Permit CITY OF 'TIGARD
ii, 4 , DEVELOPMENT SERVICES PLUMBING PERMIT
(�IP6y�jlli PERMIT # ......: PLM97 -0240
—_- 1 3125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: 06/26/97
PARCEL: 25115AA -02800
SITE ADDRESS...: 10668 SW KENT ST
SUBDIVISION ° DOVER LANDING NOa2 ZONING: R -4.5
BLOCK........... LOT... ....... ...:67 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 1 CATCH BASINS ° 0
FIXTURES LAUNDRY TRAYS 0 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: Installing a gas water heater
Owner: FEES --
JED ROBERSON type amount by date recpt
10668 SW KENT ST PRMT $ 25.00 B 06/26/97 97- 296475
TIGARD OR 97223 -0000 SPCT $ 1.25 B 06/26/97 97- 296475
Phone #:
Contractor -- —
GEORGE MORLAN PLUMBING & APLIANCES
12585 SW PACIFIC HWY
CCB (EXP 6/2002)
TIGARD OR 97223 - - - --
Phone #: 624 -6895 $ 26.25 TOTAL
Reg #..: 000027
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Misc. 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- 0001 -0010 through OAR 952 -0001 -0080. You may
obtain copies of these rules or direct questions 'to ODIC by calling __
(503)246 -1987.
--
Issued By:_ - /�� ,-- P ermittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++ + ++ + ++ ++ + ++ + + + + + + + ++ + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ . + + + + + + + + + + + + + + + + + + + + + + + + + + + +++
•
_ iTY OF TIGARD Plumbing Application Recd By
3125 SW HALL BLVD. Commercial and Residential Date Recd
GARD;.OR 97223 Date to P E.
• 503) 6 3 9 -•4171 103 Date to DS �^�''
Permit 4 rvt►L °l1- "� 7f
Print or Type Relatea SWR $
T Incomplete or illegible applications will not be accepted Called
• FIXTURES (Individual)
Name of QevefopmenuPro;ect QTY PRICE AMT
Job Sink 9.00
Lavatory
Address Street Address I Suite
9.00
1 � a1.0 Lf- --- )1 rub or rub /Shower Comb. I 9.00
31ag x City/State
Zip Shower Only
TI fo/\^2O 1'72-13 9.00
Name Water Closet 9.00
-To R -,Q ) Dishwasher 9.00
: Owner Mailing Address Suite
/049402, bf te" j Garbage Disposal 9 00
(Oto(v Washing Machine J I 9.00
C t ta Zip Phone Floor Drain 2 1
9 0 2 $+ SC'' 9.00
Name _ 3' 9.00
4' 9.00
Occupant Mailing Address •Suite Water Heater J 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal
9.00
/ D
1ame Other Fixtures (Specify) 9.00
s.-' O1Us - E MO /2.44 171- -'" 9.00
Contractor Mailing Address Suite _9.00
t 2- 506- ) WrCA P C- 141%,..) 9.00
Prior to issuance City/State Zip Phone
applicant must '/ (o%yJ C17 Z/- 1
3 (61-' 3 C I 9.00
Provide all Oregon Const. Cont. Board Lic.* Exp. Date 9.00
contractors -2 A--1 9.00
license Plumbing Lic. * Exp. Date Sewer - 1st 100' 30.00
information 2(v 4PO , pe,
Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro * Exp. Date
catabase). 11 l Water Service - 1st 100' 30.00
Name Water Service - each additionai 200' 25.00
Architect Storm & Rain Crain - 1st 100' 30.00
or Mailing Andress I Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00 I ;
Engineer CityiState Zip f Phone Commercial Back Flow Prevention Device or Anti- I 25.00 I
Pollution Device I j
:2s.:r•,be •.vork New D .Addition 3 Alteration O Repair 0 Residential Back "ow °revention Device" 15.00
^e done: Residential " Non - residential J I Any Trap or Waste Nct Connected to a F ixture •
cr.:onal description of work I I 9.00
Catch Basin 9.00
aVL.dIC.'C al S t-A-3 1-I' insp. of Existing = .umving J 40.00 ;
per/hr
;: cisanq use of Specially Requested Inspections 40.00
icing or property 12" 3 I b C.4 Per :hr
Rain Drain. single family dwelling 30.30
-, _cosed use of Grease Traps I 9.00
::icing or property
QUANTITY TOTAL
•'e ou capping . moving or replacing any fixtures? Yes L. No ,, lsorretrc a' -ser c agram s ecwree f 0uanny is > 4.
if yes see back of form) i "SUBTOTAL
I hereby acknowledge that I have react this application. that the information J
-ive- is correct. that I am :rie owner or authorized agent of the owner. and 5% SURCHARGE
•._t Plans submitted are in -cmpliance with Oregon State Laws.
gnature of Owner/Agent Date PLAN REVIEW 25% OF SUBTOTAL I
Peouirea am f 5xture ^r • > :s 9
-- � - -- -&O igt q :(, -- TOTAL I 7
Intact Person Name Phone
'Minimum permit fee is 325 - 5',' surcharge. except Residential Backflow
9
M -�N�Q U 739! Prevention Device. w -ic.i is 515 - 5'.6 surcharge
i:' 3/96
'LEASE. COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced I Qty
-Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
G'arbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater -
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
qi ail ifS1 - 6 Cited& P 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 . `
Date Requested: q — / 7- A.M. P.M. MST:
Location: 1.06G $(A1 ill t 4t BUP:
Tenant: Suite: Bldg: MEC:
Contractor: (V .. t ^ " I, Phone: / p (� Q PLM: q 7 OD- t/ 3
Owner: ; �� % L: !. Phone: (? D ! � yam 3. ELC:
Q)mot./ L� (4t &T 03 l - - ST / ■ Pa- ELR:
C / F1 F- 4 P.--=--•-' f SIT:
BUILDING BLDG (con't) : UMBIN . MECHANICAL ELECTRICAL SITE
Site Post/Beam Mg/ • eam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFlISlab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer htifel) Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved , Approved Approved Approved Approved
Appr /Sdwlk Not Approved roved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
•
- - 0-Call for-reins. • ction- -- - - - - -O Re' :pect - fee,of -$ -- - - - - -- required -before next-inspection - - - O - Unable -to- inspect - -- -
Inspector: G.� „,�;ei� ...7.4,1, Date: 9 Page of