Permit •
CITY OF TIGARD
„ d, ;•, DEVELOPMENT SERVICES PLUMB PERMIT
� h1!'ili, PERM I T # ° PLM97 -0247
+� =:_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/26/97
PARCEL: 1S136CB -02200
SITE ADDRESS...: 11220 SW 82ND AVE
SUBDIVISION....: RANCH VALLEY ZONING: R -4.5
BLOCK • LOT °3 JURISDICTION: TIG
CLASS OF WORK..: REP GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE :SF WASHING MACH : 0 BACKFLOW PRE 0
OCCUPANCY GRP..:R3 FLOOR DRAINS : 0 TRAPS ° 0
STORIES ° 0 WATER HEATERS • 1 CATCH BASINS : 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS ° 0
SINKS : 0 URINALS ° 0 GREASE TRAPS • 0
LAVATORIES ° 0 OTHER F IXTURES 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS : 0 RAIN DRAIN (ft)...: 0
Remarks: replace electric water heater with gas water heater
Owner: FEES
BRYAN S HADDIX type amount by date recpt
11220 SW 82ND PRMT $ 25.00 TAT 06/26/97 97- 296522
TIGARD OR 97223 5PCT $ 1.25 TAA 06/26/97 97- 296522
Phone #: 684 -2697
Contractor
OWNER
Phone #: $ 26.25 TOTAL
Reg #..
REQUIRED INSPECTIONS
This persit is issued subject to the regulations contained in the Water Line 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 PLM /Underfloor
approved plans. This permit will expire if work is not started Final Inspection
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 say
obtain copies of these rules or direct questions to CUNC by calling
(503)246 -1987.
Issued By: �� , � -. . L . i Permittee Signature:4d e MAW]
+++++++++++++++++++ + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by :00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
;TY OF TIGARD Plumbing,.Appiication Reed By
.3125 SW BLVD. Commercial and Residential Date Reed
:GARD, OR 97223 Date to P.E.
X03) 639 -4171 Date to DST
Permit:
Print or Type Related SWR:
Incomplete or illegible applications will not be accepted Caned
•
\
Name of Development/Pro ect _ .:FIXTURES./IndMdual) K k ,` E4 Wain
• Job 1401411 OLL.9klE._ stet` 9.00
Address Street Address Suite lavatory e.00
12 zO 5 02,1 T201-3 Tub or Tub/Shower Comb. 9.00
Bldg * City /State Zip 9l-j�?� Shower Only
7 p 9.00
Name
1 � ` ���}R D bR - Water Closet 9.00
Owner e) M a �� ` � S, , 17 x Garbage Disposal 9.00 .00 '
11 ?�� Sal R'2N� Washing Machine 90
CIty/State Zip Phone •-- 9.00
Tr&t oK 97 � - 2 7 - Drain 9.00
Name 1n r.... 9.00
•
Occupant mailing Address �" V 1� Water Heater 4' 9.00
1 9.00
- Laundry Room Tray 9.00
City/State Zip 1 Phone urinal
9.00
Name Other Fixtures (Specify) . • 9.00
� j too
Contractor ^g Address] , Suite _.. _- ...__. ... 9.00 .
(Prior to issuance City/State Zip Phone - - 9.00
applicant must 9.00
provide all Oregon Coast. Cont. Board Lic.: Exp. Date - - 9
contractors
license ewer -
lic.: Exp. Date Sewer 100' 9.00 0
00
for COT COT Business Tax or Metro: Sewer -each additional 100' 25.00
database). Date Water Service -1st 100'
- . 30.00
Name Water Service - each additional 200' 25.00
Architect Storm a Rain Drain - 1st 100' • 30.00
Or Mailing Address Sure Storm a Rain Drain - each additional 100' 25.00
or Mailing Addre;s___________
. f
Mobile Home Space 25.00
Tngineer City /State Zp Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device -- - -
saibe work New 0 Addition 0 Alteration 0 Repair O Residential Baddiow Prevention Device' 15.00
'e done: Residential 0 Non - residential 0
iitional desaiption of work Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
Insp. of Existing Plumbing _ 40.00
pert hr
•5ng use of Specially Requested Inspections 40.00
ling or property per/hr
Rain chain, single family dwelling 30.00
dosed use of
property Grease Traps _ 9.00
QUANTITY TOTAL
you capping moving or replacing any fixtures? Yes ci No Q Isarrteeic a riser diagram reputed d Cuanay Tots is 9 '�' ' ` -;;:,•41:
`
`yes see back of form) �' °' : �
'SUBTOTAL - ' - '""- . -.''
1 ereby acknowledge that I have read this application. that the information
..'n is correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE :-;:-p ;
t!at Plans submitted are in compliance with Oregon State Laws.
;ignature of Owner/A ent
9 Date PLAN REVIEW 25% OF SUBTOTAL _' - :.t :.•, ._:
Required only if Ibcaae sty. Foal is . 9 - ; ... - . -
TOTAL ;= -
• ntact Person Name . Phone
'Minimum ` �
permit fee is 525 . 5% surcharge. except Residential Badkflow
Prevention Device. which is $15. 5% surcharge
I:\plmapp.doc 12196 (dst)
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
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)
•
:OMMENTS REGARDING ABOVE: -
I: \plmapp.doc 12/96 (dst)
11 ; %..,k c : .., . ,-0
ti)-
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
p /2 0z0 �` •
Date Requested: " - /) - 17 - ! 7 A.M. Cr . ? M
Location: Z 2%Q .3 (mil J 82 r BUP: q
f
Tenant Suite: Bldg: MEC:
'� Contractor: 61e- -t / rt I4ADD 0 Phone: PLM: 7 - ( 2 7
�,/
Owner: / W Phone: 7 5 �x 7 7 ELC:
/ i /i 1ft Cd-eiA tAra.Te Re.a- ELR:
SIT:
BUILDING BLDG (can't) PLUMBIN 4 " r CHANICAL ELECTRICAL SITE
Site Post/Beam 'o : eam . r : eam Cover /Service Sewer /Storm
Footing Roof UndFUSlab Rough -In Ceiling
Slab Framing 4111WAST. Rough -In prunkler
Foundation Insulation ewer ' ood/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
Approved Approved • pprov• I Approved -4; -:.-.-.-••
Appr /Sdwlk Not Approved , o A y. 4v-.110. o • ,proved Not Approved l�
FINAL FINAL i , - ttret....ZI.A. A 1..441 / /L"
-e - -
Z / - _ - r eW
• VP ,t...-L-4....A_A_Zei....., /...4...--■--/-4 /...c...rel.../YA.v •
���
all for reinspection O Reinspection fee of $ required before next inspection 0 Unable to inspect
1
Inspector: -//e Date: / 2- -/7 -• 7 7 Page of
t