Permit CITY OFTIGARD
„,m ,, ,\ DEVELOPMENT SERVICES PLUMBING PERMIT
1 I I PERMIT # PLM97 -0259
-' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/02/97
PARCEL: 251.03DA -05400
SITE ADDRESS...: 13395 SW 107TH AVE
SUBDIVISION • ZONING: R -3.5
BLOCK...........: LOT JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
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)...: 100
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Installing sewer line
Owner: -- FEES •
DEAN TABERT type amount by date recpt
13395 SW 107TH PRMT $ 30.00 B 07/02/97 97- 296730
TIGARD OR 97223 SPCT $ 1.50 B 07/02/97 97- 296730
Phone #:
Contractor
OWNER
Phone #: $ 31.50 TOTAL
Reg #..
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
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 'm1 -0010 through OAR 952-0001-0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
e A
Issued By: 10) u� / 1.!d ``� Permittee Signature:
+++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +++ + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•ITY OF TIGARD Plumbing Application Recd By
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':3125 SW HALL BLVD. Commercial and Residential Date Recd 7- 7
rIGARD, OR 97223 Date to P.E.
503) 639 -4171 Date to DST
Permit 9 f/,M41 - D
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Called
Name of DevelopmenuPro ect :EP. tilisitialliStseS ..Q1221 AT N:4 a • , ii
Job TA' Ei 9.2. t 1DE JCt` sink 9.0
Address Street Address Suite 9.00
\339S S W t (1? t-t= AUE Tub or Tub/Shower Comb. 9.00
Bldg s City /State Zip Shower Only
_ 716A.9.45 / CM- 97223 • 9.00
Water Closet 9.00
Name
i DEA/4 d• SAN0t2A� 174-�`�T Dishwasher - 9.00
Owner Mailing Address Suite G° ' b° ge D 9.00 •
13395 S� - 1o'7 .►E Washing Machine
9.00
City/State Zip Phone Floor Drain r 9.00
7T ./..r , 61 9 722 3 Ge4-• -0401 3- 9.00
Name ..
- SAME Ads Alto 4" 9.00
Occupant M ailing Address Suite water Heater 9.00_
Laundry Room Tray - • - 9.00
City/State Zip Phone Urinal
9.00
Name Other Frrdtues (Specify) - - 9.00
V 100 �� 9.00
Contractor Mal ling Address ' Suite .... -. - -- _. -.. .-- ..
(Prior to issuance City/State Zip Phone - 9.00 .
applicant must -. 9.00
provide all Oregon Const Cont. Board tic.* Exp. Date - 9.00
contractors
license Plumbing Lis.* - 9.00 -
infortnatian Exp. Date - Sewer-1st 100' - I p -pb 13�e J�
for COT
Sewer - each additional 1W 25.00
database). COT Business Tax or Metros Exp. Date Wad Service -1st 100' 30.00 -
Name water Service -each additional 200' 25.00
Architect Storm & Rain Drain -1st 100' . • 30.00
or Mailing Address - Suite Storm 3 Rain Drain -each additional 100' 25.00
Mobile Home Space 25.00
Engineer Cily /State Zip Phone C Device Flow n Device or Antes . 25.00 Y
Describe work New 0 Addition 0 Alteration 0 Repair 0 Residential Baddlow Prevention Device' 15.00
to be done: Residential 0" Non- residential 0 Any Trap or waste Not Connected to a Fixture 9.00
Additional desaipteon of work - - - - - - . Catch Basin - - - 9.00 -
-- - Insp. of Existing Plumbing - 40.00
S Eg_. l}00K-ue permr
xisting use of SPIN Insp 40.00
7uilding or property Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
_ing or prosy •
QUANTITY TOTAL j'
Are you capping , moving or replacing any fixtures? Yes ❑ No ❑ Isorrreaic ar riser diagram is required if (Needy Taal is 9 ? ;",:
;if yes see back of form) *SUBTOTAL ._.r-: , -
'Q . :' _.,,
ti
�.�
hereby acknowledge that I have read this application, that the information :• '
,,ken is cored, that I am the owner or authorized agent of the owner'. and 5% SURCHARGE "'..- - : 1, Sd
: =-
: at clans submitted are in compliance with Oregon State taws. - '� .:
i gnature o NAgerrt _ Date PLAN REVIEW 25% OF SUBTOTAL _ - iti
Rea+rired arty 1 tbsn -e dry. tow is > 9
/ A. TOTAL = ' r- 0/.5 ;intact Person -
Phone --
•Minimum permit fee is 525 + 5% surcharge, except Residential Backflaw
Prevention Device, which is 515 + 5% surcharge
I:\ptmapp.doc 12/96 (dst)
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'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)
6/6/00 Activities for Case #: PLM97 -00259
2:02:52 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 7/2/97 B PASS BON 7/2/97
PLMA005 Create Permit 7/2/97 B PASS BON 7/2/97
PLMA799 Final Inspection BON 7/2/97
PLMA705 Sewer Inspection 7/2/97 7/8/97 MRS PASS AKJ 4/3/00
PLMA050 (F) Issue permit 7/2/97 B PASS BON 7/2/97
PLMA740 Misc. Inspection 2/23/00 2/23/00 2/23/00 JMT DONE No Hold JMT 2/23/00 research inspection request
PLMA800 Case Finaled 4/3/00 AKJ DONE No Hold AKJ 4/3/00
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