Permit PLUMBING PERMIT J
CITY OF T I GARD DATE 11/22/9 -0350
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 151 36AD -06 100
SITE ADDRESS...: 11419 SW PACIFIC HWY
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..:B2 FLOOR DRAINS • 0 TRAPS • 0
STORIES • 0 WATER HEATERS 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS : 0 SF RAIN DRAINS • 0
SINKS • 2 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: Tenant improvement
Owner: FEES
BUSTERS SMOKEHOUSE type amount by date recpt
11419 SW PACIFIC HWY PRMT $ 25.00 B 11/22/95 95- 273146
5PCT $ 1.25 B 11/22/95 95- 273146
TIGARD OR 97223
Phone #:
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 26.25 TOTAL
Reg #.. .
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 Final Inspection
approved plans. This permit will expire if work is not started _ __
within 180 days of issuance, or if work is suspended for sore
than 180 days.
Perm ittee Si_ nature: f / �_ __
Is sued By: � . IL�1. �� %- ____.
Call for insaection — 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW HaII Blvd. Permit # Puy) ►c-(Y
Tigard, OR 97223 SCAR /S
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
"°"'° ° , 1 New Single Family Residences Only
❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job 7(W? Sf e - ��6i , G /IC/ ❑ 3 BATH HOUSE $225.00
Address awstu. a Fee includes all plumbing fixtures in the dwelling and the first 100 feet
T� (o a. o / 97 z3 of water service, sanitary sewer and storm sewer. See fees below.
N. name of mes s) FIXTURES QTY PRICE AMT
,e/ �/�/7 f .- 1 Sink / 9.00 9, ao
Mang Ad°°° ' '°"° Lavatory 9.00
Owner //+‘/? 54/ A.... J 7c, 4 y Tub or Tub/Shower Comb. 9.00
/� Shower Only 9.00
City/State �� g r� air 7 7 g ; Water Closet 9.00
Ramie, " ..l °t a°"°') 7 Dishwasher 9.00
/ / 7� , , > , $ "a-- Garbage Disposal 9.00
Occupant M ,�„ g. an... Washing Machine 9.00
// ( /y S <r/ t7G, / -c / 7 Floor Drain 9.00
City /State Water Heater 9.00
/ , 9� / (? 4 9 7 Z .3" Laundry Room Tray 9.00
r / 34° Urinal 9.00
PA-Af t ii- 7L. UP8j 1106_ may! -7, > Other Fixtures (Specify) 9.00
Mang Aches Pnma // ` 9.00 vd
Contractor e7. �7 ...0e '0 /I
Aell 1 w E r gal �_ 9.00
City/State ( r0 9.00
UGt„' c- IAA 704439-- Sewer 1st 100' 30.00
State Registration No. City Bu.. Too No. Sewer - ea. Addit. 100' 25.00
/788 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti - Pollution Device 9.00
Signora ( or q Date Any Trap or Waste Not
( - 4 Connected to a Fixture 9.00
Descri a work new Q addi ' n Q alteration repair 0 Catch Basin 9.00
to be done residential 0 non - residential Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property f� �•-. Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of 7'/
building or property ,f ?s 'N k
'(Except residential backnow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL ZC , •
PERMITS BECOME VOID IF WORK OR CONSTRUCTION /
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 2
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL - ?:b „ '.
Special Conditions
Date issued by
•
02/22/2000 Activities for Case PLM95 -00350 •
2:17:46 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 11/20/1995 B PEND B 11/21/1995 •
PLMC005 Permit Created 11/21/1995 B PEND B 11/21/1995
PLMC725 Top -out Insp 11/21/1995 12/26/1995 MS FAIL MRS 12/26/1995 indirect waste pipe needs to be
trapped and vented over 15
feet. •
PLMCO50 (F) Ready to issue 11/21/1995 B PEND B 11/21/1995 need contractor info.
PLMC060 (F) Issue permit 11/22/1995 B PASS B 11/22/1995 •
PLMC060 (F) Issue permit . 11/22/1995 JSD PASS JD 11/22/1995
PLMC060 (F) Issue permit 11/22/1995 JSD PASS JD 11/22/1995
PLMC060 (F) Issue permit 11/22/1995 B PASS B 11/22/1995
PLMC800 Case Finaled 01/02/1996 MS PASS MRS 01/03/1996
•
•
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection (Rec -O- Phone): 639 -4175 Business Phone: 63 -4171
Inspection:
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing if b.
Alarm Water Line Insulation - ech.
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
Date Requested: /� ‘ Time: AM PM
Address: /7 y C � •�
Builder: Permit #: , 2 f,--C-03--C.
,--C Gv-S0
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector . Date: ® --
PROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.