Permit CITY OF TIGARD
-: l i ' ; DEVELOPMENT SERVICES PLUMBING PERMIT 13125 SW Hall Blvd., Tigard,
OR s PERMIT # TM9E -0334
DATE ISSUED: 12/06/96
PARCEL: 1S136DB —O2602
SITE ADDRESS...: 11596 SW PACIFIC HWY #OLD
SUBDIVISION • ZONING: C —G
BLOCK • LOT •
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:M FLOOR DRAINS • 0 TRAPS • 0
STORIES • 0 WATER HEATERS • 0 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)...: 100
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: SANITARY SEWER MAINLINE PREVIOUSLY EXTENDED. This permit bldg lateral
AND NEW SEWER LIFT STATION (added 12/06/96). Septic tank must be
capped, filled and inspected by WAC. Call 639 -4175 for final insp.
NEW LIFT STATION ADDED 120696
Owner: FEES
PHYLLIS STEWART type amount by date recpt
621 S.W. ENGLEWOOD DRIVE PRMT $ 30.00 JMH 11/08/96 96- 286238
5PCT $ 1.50 JMH 11/08/96 96- 286238
LAKE_ OSWEGO OR 97034
Phone #:
Contractor:
WATER & ASSOCIATES, INC
11080 SW ALLEN BLVD. #100
BEAVERTON OR 97005 --
Phone #: 643 -9410 $ 31.50 TOTAL
Reg #..: ENG
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspect ion
Tigard Municipal Code, State of Ore. Specialty Codes and all other I n s p existing /ca
applicable laws. All work will be done in accordance with Final Inspection
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.
Permittee Signature: 1441
4
/ Call for inspection — 639 -4175
CITY OFTIGARD
r,:y n , ,;1 A1
DEVELOPMENT SERVICES PLUMBING PERMIT
^^fi�l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # PLM96 -03 4
DATE ISSUED: 11/08/96
1
PARCEL: 1S136DB -02602
SITE ADDRESS...: 11596 SW PACIFIC HWY #OLD
SUBDIVISION • ZONING: C —G
BLOCK LOT •
CLASS OF WORK.. :ALT GARBAGE DISPOSALS °: 0 MOBILE HOME SPACES.: 0
1 TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:M FLOOR DRAINS 0 TRAPS ° 0
STORIES - 0 WATER HEATERS • 0 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)...: 100
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS ° 0 RAIN DRAIN (ft)...: 0
Remarks: SANITARY SEWER MAINLINE PREVIOUSLY EXTENDED. This permit bldg. lateral
Septic tank must be capped, filled and inspected by WPC.
Owner: FEES
PHYLLIS STEWART type amount by date recpt
621 S.W. ENGLEWOOD DRIVE PRMT $ 30.00 JMH 11/08/96 96- 286238
SPCT $ 1.50 JMH 11/08/96 96- 286238
LAKE OSWEGO OR 97034
Phone #:
Contractor:
OWNER
Phone #: $ 31.50 TOTAL
Reg #° ° : 99999
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other I n s p existing/ca
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This persit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
Permittee Signature: /%.. kattiL.
Issued By :401 /i;�1 .L 1.
i 111.
Call for inspection — 639 -4175
INV. # I"et INV. DATE 11/1i/9t) TERMS: CwF:I' , < ►) I)NY;i
4 SH m. Clear Wai CONT. # 1 h i°; P.O. # JOB #
SANITATION, INC. BILLING PERIOD 11/01/91' 'It) 11 /11/941
P.O. BOX 1404 TUALATIN, OREGON 97062
(503)692 -9009
QTY. DESCRIPTION PRICE INVOICE PERIOD AMOUNT
• LE.�SEE
NAME /ADDRESS PL I4 HOW 'l'4NK '1 WO (;AI., 1.1 /I () X i1►,1►I t
• ■
TIHk: F'ACIUHY (k.' 'I'IGAHI
11h9b SW PACIFIC HWY
T1(iAHI), OR 911.43-
{, '
1 SITE LOCATION
•
.-4.1S96 SW PACIFIC HWY - WA.S
H -Z
�I r
J
TI.C'AE11) OR A FINANCE CHARGE COMPUTED AT A PERIODIC RATE OF 1% PER MONTH WHICH
IS AN ANNUAL PERCENTAGE RATE OF 12% IS APPLIED TO PAST DUE BALANCES
STATEMENT FOR THIS CONTRACT: SUB TOTAL 130.011
0 -30 DAYS I 31 -60 DAYS I 61 -90 DAYS I 90 + DAYS I TOTAL DUE 0
Zb4 . U2 0 , UL 0.00 U.0(. 64 . U2 DUE THIS INVOICE 230.0)
+ : _
1
CITY OF TIGARD Plumbing Application Recd By
13125 SW 'HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171 Date it DST
Permit It
Print or Type Related SWR 5
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Sink 9 00
Job �� i'l$ } -t�0
St reet Address j Suite Lavatory 9.00
Address Tub or Tub/Shower Comb.
Bldg i City/State ( Zip Shower Only 9.00
1 1 c%L. rz-f- Water Closet 9.00
N ��` Dishwasher
I't1�� ss Suite
G ✓I .L,1.��G1.� 9.00
( Owner Q M f Address Garbage Disposal 9.00
.'U ¢j(" 4 JCXC) Washing Machine 9.00
City/State Zip Phone Floor Drain 2- 9.00
• 1.li94.6 >rsl,o gR0.A V $c0 3 9.00
Name
TIi2ri� heat: i7.,V 4' 9.00
Occupant Muffing Address C Suite Water Heater 9.00
Laundry Room Tray 9
City/State Zip Phone Urinal 9.00
Name Other Fixtures (Specify) 9
1�1 1&1C.0�1 ) 1A LS& 9.00
Contractor Mailing Address Suite 9.00
City/State Zip Phone
9.00
9.00
Oregon Conet. Cont. Board Lie* Exp. Date 9.00
AIWA Copy of
9.00
Commit Plumbing tic. * Exp. Date Sewer - 1st 100'
Licenses
I 30.00 30
Sewer - each additional 100' ' 25.00
COT Business Tax or Metro ill Exp. Date W ater Service - 1st 100' 30.00
(�-i7 f l -of -c 7 I
Name Cp F: t_AS Water Service •each additional 200' 25.00
Architect ��j� ,�� C-- Storrs & Rain Drain - 1st 100' 30.00
Or Malting Address S :e Storm 8 Rain Crain - each additional 100' 25.00
IA lO C . to 1 0 0 Mobile Home Space 25.00 I
Engineer City/S�ta Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
e:A 1 IV < q - j -1410 Pollution Device
Describe wort New 0 Addition 0 Alteration Repair O Residential Backflow Prevention Device 15.00
to be done: Residential 0 Non-residentialX Any Trap or Waste Not Connected to a Fixture I 9.00
• Additional description of wont Catch Basin 9.00
6 OIJPI1 b ti\ '1-O'rC--- Insp. of Existing Plumbing I 40.00
•
oenhr
Specially Requested Inspections 40.00
xisang use of oenhr
ouiltfing or property -11.12.- � G - 1-.C:1 ' Rain Crain. single family dwelling 30.00
Proposed use of Grease Traps 9.00
- 1
building or property 1 (t G . 1(::; , S -1 -/ i
QUANTITY TOTAL
Are you apping , moving or replacing any fixtures? Yes ❑ No* Isometric or riser giagram is requires if Quandy Total is > 9
(If yes see back of form) 'SUBTOTAL tx-
I hereby acknowledge that I have read this application, that the information
I given .s correct. teat I am the :caner or authorized agent of the owner. and 5% SURCHARGE
that plans submitted are in compliance with Oregon State Laws. f ,
Signature of Owner/Agent Date PLAN REVIEW 25% OF SUBTOTAL I
Required only if retire qty. total is > 3
TOTAL I 356
Contact Person Name Phone
'Minimum permit fee is 525 • 5% surcharge. except Residential Backflow
Prevention Device, which is 515 • 5% surcharge
i:ldstskplmapp.doc 8/96
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
Wr Gas Line Appr /Sdwlk Reins.
Other:
Date: 11113111,p_ A.M Entry:
Address: , 1.5-949 P '
Tenant: -C/lAJ Ste: MST:
BUP:
Con /Own: 7 8' — d 5 Z MEC:
PLM: 'Y, O le C
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
..../
,/W.A4P _....- ...."
Inspector: ��� Date: . , ,
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO
.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
e
Other:
Date: ///?;2.--/5 e A.M. P.M. Entry:
Address: / 1 . � 4 i d � e
Tenant: Ste: MST:
BUP:
Con /Own: MEC: , /
PLM: /
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
.P/ ,
.1 i
w! ii ��� /
- 737:2 - 5 ‘fxliv
f ' - Z
Ins ector: Date / Y,7 f
A OVED _ DISAPPROVED /CALL FOR REINSP. CF CO