Permit CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #.......: PLM96 -0118
i 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 05 / 0 i / 98
PARCEL: 2S112CA -13100
SITE ADDRESS...: 15532 SW 76TH AVE
SUBDIVISION : RENAISSANCE WOODS NO. 2 ZONING: R -7 PD
BLOCK . LOT •055 JURISDICTION: TIG
CLASS OF WORK..: ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE :SF WASHING MACH 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:R3 FLOOR DRAINS . 0 TRAPS • 0
STORIES • 0 WATER HEATERS : 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS : 0 SF RAIN DRAINS 0
SINKS - 0 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: Giesbrecht
Owner: FEES
FRANK B GIESBRECHT type amount by date recpt
15532 SW 76TH PRMT $ 15.00 JSD 05/01/98 98- 305422
TIGARD OR 97224 5PCT $ 0.75 JSD 05/01/98 98- 305422
Phone #: 624 -2141
Contractor
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TIJALAT I N OR 97062
Phone #: 691 -6166 $ 15.75 TOTAL
Reg #..: 000879
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backflow Prev
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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- iai1 -wi 10 through OAR 952 'T '.1 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
= Permittee Signature: :, .C' t4
Issued By �,� g
+ + + + + + + + + + + ++ + + + ++ Q"++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Application Reed By
13125 - SW HALL BLVD. Commercial and Residential Date Recd : :- / a
TIGARD, OR 97223 Date to P.E.
Date to DSjf
(503) 639 -4171 Permit /� a
Permit * /� , t. / g 0 11 O
Print or Type Related SWR x v •
Incomplete or illegible applications will not be accepted Called (7 2
Name of DevelopmentIProlect 'it FIXTURES (individual) QTY PRICE `AMT
Sink 9.00
Job 15 `a (ti9- �76,44` Lavatory 9.00
Address Street Address 1 4, Suite
Tub or Tub /Shower Comb. 9.00
Bldg s City /State Zip Shower Only 9.00
Water Closet 9.00
Name G L br - C .0 l f Dishwasher
• 1 AIL 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
FSS 3 J 5 7O Washing Machine 9.00
�rState Zip Phone Floor Drain 2 9.00
• w c&. 97aat 3- 9.00
4 ' 9.00
Occupant Malang Address Suite Water Heater -- 9
Laundry Room Tray 9.00
City/State Zip Phone Urinal - 9.00
Name Other Fixtures (Specify) - 9.00
C'1 f� j WIM ervt f 1 kitn 9.00
Contractor Mamg Address Site 9.00
ii 1 a0 sti3O.,1,JU' 4v Li 9.00
City/State Zip Phone ,
Zwa,Id u✓ Or 91062 q1 -61h -- _ 9.00 - .
Oregon Cant. Cont. Board Uc.S p. D to 9.00
Angels Copy of { � q Q 2 9.00
Exp. ate _ Sewer - 1st 100' 30.00
Licenses P � 5 . 0 P6 , II 2 /CLy Sewer - each additional 100' I 25.00
COT Business Tax or Metro 2 Exp. / Date
bate Water Service - 1st 100' 30.00
a Li 154, ��7 1 Water Service - each additional 200' - 25.00
i Name
Architect Storm & Rain Drain - 1st 100' 30.00
or Mailing Address Si..;e Storm & Rain Drain - each additional 100' 25.00 I
Mobile Home Space 25.00
Engineer 1 City/State up Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
l Describe work New 0 Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' I 15.00 /5 ocn
• to be on
de_ Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture I 9.00
Additional desaipuon of work
Catch Basin I I 5.00
•
. Insp. of Existing Plumbing
1 I 40.00
per/hr
° - 9 use of Specialty Requested Inspections I 40.00
oerihr
xuidinq or property Rain Drain. single family dwelling 30.00 1
Proposed use of Grease Traps I 9.00
building or property
QUANTITY TOTAL
Are you ca pping . moving or replacing any fixtures? Yes ❑ No t7 Isometric or riser diagram is required A t]uanay Total is > 9
(If yes see back of form) 'SUBTOTAL t S
I hereby acknowledge that 1 have read this application. that the information
given s correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE
that plans submitted are in comoliance with Oregon State Laws. f
Signature of Owne /Agent Date PLAN REVIEW 25% OF SUBTOTAL
/ / (� (% Required only if fixture qty. total is >_ 3
I .L.J. Al.�L��hiL U /V TOTAL ( CI(
Contact Pe T on Name Phone ,
1 i f 'Minimum permit tee is 525 + 5% surcharge. except Residential Backflow
■ ►' l Jot r y r u t� �-' S 6 _ 6/I( Prevention Device. which is 515 + 5% surcharge
i:\dststplmapp.doc 8/96 .
PLEASE COMPLETE AS APPROPRIATE TO PROJECT: Y;
Fixtures to be capped, moved or replaced 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)
7 'OMMENTS REGARDING ABOVE:
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: !! �� - 7 -q f? A.M. P.M. MST:
Location: / 5 5 3 . 2 i() 7& ax-c__, , BUP:
Tenant: Suite: Bldg: MEC:
Contractor: II, b.,.._. f /L AP / Phone: 6O qt- 6 / 6 to PLM: W
Owner: 1 -ji.,e2/)4 ' Phone: 6a -T '–',./ I f / ELC:
..-e_ ELR:
G:,c- cA.A 2 7 o ed) Srr:
BUILDING BLDG (con't) • rr 'I: 1' r MECHANICAL ELECTRICAL SITE
Site Post/Beam • • v • . oa Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp 'Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab / /
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt . ' ,A ...e4
Approved Approv Approved Approved App s ed
Appr /Sdwlk Not Approved ved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL
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O Call for reinspect' O Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: -__ . Date: ,_,5 7 / xt 9 Page of