Permit CITY OF TIGARD GI� PERMIT #I N PLM1999 I 00418
DEVELOPMENT SERVICES O �'
��' 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/10/99
SITE ADDRESS: 16500 SW KING CHARLES AVE PARCEL: 2S115BC -04900
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 100 feet or less of water service.
FEES
Owner:
Type By Date Amount Receipt
OMUNDSON PRMT DEB 12/10/99 $50.00 KING CITY
16500 SW KING CHARLES 5PCT DEB 12/10/99 $4.00 KING CITY
KING CITY, OR 97224
Total $54.00
Phone 1: 598 -8558
Contractor:
CROWN PLUMBING
23172 SW STAFFORD RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 771 -9449 Water Service Insp
Final Inspection
Reg #: LIC 000042
PLM 34 -70pb
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification -Een. eery. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
ou may obtain copes of these rules or direct questions to OUNC by calling (503) 246 -1987.
---' ,
Issued By: ! ..v/i4/1 Permittee Signature: / I p / ; /
Call (503) 63. 4175 by 7:00 P.M. for an inspection needed th next b iness day
DEC -09 -99 THU 10:53 AM City of King City FAX:503 639 3771 PAGE 2
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, 'qR 97223 Date Rec'd -
(503) 639 -4171 . Date to P.E. •
Print or Type Date to DST 12. -q -q,R
PermitiR Am 64.22 -�g/,
Incomplete or illegible applications will not be accepted
Related MR 0
Called
Name of Developrnent/Project TURE$'Cltiiividual► `F ! ''' ":QT.1! ` !- ''''AMAT'; =
Job Sink 11,50
Addre S Street Address Suite Lavatory 11.50
AS o Sw K wl C l.•o Tub or Tub /Shower Comb, 11.50
/ 11' I Bldg # City/Slate Zip Shower Only 11.50
•
•
Name Water Closel/Urinal (Specify) 11.50 ^
(7 ► n 2 C . W 4 5 0 >.) Dishwasher 11.50
Owner Mailing Address Suite Urinal 11.50
/4,,to 0 SW - K, yJ 6," vie Garbage Disposal 11,50
City/State Zip Phone _
T,1 vv i . C. -i-.o DR 9 7�'�I 3 ..... 9 e ..., S S F1' Laundry Tray 11.50
Name J Washing Machine /Laundry Tray (Specify) 11.50
- Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3` 11.50
. 4" : 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
i
� ( r y ,�c MFG Home New Water Service 28.00
Contras
l or Mailing Address ' Suite MFG Home New San/Storm Sewer 28 -00
Pf,9 7 9 E T'Vem^c- s Hose Bibs 11.50
Prior to permit /Sts a Zip Phone • Roof Drains 11.50
issuance, a copy 4 e'.4- ..eJ 6 a ?720 to 7 7/ - 9 94 9 '
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date - •
required if 9 ?-4"7 I o O Other Fixtures (Specify) 15,00
expired in COT Plumbing Lic. # EXp Date
database 4 3 y .-- 70 P g d 0 ,
Name '
A rc h itect Sewer -1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Ci /State Zip Phone Water Service - 1st 100' . N t 38.00 3
Engineer Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38,00
Newt Repair 0 Replace with Ilke kind; Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Resi ntial 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32,00
s� v v` Residential Backflow Prevention Device" 19.00
iv Catch Basin 11.50
Are you capping, moving or replacing any fixtures? ' Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 Inspections per/hr .
If yes, see back of form to indicate work performed by � Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. . ir : `- , ;', , '' ,,:.
QUANTITY TOTAL :.: r::. ;:. ?;� , ;:i54 „,.
I hereby acknowledge that I have read this application, that the•information ^' f
Isometric or riser diagram is required d Quantity Total is > 9 N:F..;.`'k;d, ,t '.':: ';'
given is corned, that I am the owner or authorized agent of the owner, and *SUBTOTAL f ;;. s' ' ?,iy,
that plans submitted are in compliance with Oregon State Laws. - ,, >. ,, , : ;. ; , ; i i , 4 : . +• Date :,,::;,it;�r,;ri '•.. :.,1- :.5?;
SIgnatur)=Age
I " v i'- , -9q 8% SURCHARGE :(yg4``i 8!T yet,
Contact Person Name
� - „ ` _ n 9 - - "PLAN REVIEW 25% OF SUBTOTAL !
t .aE t„ r; ` w : .r:, x , ,:: - �; i R equired only it future qty. total Is> 9 ..ii:; ''
.y�� � , a : : , .i�r. , • i�d? k� °' ' ''I d ;w(,.r TOTAL
1 f Y. �I �sy' { � d - " 4 1 YN' 8 i cy j . l l . � 1 n i tL
4,1 hie n04 calll p It _ r j t h o llingr , } . 466012'4. `ell(; :i ' i - Minimum permit fee la $5O' S% surcharge, except Residential Backllow Prevention
1 ..f ... of�iiiiig ur 3 . s e-r ». .._.,..u ''. j to r -S R r # Device, which Is $25.8% surcharge t R -
"'All New Commercial Buildings require plans with isometric or riser diagram end
plan review.
I: tdetswormssetu,nepp,doc 70/1I59 - . -
Case Activity Listing 1/7/2005
1:59:38PM
TIDEMARK Case #: PLM1999 -00418
COMPUTER, SYSTEMS, INC.
. u. .�. �, nF �.�.
>
` Date�2 r� Dates3: id.=,
t D c ri tton�. Date.1. Ho Dts To- °B B. M �Notes
PLMA003 Application received 12/9/1999 None FAXD DEB 12/10/1999
DEB
PLMA005 Create Permit 12/10/1999 None DONE DEB 12/10/1999
DEB
PLMA711 Water Service Insp 12/10/1999 12/10/1999 12/14/1999 None PASS TLP 12/15/1999
TLP
PLMA799 Final Inspection 12/10/1999 12/10/1999 12/15/1999 None PASS TLP 12/15/1999
TLP
PLMA050 (F) Issue permit 12/10/1999 None DONE DEB 12/10/1999
DEB
PLMA800 Case Finaled 12/20/1999 None DONE JMT 12/20/1999
1 JMT
1
PLMA055 (F) Reprint Permit 3/9/2000 None DONE BON 3/9/2000
BON
Page 1 of 1 CaseActivity..rpt