Permit A CITY OFTIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
°- " y �l . - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERM T T 977- G 1
DATE ISSUED :: 01/288 / /37
<t� PARCEL: 1S134BC -90013
SITE ADDRESS; ° 10857 SW 1.2193". AVE •
SUBD�I"V�ISION,. o">.. ":* •WOOf}SPR.ING �C,ONDOS - TON I•NG: R -7
BLOCK.°° ° °°°° ° ° °° LOT. °°°°°°°°°° ° °:13 ��
CLASS OF WORK° °:ALT GARBAGE DISPOSALS °: 0 OBILE HOME SPACES.: 0
TYPE OF USE. . ° °:SF WASHING MACH. ° ° ° ° °: 0 BACKFLOW PRE VNT RS. °: 0
OCCUPANCY GRP ° ° :R3 .FLOOR DRAINS 0 TRAPS— °°°°°°° °°°°: 0
STORIES ° ° ° °. ° ° °: 0 WATER. HEATERS 1 CATCH BAS INS°°°°°° °: 0
FIXTURES - - - -- LAUNDRY TRAYS— ..: 0 SF RAIN DRAINS ° 0
SINKS. ° . &.,•.'.,-. ...,,,:,,,, 0.,;- ° r _ UR;I NAL,p,, a 4 „ . , .. . . I . , .., , ., o ..... � GREASE ?T RAPSe ° • ,:,° ° 0
LAVATORIES°°° ° °: 0 OTHER FIXTURES ° 0
. TUB/SHOWERS ° ° ° •°..° _ 0.:,,, `: + „. •
,.• ,;:., „SEWER..L.INE. (ft.) ;,. ,0,,.,,
WATER CLOSETS ,..: 0 WATER LINE (ft ) °°°: 0 '
DISHWASHERS ° :° ° 0 • . RRI.N. DRAIN•. (ft) °. -, :, 0,
Remarks: Water Heater replacement
Owner: -- FEES
JOANNE MORKS type amount by date recpt
10857 SW-121ST '. ,- -,. �PRMT $ 25.00 JSD 01/28/97 97- 289579
5PCT $ 1.25 JSD 01/28/97 97-289579
TIGARD OR 97223
Phone #1. -•30 70.. ; 0.
Contractor: - -- ---- - - - -.. -- --
• GEORGE MORLAN PLUMBING.- .
5 529 SE FOSTER RD
PORTLAND OR 97206 - --
Phone ##: 771 -1145 $ 26.25 TOTAL
Reg # ° °: 02734
. r. REQUIRED INSPECTIONS
This permit is issued subject to the..regulatiens .contained in Abe-. ., . Mi.sc,. Inspect ion •
Tigard .Municipal-Code,. State.of-Orei Specialty,..Cade.s . and: al l -other- • F.i na 1;, I.n s pe ct ion. , _
applicable, laws.: All work •wi 4 be , done in,, accordance , :with ,: , .• ,, , , ..
approved plans.. This- permit will expire-if viorktis ;tot; •4tarte,dR
- within 180 -days ;of .issuance, orr,if -work' °is :suspended._fo ; ® nre - , ,:,,: 7,.... .. .. • . ' . , «' , , .. ,
---------1.- �/ .___
Permittee Signaty G— 44 -
Issued B .. - -- � _
• . -
.. ,: . -� :; Ca,l�,l.� for ,ins.pe.pj.“.on,.,. —, 639 -4175
CITY OF TIGARD . Plumbing Application Rec'd By ---D.
1 3125 SW HALL BLVD. Commercial and Residential Date Rec'd d
TIGARD, OR 97223 Date to P.E.
'503) 6394171 Date to DST�j
Permit x PL/vt 4 - 000(
Print or Type Related SWR x lu - T/);4
Incomplete or illegible applications will not be accepted Called rii c.-
• Name of Develo // pment/Prole / c � t ,,� 1 n Q / FIXTURES (individual) QTY PRICE AMT
• 6 ,4y ]"l e/ , /Qddh'1Cfl Sink 9.00
Job. �n�h r er
Address Street Address l Suite Lavatory 9.00
/bP5 7 $ ,_/ /DI 1 s� Tub or Tub /Shower Comb.
9.00
Bldg it City/State , G � Zip �� t Shower Only 9.00
Water Closet 9.00
Name V
,//l Dishwasher 9.00 r
Owner Mailing Address / � , Suite Garbage Disposal 9 00
10 r 5 S�, i Z t Washing Machine 9.00
City/State • Zip Phone Floor Drain 2' 9.00
T y 7 01723 Sc0- 3070
ryme 3 " 9.00
i �lir Ai.� 4' • 9.00
Occupant Malang Address Suite Water Heater / 9.00
•
Laundry Room Tray 9.00
City/State Zip Phone Urinal 9.00
t Name
Other Fixtures (Specify) 9.00
� e -- a hor 9.00
Contractor Mailing ddress 9
izSrrs S • P l 00
t
9.00
City/State Zip Phone 9.00
7 ,.Z! a I t `72) Gtr - 73 Q )
Oregon Const. Cont. Board Lic. Exp. Date 9.00
Mach Copy of 02:1 ': G / m / 9.00
Current Plumbing Lic. # Exp. Date Sewer - 1st 100' 30.00
Licensee 2 - ( ) J ' ,./'D/41 Sewer - each additional 100' 25.00
COT Business Tax or Metro S Exp. Dat Water Service - 1st 100'
30.00
Name Water Service - each additional 200' 25.00
I Architect Storm & Rain Drain - 1st 100' 30.00
Addr ess Storm & Rain Drain - each additional 100' 25.00
Mai
or I ling Si.. :
Mobile Home Space 25.00
Engineer rCityiState Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
• Describe work New 0 Addition 0 Alteration 0 Repair O Residential Backflow Prevention Device' 15.00
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture i 9.00
Additional desrnption of work Catch Basin I
1 9.00
i
t Insp. of Existing Plumbing 40.00
I
I
per/hr
Specially Requested Inspections i 40.00
Existing use of cerrhr •
I ^9 or ProPettY Rain Drain, single family dwelling I 30.00
' Proposed use of Grease Traps I 9.00
building or property
QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes ❑ No a Isometric or riser diagram is required if Cuanay Total is > 9
(It yes see back of form) 'SUBTOTAL
I hereby acknowleage that I 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.
Signature of Owner /Agent . Date PLAN REVIEW 25% OF SUBTOTAL
!
•
�� J .i 7 / 7 Rem/iced / / . J� Reiced only if future qty. total is > 9 TOTAL l 76.
Contact Person Name Phone
il
'Minimum permit fee is 525.5% surcharge. except Residential Backflow
! 7 , /e /W/OV 62-'1 Prevention Device, which is 515 + 5% surcharge
i:\dstslplmapp.doc 8/96 ,
Hi
PLEASE 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)
COMMENTS REGARDING ABOVE:
5/10/00 Activities for Case #: PLM97 -00021 EXPIRED
1:00:05 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA007 Application received 1/28/97 JSD PASS JD 1/28/97
PLMA799 Final Inspection JD 1/28/97
PLMA740 Misc. Inspection 1/28/97 JD 1/28/97
PLMA050 (F) Issue permit 1/28/97 JSD PASS JD 1/28/97
PLMA845 Request inspection research 3/28/00 JMT DONE No Hold JMT 3/28/00
PLMA850 Expired by limitation 4/18/00 HAP DONE No Hold AKJ 4/18/00
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