Permit •
A. CITY OFTIGARD DEVELOPMENT SERVICES PLUMBING PERMIT
1.1.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # • PLM98 - 0279
DATE ISSUED: @8/13/98
PARCEL: 1S136AD -04000
SITE ADDRESS...: 11509 SW PACIFIC HWY
SUBDIVISION • VILLA RIDGE ZONING: C —G
BLOCK • LOT • @07 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B FLOOR DRAINS 0 TRAPS • 0
STORIES • 0 WATER HEATERS • 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS - 0
SINKS • 3 URINALS 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 1 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Installation of 2 new bar sinks, moving 1 existing lavatory & 1 exist in
g
water closet.
Owner: FEES
DAVID GREENSPAN type amount by date recpt
11509 SW PACIFIC HWY PRMT $ 36. DLH 08/13/98 98- 308230
TIGARD OR 97223 SPCT $ 1.80 DLH 08/13/98 98- 308230
Phone #:
Contract or
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN OR 97062
Phone #: 691 -6166 $ 37.80 TOTAL
Reg 41..: @00879
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 Misc. Inspection
applicable laws. All work will be done in accordance with Insp existing /ca
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. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 -0001 -0810 through OAR 952 - 8881 -0088. You may
obtain copies of these rules or direct questions to OUNC by calling
(583)246 -1987.
Issued By• ( " 1" •i Permittee Signature:] /j, d__„/
++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + +,l +,• + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Ch
13125 SW HALL BLVD. Commercial and Residential Rec'd B
TIGARD, OR 97223 Date Recd g // - 9?
(503) 639 -4171 Date to P.E. ----'
Print or Type Date to DST °-
Incomplete or illegible applications will not be accepted Permit# /� A °;�; ��
Alt //�► Related SWR # ` ) (LQ $- O
I �� � �� � � � Called / -9f Ail-4x su /rgrQ..1
Name of Development/Project FIXTURES (individual) a QTY PRICE, -AMT
Job ("- e Ek.NSprAti (,t.; (J9 L Sink 9.00
Address Street Address �0' 11 __ � Suite Lavatory 3• 9.00 00
11504 W en/,Ice- t� _ Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
Name
t�f�R� Off � )22L I Water Closet 9.00 q vo
t c Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
City /State Zip Phone Floor Drain/Floor Sink 2" 9.00
Name 3" 9.00
^ 1 a■3 fl b 2.. f ki Ps ti 4" 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
)IS'b9 ✓Z 9p'dQc. 147 Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
r re_D r a_ 177 - 7Li Urinal 9.00
�/Nam� r Other Fixtures (Specify) NesFtQ.K,/.._ 9.00
Contractor Mailing Address Suite 1 9.00
1112.b SIJ t 0tu5Tleii -wi\Y 9.00
Prior to permit City/State Zip Phone Sewer - 1st 100' • 30.00
issuance, a copy UA1 Ntt fJ\ (Ni R g7/k,2_ ( - 191U1ri Sewer - each additional 100' • 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date -
required if - ign(,) 12._ PC? Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes O No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work:
Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
per/hr
Are you capping moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes ® No O Grease Traps 9.00
If yes, see back of form to indicate work performed by il
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL f
Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. 'SUBTOTAL 77
I hereby acknowledge that I have read this application, that the information 30 DO
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE $ O,
that plans ubmitted are in complian with Oregon State Laws. i .
Signs u of Owner /Agent / Date "PLAN REVIEW 25% OF SUBTOTAL
ee , � ,V -9d Required only if fixture qty. total is > 9
° TOTAL
Contact Pers9 Nartte / y Phone
'�we•�w �J ' A� ,,- 'Minimum permit fe e is $25 + 5% surcharge, except Residential Backflow "
l &9 `e SQ
1 "� ( h ' C 'C Prevention Device, which is $15 + 5% surcharge
•
/ , "All New Commercial Buildings require plans with isometric or riser diagram
LX SS` 7 3�] and plan review
I:tdststplumapp.doc 7/2/98
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed/Capped
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet 1
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify) A p, Si ti ks ,q
COMMENTS REGARDING ABOVE:
•
1: ldsts\plumapp.doc 7/7/98
Page No. 1 CASE HISTORY FOR CASE NO.: PLM98 -0279
DAVID GREENSPAN
11509 SW PACIFIC HWY
12/09/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
PLMC003 Application received / / / / 08/11/98 RECD DEB 08/11/98 DRA
PLMC005 Permit Created / / / / 08/11/98 DONE DEB 08/11/98 DRA
PLMCO50 (F) Issue permit / / / / 08/13/98 reprinted due to system crash on 8/12/98 NOTE JMT 08/19/98 JT
PLMC725 Top -out Insp 08/11/98 / / 10/07/98 PASS TLP 10/07/98 GES
PLMC799 Final Inspection / / / / 11/02/98 No access FAIL TLP 11/02/98 J *H
PLMC799 Final Inspection / / / / 11/03/98 PASS TLP 11/03/98 TLP
PLMC800 Case Finaled / / / / 11/03/98 PASS TLP 11/03/98 J *H
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