Permit CITY OF TIGARD
PLUMBING PERMIT
i�' 6"I DEVELOPMENT SERVICES PERMIT PLUMBING
..: PERMIT �
. 4 0 411 -- 131 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 12/09/97
PARCEL: 1S136CD —CARTY
SITE ADDRESS...: 11710 SW PACIFIC HWY
SUBDIVISION • ZONING: C —G
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -COM WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1
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)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Installation of commercial backflow prevention device.
Owner: FEES
SCONZO /HALLSTROM type amount by date recpt
919 124TH AVE NE PRMT $ 25.00 DRA 12/09/97 97- 30157E
STE 101 5PCT $ 1.25 DRA 12/09/97 97- 301572
BELLEVUE WA 98121
Phone #:
Contractor
OREGON GROUNDS MANAGEMENT INC
PO BOX 8247
BEND OR 97708
Phone #: 503 - 383 -1841 $ 26.25 TOTAL
Reg #... 5813
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backf low Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect ion
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 - 0001-0010 through OAR 952- Y " -0080. You may . •
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
i �
Issued y:_ Permittee Si gnat ur i° Are
++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +. + +.- + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing CZ lt - n •
g Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Recd I -� ; 07
TIGAi2D, OR 97223 Date to P.E.
Date to DS
(503) 639 -4171 Permit# 9 7- a3
Print or Type Related SWR #
/?
Incom lete or illegible applications will not be accepted Called
s77. 0 am !!!!!! eve opmen ro'ect / 7 On back indicate Work Performed by fixture.
Job Al'I'f' o,FIXT y ; := ;.• r . •is � : QTY . PRICE-, • AMT
Address " treetAddress uite Sink 9.00
e� �7 C �� Lavatory 9.00
Bldg # Stat /7 „.. / Tub or Tub /Shower Comb.
9.00
N ��� Shower Only 9.00
• P f Water Closet 9.00
Owner Mailing Abdress Suite Dishwasher 9.00
Garbage Disposal 9.00 •
City /State Zip Phone
Washing Machine 9.00
• N� Floor Drain 2" 9.00
l� ✓ !/ 3" 9.00
Occupant ai Addr - Suite 4"
17 /pyz) G :-. 9.00
/ :ty /State � Z " i ! Phone Water Heater 0 conversion 0 like kind 9.00
/r/ ���e z Laundry Room Tray 9.00
41:" e e � � Urinal
C y am- /
L. �� ! ..4 '_ /L' Other Fixtures (Specify) 9.00
ify) 9.00
ontractor Fr Addre Isult 9.00
Prior to permit A my Stat Z • Phone 9.00
issuance, a copy . /�y _l 1 0 . _ , , fir 'y sC, 9.00
of all licenses are Oregon C. • . Board Lic.# Exp. Date 9.00
required if Sewer - 1st 100" 30.00
expired in COT P umbingtic. # Exp. Date
database 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 Addition 0 Alteration 0 Repair 0 Pollution Device / �D
to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device' 15.00
Additional description of work• / j/� ' ��c� / A Any Trap or Waste Not Connected to a Fixture 9.00 '
-J/� i y '-- a T /5/.0/e/77 C/ Gild � :o::ting Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40.00
building or property _ per/hr
Rain Drain, single family dwelling 30.00
Prupc use Grease Traps
build:. 7r property 0� 9.00
■
/ QUANTITY TOTAL
C , - ,4.
4T
.1 i•., .cknowledge that I have read this application, that the information Isometric or riser diagram is required if Quanity Total is > 9
gi crrect, that I am the owner or authorized agent of the owner, and ` ` <' � D
th • submitted are in compliance with Oregon State Laws.
*SUBTOTAL .: , 7 . .
Sig Owner/Ag :.• Date/ 5 %SURCHARGE
f�
`. r
r,/ PLAN REVIEW 25% OF SUBTOTAL
,(,..
,n. 3 n Name Phone � j Required only if fixture qty. total is > 9 ..
/J C�/� ��Lc / TOTAL , .i..7�
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
: p.doc 5/97 -
PLEASE COMPLETE:
. Quantity bk:Work:Perform
Replace Removed/Capped
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:
hdsts1pirrlaPP d° 5197 (a/ 3 6) - 60 4-/O
Page No. 1 CASE HISTORY FOR CASE NO.: PLM97 -0523
SCONZO /HALLSTROM
11710 SW PACIFIC HWY
06/17/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
PLMC003 Application received / / / / 12/09/97 RECD DRA 12/09/97 DRA
PLMC005 Permit Created / / / / 12/09/97 DONE DRA 12/09/97 DRA
PLMCO50 (F) Issue permit / / / / 12/09/97 PASS DRA 12/09/97 DRA
PLMC750 RP /Backflow Preventer 12/09/97 / / 02/02/98 PASS TLP 02/02/98 J *H
PLMC799 Final Inspection / / / / 02/02/98 PASS TLP 02/02/98 J *H
PLMC800 Case Finaled / / / / 02/02/98 PASS TLP 02/02/98 J *H
' *at'.: