailing Address 0 Suite a Water Heater . 9.00
Laundry Room Tray
City/State , Zip v Phone 9.00
Urinal 9.00
Na �°' I Other Fixtures (Specify) ' 9.00
! l� .) eei 9.00
Contractor mops Aaa 1 dU 0( 1 Suite 9.00
(Prom to issuance C' Zip Phone
r ne 9.00
applicant must ryr late � /6 0 120 1 aR c J2Z I 9.00
provide alt Oregon Cons Cont. Board Lic.x Exp. Date 9.00
contractors / 22 I /0 ! R - / / _9 g 9.00
License Plumbing Lic. * Exp. Date Sewer - 1st t00' 30.00
information 24 - 'j`F 3 PO I k , 3 / _ q g
for COT COT Business Tax or Metro* i Exp. Date Sewer each additional 100' 25.00
database). I G I q I eF - 0 / -18 Water Service - 1st 100' 30.00
Name Water Service • each additional 200' 25.00
Architect M r 1A Storm & Rain Drain - 1st 100' 30.00
Or Mating Address Suite Storm & Ram Dram - each additional 100' 25.00
2007 e7e ti I Mobile Home Space 25.00
Engineer C' ra/d�e,,,� '1w Zip Phone �� • Commercial Baca glow Prevention Device or Anti- 25.00
ld�w V� q7i I p[3 - �Z� Pollution Device
Describe .vork New 0 Addition C .alteration 0 Repair C Residential Backftow �revenuon Device' 15.00 1 •
to ae done: Residential 0 Non - residential C Any Trap or Waste Not Conneceo to a Fixture I I 9.00
.acci::onal descnotion of work
Catch Basin
9.00 I •
insp. of Extsung r.umoing 1 40.c0
perrhr
?.cisang use of
%acing or property Specialty Requested Inspections i 40.00
oenhr
I Rain Dram. single family dwelling I I 30.•30
?rocosed use of n // fr �` OtInif ` Grease Traps I 9.00
Pudding or property �tI t' I e, I / (i I'd )
QUANTITY TOTAL
Are you caooing . moving or replacing any fixtures? Yes [ NoX Isometric x nser eiagram :s recwred 4 Quanay Total is 3
(If yes see back of forml 'SUBTOTAL /
l hereby acknowledge that t have read this appiication. that the information . 62('!- f> !
riven is correct. that I am :he owner or authonzed agent of :he owner. and 5% SURCHARGE )11'4
:hat plans submitted are i .:amoliance with Oregon State Laws. _
Signature w Own �(Ag� nt Date PLAN REVIEW 25% OF SUBTOTAL
i�yll/nl fl frt J U/V I ► I Rec„seo cr,M 14x time ^y :otat s > 9
` TOTAL 4 �.
Contact Person Name Phone T e' i
14 Al 22 -Minimum permit fee is 325 • 5% surcharge. except Resioenuai Bacilli 26,;......-
Prevention Device. wruc. is S15 - 5'.'a surcharge ''�r
i. :'tlsts'.plmaop.doc 3196
LEASE COMPLETE AS APPROPRIATE TO PROJECT:
1 Fixtures to be capped, moved or replaced I Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
;OMMENTS REGARDING ABOVE: