Permit CITY OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVI DATE ISSUED: 11 -0429
PARCEL: 18136DB -02400
SITE ADDRESS...: 11644 SW PACIFIC HWY
2UBDIVISION • ZONING: C —G
BLOCK • LOT : JH I t I CT I ON: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: _ ..___ —_ -_-_ 2PA=_B
PE DP U2E .2F WA2HING MACH : 0 BACKFLOW PREVNTRS... 0
OCCUPANCY GRP..:R3 FLOOR DRAINS 0 TRAPS ° 0
TORIES . 0 WATER HEATERS • 1 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS : a0 SF RAI1 DRA IN=
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
_ - SHWAE -:ERS . 0 RAIN DRAIN (ft).. .. 0
Remarks: Champion — replace electric water heater to gas
Owner: FEES
BOBBI CHAMPION type amount by date recpt
2046 SUNRAY CIR PRMT $ 25.00 JSD 11/18/98 98- 310920
WEST LINN OR 97068 5PCT $ 1.25 JSD 11/18/98 98- 310920
Phone #:
Contract or
SPECIALTY HEATING & FABRICATIO
9528 SW TIGARD ST .
TIGARD OR 97223
Phone #: 620 -5643 $ 26.25 TOTAL
Reg #. . 000665
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 '.4 through OAR 952-000I-0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
• C T
Issued s . _ Permittee Signature: Qii �T'^ 4"=4-4-4-+ ++ ++ + + + + ++ + + ++ + + + + + + ++ ++ + + + + + + + + + ++ + + + + ++ + + + + + ++ + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
4--+- 4-+ 4- 4-+++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
CITY OF TIGARD Plumbing Permit Application Rec'd By
13126 HALL BLVD. Commercial and Residential Date Rec'd If , 40 �
TIGARD, OR 97223 Date to P.E.
Date to DST
(503) 639 -4171 Permit # G °8 -!5 f/e 5
Print or Type Related SWR m #
Incom lete or illegible applications will not be accepted Called Q 7`G
Name of Developme Pr )e On back Indicate Work Performed by fixture.
Job ; FIXT_URESf( Individual); ^•,:,q�/:.! ; t.V.INF e;'r .aTY.t ,IPRICE::A_MT:.:
Address Street Address Suite Sink 9.00
l / 6 ff Jt4/ f CIte /C awy - Lavatory 9.00
Bldg # City /State Zip Tub or Tub/Shower Comb. 9.00
Name Shower Only 9.00 '
$ o e. g i CH A 04 ion] Water Closet 9.00
Owner Mailing Address ,, Suite Dishwasher 9.00
2-404(0 - / �7 C42 Garbage Disposal 9.00
City/Stale Zip Phone
s>G/ryn/ Mt- 17Obd 65.6-53-d-2- Washing Machine 9.00
Name Floor Drain 2' 9.00
3' 9.00
Occupant Mailing Address Suite 4' 9.00
City /State Zip Phone Water Heater conversion 0 like kind / 9.00
Laundry Room Tray f 9.00
Name Urinal 9.00
S rr:G /4 / 7 4 / /164 - /v6I F Other Fixtures (Specify) 9.00 '
Contractor Mining Address Suite
%S.zB J J J 1 f t " S-1 9.00
Prior to permit Ci /State Ip Phone 9.00
Issuance, a copy // 9 4,,. r y- V S O 9.00
of all licenses are Oregon Const. Cont. Board Uc.# Exp. Date 9.00
required If 6 65 3 /) - , / Sewer - 1st 100' 30.00
expired In COT Plumbing Lic. # Exp. Date
database 37- 4- 21 P.1 1' --30-9.9 Sewer -each additional 100' 25.00
Name Water Service - 1st 100' 30.00
Architect Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration
Repair 0 Pollution Device
to be done: ResidentiayL Non - residential 0 Residential Backflow Prevention Device' 15.00
Additional description of work: LA Any Trap or Waste Not Connected to a Fixture 9.00
\ -t t Cc. `V ot+c- h,Q .,,, Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40.00 1
building or property Re - 1 -4 %-t- tA IC I--1 Se per/hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00 1 /
building or property
QUANTITY TOTAL y '. i° : ;41' it. „'r:':;:
I hereby acknowledge that I have read this application, that the information isometric or riser diagram is required If Is > Quanity Total 9 '.1e.:51'.... :.. 'T' °� '�
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL :+ � - - • - ` j C
that plans submitted are in compliance with Oregon State Laws. '1 , " ,
Signature of Owner /Agent Date
0 `� -- ///1819 5% SURCHARGE V. , . ,: +' ' ^:
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL = ?4:i?,},; A ri. �} F S
p� Required only it ibdure qty. total is > 9 r , ".. ' ", „: S
!/41/6 6 Ao -'$j y, j TOTAL ;,,,,, 4,:::.',:.'„--06 .,
'Minimum permit fee Is $25 + 5% surcharge, except Residential Backroow •
Prevention Device, which is $15 + 5% surcharge
I :ldstslplmapp.doe 5/97
PLEASE COMPLETE:
. .
:::FixtOre Ottn
• ••• • • • New:-
• : •• . : : . ..r. Replaced RemovedlCapped
.
. . . „
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:
lAdstMpIrriapp.doe 5/97