Permit P LUMBING PERMIT
OF � PERMIT # ^ PLM96-0054
cflY DATE ISSUED: 05/13/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd Tigard, Oregon 97223.8199 (503) 639-4171 � ' ' PARCEL: 25101BC-02800
SITE ADDRESS...: 08250 SW HUNZIKER RD.
SUBDIVISION....: ZONING: I—L
BLOCK..........: LOT.............
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:COM WASHING MACH......: 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B2 FLOOR DRAINS ^ 0 TRAPS ^ 0
STORIES........: 0 WATER HEATERS.....: 1 CATCH BASING ^ 1
FIXTURES LAUNDRY TRAYS : 0 SF RAIN DRAINS ^ 0
SINKS ^ 0 URINALS...........: 0 GREASE TRAPS.......: 0
LAVATORIES.....: 2 OTHER FIXTURES ^ Q
TUB/SHOWERS ^ 0 SEWER LINE (ft)...: 80
WATER CLOSETS..: 2 WATER LINE (ft ) ... 0 .
DISHWASHERS....: 0 RAIN DRAIN (ft). : 180
Remarks: Construction of a 12,600 sq. ft. pre—engineered steel warehouse
Owner: FEES
JIM SEVERSON type amount by date recpt
29404 SW HEATER ROAD PRMT $ 139.00 B 05/13/96 96-279330
5PCT $ 6.95 B 05/13/96 96-279330
SHERWOOD OR 97140
Phone #: 684-0443
Contractor: -----
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD OR 97223 —
Phone #: 503-639-5296 $ 145.95 TOTAL
Reg #. . : 002439
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Top—out Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Storm Drain Insp _
applicable laws. All work will be done in accordance with Rain Drain Insp
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.
.
' ---------
-- -
Permittee Signature: "A
�u
I ssued By: ��- �� ~/ 4— ______________
Call for inspection — 639-4175
ret d -L5
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125,SW Hall Blvd. Permit # N \ 1 -(2 1 /
' Tigard, OR 97223 SW (Z ° I!a- b(7-61
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Na1e of Develo New Single Family Residences Only
Warehouse Development Project
1'250 SW H key Rd. ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job ❑ 3 BATH HOUSE $225.00
Address Dltyfstate DP Fee includes all plumbing fixtures in the dwelling and the first 100 feet
Tigard, OR 97223 of water service, sanitary sewer and storm sewer. See fees below.
Name (or name of Sassiness) FIXTURES QTY PRICE AMT
James A. Severson 684 -0443 Sink - 9.00
Waling Address Phone Lavatory 2 9.00 18.00
Omer 29404 SW Heater Rd Tub or Tub /Shower Comb. 9.00
Shower Only 9.00
S Sherwood, OR 97140 _ Water Closet 2 9.00 'i O. UU
Name (or name of busmen) Dishwasher 9.00
Garbage Disposal 9.00
Occupant Mailing Addy°,° Phone Washing Machine 9.00
Floor Drain 9.00
cnyfstate 4 ' Water Heater 1 9.00 9 .00
Laundry Room Tray 9.00
Name ,o�� ( Urinal 9.00
f /.J°st K ( li,_/.�b( Other Fixtures (Specify) 9.00
Malang Address V shone 9
Contractor
9.00
cdyfstate • DP 9.00
Sewer 1st 100' 80' 30.00 30.00
State Registration No. Cdr Bus. Tax No. Sewer - ea. Addit. 100' 25.00
Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 100 30.00 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 80 ( 25.00 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti - Pollution Device 9.00
Signature (owner or agent) Date Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new ax addition 0 alteration 0 repair 0 Catch Basin 1 9.00 9.00
to be done residential 0 non - residential COX Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00 /hr
Existing use of
building or property material storage Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of material storage
building or property
'(Except residential backtlow
prevention devices)
NOTICE `Minimum Fee $25.00 SUBTOTAL 139.00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 6.95
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED > c....
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL 1,tS8.
Special Conditions / /
( I05,°IS
Date issued by t
v�
Page No. 1 CASE HISTORY FOR CASE NO.: PLM96 -0054
JIM SEVERSON
08250 SW HUNZIKER RD
02/11/99
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
- - - - - -- ------------------------ - - - - -- -- - - - - -- -- - - - - -- -- - - - - -- ---------------------------------------
PLMC015 DST Post Review Complete / / / / 05/09/96 PASS B 05/09/96 BON
PLMCO50 (F) Ready to issue / / / / 05/09/96 need contractor info PEND B 05/09/96 BON
PLMC060 (F) Issue permit / / / / 05/13/96 PASS B 05/13/96 BON
PLMC120 Plumbing Undersl 05/08/96 / / 05/07/96 PASS TLP 05/08/96 TLP
PLMC725 Top -out Insp 05/09/96 / / 10/01/96 PASS MS 10/02/96 MRS
PLMC730 Storm Drain Insp 05/09/96 / / 11/13/96 PASS TLP 12/02/96 TLP
PLMC735 Rain Drain Insp 05/09/96 / / 11/13/96 PASS TLP 12/02/96 TLP
PLMC799 Final Inspection / / / / 11/13/96 PASS TLP 12/02/96 TLP
PLMC800 Case Finaled / / / / 11/13/96 PASS TLP 12/02/96 TLP