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Permit CITY OF TIGARD Plumbing Application Rec'd By < 13125 SW HALL BLVD. Commercial and Residential Date Recd f /� �`�� TIGARD, OR 97223 / �3 �� Date to P.E. / / Date to DST (503) 639 - 4171 ` /G�n Permit # PL/�'i 9 �-(j(.f( Print or Type Related SWR # Incomplete or illegible applications will not be accepted Called Name of Development/Project jJ/ ( 1�.� On back indicate Work Performed by fixture. Job 'S(D g - A I( is .FIXTURES (Individualy1 . a , .',_ • 4, A ; ; .QTY: 'ii P RICE .. AMT;t AddTel c) yrAd e; 2 92 Suite Sink 9.00 J (/ Lavatory 9.00 Bld g / i "" # Ci S tate y Tub or Tub /Shower Comb. 9.00 C} K- Shower Only 9.00 Name A ( c y f� Water Closet 9.00 Owner Mailing g AYddress Dishwasher 9.00 #Z.? Garbage Disposal 9.00 C } "ty�St t ip ' Ph ,f �� � � e � 5 '2 ' .c7 Washing Machine 9.00 Name E � Floor Drain 2" 9.00 Cam `. Ct 3 7! 5 3" 9.00 Occupant Mailing Ad res tC 4" 9.00 City /State Phone Water Heater 0 conversion 0 like kind 9.00 Laundry Room Tray 9.00 Name Urinal 9.00 Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 Prior to permit City/State Zip Phone 9.00 'issuance, a copy 9.00 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date 9.00 required if Sewer - 1st 100" 30.00 3© ? expired in COT Plumbing Lic. # Exp. Date Sewer - each additional 100' 25.00 2 "� database Name Water Service - 1st 100' 30.00 Architect t�(/ 'G e � ko , '1A- Water Service - each additional 200' 25.00 or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00 Storm & Rain Drain - each additional 100' 25.00 Engineer City/State Zip Phone Mobile Home Space 25.00 Commercial Back Flow Prevention Device or Anti- 25.00 Describe work New 0 Addition 0 Alteration 0 Repair 0 Pollution Device to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device' 15.00 Additional description of work:: Any Trap or Waste Not Connected to a Fixture 9.00 4 (' f < < e _ i✓)L- Catch Basin 9.00 pia4/----5 l Insp. of Existing Plumbing 40.00 ,� , ,, 7 per /hr Existing use of / hl-17 - �7^ Specially Requested Inspections 40.00 building or property (' u / per /hr Rain Drain, single family dwelling 30.00 Proposed use of 1 ac-5-7,-„, Grease Traps 9.00 building or property QUANTITY TOTAL • I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quanity Total is > 9 given is correct, that I am the owner or authorized agent of the owner, and that pl. • - submitted are in compliance with Oregon State Laws. *SUBTOTAL a ° � j Sign. u/ nertAg- t ,, - // Date 5% SURCHARGE • v .�eA ` .A PLAN REVIEW 25% OF SUBTOTAL Con .: ct Person Name Phone Required only f fixture ` q y qty. total is > 9 f Z-5/623 TOTAL "Minimum permit fee is $25 + 5% surcharge, except Residential Backflow Prevention Device, which is $15 + 5% surcharge Cmists tolmapp.doc 5/97 PLEASE COMPLETE: - . . by. New , Moved Replaced Removed/Capped Sink Lavatory Tub or Tub/Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine • Floor Drain 2" 3 " 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: 1.1dstskplmapp.doc 5/97 CITY OF TIGARD DATE: 13125 SW HALL BLVD. TIGARD OR 97223 STREET OPENING PERMIT PERMIT #: V- 503 - 639 -4171 F -503- 684 -7297 ; -C' T I APPLICANTS NAME: 1 ADDRESS: - Z 77Z cu �/t i�' ZIP: 722 TELEPHONE #: ��� I CONTRACTOR'S NAME: ADDRESS: ZIP: TELEPHONE #: PLANS BY: r-4?rniE (4401 1 �/ ADDRESS: ZIP: TELEPHONE #: DESCRIPTI • OF WORK TO BE DONE: •)(2, (0) Co •P, or' ESTIMATED VALUE OF WORK (within the public right of way):$ WORK LOCATIONS /SITE ADDRESS: SS' / t- • IS THIS WORK RELATED TO A LAND -USE ACT IF SO SPECIFY (MLP, SDR, ETC.) NO: IS THIS WORK RELATED TO A BUILDING PERMIT? s IF SO, SPECIFY, (BLDG. PERMIT) NO: I `stropn.doc (dst) 5816 O0Z6 0016 0026 00176 O 0 N 0096 000b p V o 1 sr LIZ6 \`MEM bZ6 0 ZGZ6 00291 p uZ 6-M S i SLO91 16036 9ZI9I 16048 OL£6 01116 OZI6 09 b6 ZLZ6 Z8 Z6 LIZ6 F L£Z6 91 G6\ OZZ6 AI ec \o ' a ro -o \ 94 '50 9E96 0186 £cr oZ96 6/6/00 Activities for Case #: PLM97 -00462 Lof . 1:27:27 PM it / . Assigned Hold Updated {• , r Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMA003 Application received 11/17/97 JSD PASS JD 11/18/97 Received concurrently with a street opening permit application. PLMA005 Create Permit 11/18/97 JSD PASS JD 11/18/97 PLMA799 Final Inspection JD 11/18/97 PLMA705 Sewer Inspection 11/18/97 JD 11/18/97 PLMA040 (F) Ready to issue 11/18/97 JSD PASS JD 11/18/97 This can be issued as soon as the street opening permit has been issued. This is a vacant lot adjacent to the street. Contractor information needed. jsd PLMA080 Void Permit 11/26/97 DRA VOID DRA 11/26/97 Permit was issued under PLM97 -0466 on 11- 19 -97. Page 1 of 1