Permit �
PLUMBING PERMIT ~
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CITY � TI ��r� � PERMIT #.......: PLM96-0011
^. ��N���������v DATE ISSUED: 08/08/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 9722 308199 (503) 639-4171 PARCEL: 2S104AA-03600
SITE ADDRESS...: 12515 SW KAREN ST
SUBDIVISION ^ BELLWOOD ZONING: R-4.5
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BLOCK..........: LOT... ..... .....:30
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CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OFUSE....:SF WASHING MACH ^ 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP.. :A1 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 FIXTURES ^ 0
TUB/SHOWERS....: 0 SEWER LINE (ft)...: 0
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS ^ 0 RAIN DRAIN (ft)...: 0
Remarks: Install new water heater.
Owner: --- - FEES ------ ---
ART MARTINEZ type amount by date recpt
12515 SW KAREN PRMT $ 25.00 JSD 01/24/96 96-275262
5PCT $ 1.25 JSD 01/24/96 96-275262
TIGARD OR 97223
Phone #:
Contractor: -
. KODIAK PLUMBING
6604 SE WOODSTOCK
PORTLAND OR 97206 - ` --
Phone #: 318-9098 MBL $ 26.25 TOTAL
Reg #..: 72465
------- REQUIRED INSPECTIONS -------
This permit is issued subject. to the regulations contained in the Misc. Inspect ion ____ _________
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. -__-__-__' _ ---'
_ _
_ ____ ____
/-5'11( 4//b �� ___' ___ .
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Permittee S � _____ _______
' - . -_ -_- ' �
Issued By : Y�^ -_ ___- __--- ___
Call for inspeet ion - 639-4175
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # 8-07q6-- aO//
Tigard, OR 97223
(503) 639 -4171 � `ued O
MINIMUM $25.00 PERMIT FEE + ST SURC HARGE
Name of ° ""' °D '" °" New Single Family Residences Only
1_-k ✓ A-G - 0-- -F), ,
7
Job '3-..S1 S ' - 4) O. 4 Et A.)
0 1 BATH HOUSE $140.00 TH HOUSE $225.00 TM HOUSE $195.00 3
Address Caws. u. Fee includes all plumbing fixtures in the dwelling and the first 100 feet
( Q IZ` J'7'l2_ j of water service, sanitary sewer and storm sewer. See fees below.
"""O le n°me m O1e """ FIXTURES QTY PRICE AMT
Sink I 9.00
Wang madras. P1O1' Lavatory 1 9.00
Owner !L----t--e Tub or Tub/Shower Comb. 9.00
G"'StatO a " Shower Only 9 .00
Water Closet 9.00
Name (or name of °lens) Dishwasher 9.00
Garbage Disposal 9.00
Occupant MWm nadrw Phone
Washing Machine 9.00
4.,ciL1 Floor Drain 9.00
a'+"sa ao Water Heater ! 9.00
rf ." /1y�1 ∎,->,c ., _ .3 rh-_ 90 ? Laundry Room Tray 9.00
Name l/ U' / Urinal 9.00
? k 7 ,z( ( )2/� �i /3/ 11..,- Other Fixtures (Specify) 9.00
Maiq Address Phone 9.00
Contractor
(2-0a S. i'. - 7.5Co7474- 69
9.00
a
lZ 9.00 // �i� "/
7 �� jr�A2c�t ' Sewer 1st 100' 30.00
Snits Ro O t,^n w. M ` Coy' e'"• Tu No. Sewer - ea. Addit 100' 25.00
72-//:.._ .O" 2 / ' - r/ >9 Water Service 1st 100' 30.00
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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' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit 100' 25.00 9
number given is co ct (If exempt from State registration, please
give re son below Mobile Home Space 25.00
ry /��
Back Flow Prevention
/�1 Devi ce or Anti-Pollution Device 9.00
°' s O ates Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration \ repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00 /hr
Existing use of
building or property 5 �� - t e q Rain Drain, single family dwelling 30.00
Residential backflow prevention
.c- ct / L � fQ devices 15.00
Proposed use of
building or property
'(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL (
PERMITS BECOME VOID IF WORK OR CONSTRUCTION j�
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE /
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25 %. OF SUBTOTAL -
( I� � TOTAL C
Special Conditions ,, ,� / ,.
l.0 (lX(.(.f �l (l�(J Date issued �¢{ ! ii by +1 /b/ ! b
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
KODIAK PLUMBING
6604 SE WOODSTOCK
PORTLAND OR 97206
Plumbing Signature Form
Permit # PLM96 -0011
Date Issued.: 04/16/96
Parcel 2S104AA -03600
Site Address: 12515 SW KAREN ST
Subdivision.: BELLWOOD
Block Lot: 30
Zoning R -4.5
Remarks:
Install new water heater.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order
for the plumbing permit to be valid, please have the appropriate individual from your company sign
below and return this Plumbing Signature Form prior to the start of work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER: PLUMBING CONTRACTOR:
ART MARTINEZ KODIAK PLUMBING
12515 SW KAREN 6604 SE WOODSTOCK
TIGARD OR 97223 PORTLAND OR 97206
Phone #: Phone #:
Reg #•.: 72465
X , : ,
Signature of Authorized Plumber
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639 -4171, ext. #310
I 1 I -,■ ` PL. .- 3 11- C Z 1 ( i
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: R /0/9 A.M. P.M. MST:
Location: 125L5 00 t 'AO Q i't A t BLIP:
Tenant: Suite: Bldg: MEC: 5 'O
Contractor: IL I Phone: 7 PLM: q(e l I
Owner: A I .1/4 , , I 01 L1 L L/rl,/./L� .yL!i 'hone: ELC:
;r, . , l c ' I I < r / A P " / ' LR:
(/fIl: w/ I'/ Far' " . ��/'li��"! i I I r ' �)
SIT:
BUILDING BLDG( on't) . ' �lllu1C
tJI: 4/■ ' .: ■ : ELECTRICAL SITE
Site Post/Beam . . ■ earn Pos :earn Cover /Service Sewer /Storm
Footing Roof UndFUSlab Rough -In Ceiling Water Line
Slab Framing Top Out in Gas Line - Ro • : -In UG Sprinkler
Foundation Insulation Sewer VP (i Hood/Duct ' econnect Vault
Bsmt Damp Drywall Storm ' i ! Temp Service MISC.
Masonry Ceiling Rain Drain 1 UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump , Low Volt
Approved roved Approved Approved
Appr /Sdwlk Not Approved • . ved of •_ i oved Not Approved Not Approved
FINAL ! FINAL FINAL
, 1 ,), 9 /- ( e/ ,„-,,,i,,,,,
' i. - .
- i' , I / , ir AP
_#' re avow ■.- r
I
O -Call- for-reinspection - - -0 Reinspection fee of $ - - -- -required-before next inspection O Unable to inspect -
Inspector: /K42 Date: 7/ iI "? Page of